Complicated and large acetabular bone defects present the main challenges and difficulty in the revision of total hip arthroplasty(THA).This study aimed to explore the advantages of three-dimensional(3D)printing techn...Complicated and large acetabular bone defects present the main challenges and difficulty in the revision of total hip arthroplasty(THA).This study aimed to explore the advantages of three-dimensional(3D)printing technology in the reconstruction of such acetabular bone defects.We retrospectively analyzed the prognosis of four severe bone defects around the acetabulum in three patients who were treated using 3D printing technology.Reconstruction of bone defect by conventional methods was difficult in these patients.In this endeavor,we used radiographic methods,related computer software such as Materialise's interactive medical image control system and Siemens NX software,and actual surgical experience to estimate defect volume,prosthesis stability,and installation accuracy,respectively.Moreover,a Harris hip score was obtained to evaluate limb function.It was found that bone defects could be adequately reconstructed using a 3D printing prosthesis,and its stability was reliable.The Harris hip score indicated a very good functional recovery in all three patients.In conclusion,3D printing technology had a good therapeutic effect on both complex and large bone defects in the revision of THA.It was able to achieve good curative effects in patients with large bone defects.展开更多
The biomechanical effects of acetabular revision with jumbo cups are unclear.This study aimed to compare the biomechanical effects of bionic trabecular metal vs.titanium jumbo cups for the revision of acetabular bone ...The biomechanical effects of acetabular revision with jumbo cups are unclear.This study aimed to compare the biomechanical effects of bionic trabecular metal vs.titanium jumbo cups for the revision of acetabular bone defects.We designed and reconstructed American Academy of Orthopaedic Surgeons(AAOS)type I–III acetabular bone defect models using computed tomography scans of a man without acetabular bone defects.The implantation of titanium and trabecular metal jumbo cups was simulated.Stress distribution and relative micromotion between the cup and host bone were assessed using finite element analysis.Contact stress on the screws fixing the cups was also analyzed.The contact stress analysis showed that the peak contact stress between the titanium jumbo cup and the host bone was 21.7,20.1,and 23.8 MPa in the AAOS I–III models,respectively;the corresponding values for bionic tantalum jumbo cups decreased to 4.7,6.7,and 11.1 MPa.Analysis of the relative micromotion showed that the peak relative micromotion between the host bone and the titanium metal cup was 10.2,9.1,and 11.5μm in the AAOS I–III models,respectively;the corresponding values for bionic trabecular metal cups were 17.2,18.2,and 31.3μm.The peak contact stress on the screws was similar for the 2 cup types,and was concentrated on the screw rods.Hence,acetabular reconstruction with jumbo cups is biomechanically feasible.We recommend trabecular metal cups due to their superior stress distribution and higher relative micromotion,which is within the threshold for adequate bone ingrowth.展开更多
Acetabular component revision in the presence of severe bone loss is difficult for reconstructing an acetabular component in the anatomical hip center. Various treatment options are available, although often the aceta...Acetabular component revision in the presence of severe bone loss is difficult for reconstructing an acetabular component in the anatomical hip center. Various treatment options are available, although often the acetabular defect cannot be corrected with a single option alone. Precise assessment of the bone loss and a suitable combination of methods are needed. Here we report a case of multiple failures with impaction bone grafting reconstruction for an acetabular bone defect of American Academy of Orthopedic Surgeons classification type III. We finally reconstructed the acetabulum with three femoral head allografts and a Kerboull-type acetabular reinforcement device. The allograft was a casted, jet-type helmet-like shape. A year later the patient was able to walk without a cane and perform light agricultural work. Accurate evaluation of the acetabular bone loss and appropriate reconstruction is important.展开更多
目的:深入研究全髋关节置换术(total hip arthroplasty,THA)治疗髋臼骨折继发创伤性关节炎的临床疗效。方法:回顾性分析2019年10月至2022年6月,采用THA治疗15例髋臼骨折继发创伤性关节炎患者,男8例,女7例,年龄40~76(59.20±9.46)岁...目的:深入研究全髋关节置换术(total hip arthroplasty,THA)治疗髋臼骨折继发创伤性关节炎的临床疗效。方法:回顾性分析2019年10月至2022年6月,采用THA治疗15例髋臼骨折继发创伤性关节炎患者,男8例,女7例,年龄40~76(59.20±9.46)岁。记录术前及术后假体松动、髋关节脱位、髋关节活动度、神经损伤等情况,采用Harris评分、视觉模拟评分(visual analogue scale,VAS)、影像学检查评价髋关节功能及手术疗效。结果:15例均顺利完成手术,术中无神经、血管损伤,术后切口均Ⅰ期甲级愈合,无感染。随访时间6~39(18.33±9.27)个月。其中1例术后半年发生髋臼侧假体松动,经过翻修手术后恢复良好;1例髋关节脱位,经切开复位处理后治愈,无不良后果。术后末次随访Harris评分(88.60±4.01)分,与术前(47.20±11.77)分相比,差异有统计学意义(P<0.05)。术后末次随访VAS评分1(1)分,与术前8(2)分相比,差异有统计学意义(P<0.05)。末次随访时,本组所有患者疼痛症状减轻或消失,关节功能满意;末次随访影像学资料显示关节假体贴合良好,无异位骨化发生,假体无松动。结论:THA治疗髋臼骨折继发创伤性关节炎疗效可靠,能有效提高患者的生活质量。术前对患者全面评估、骨缺损评估,术中髋臼、股骨、内固定物与骨缺损的处理是手术成功的关键因素。展开更多
AIM To evaluate the clinical and X-ray results of acetabular components and tantalum augments in prosthetic hip revisions.METHODS Fifty-eight hip prostheses with primary failure of the acetabular component were review...AIM To evaluate the clinical and X-ray results of acetabular components and tantalum augments in prosthetic hip revisions.METHODS Fifty-eight hip prostheses with primary failure of the acetabular component were reviewed with tantalum implants. The clinical records and X-rays of these cases were retrospectively reviewed. Bone defect evaluations were based on preoperative CT scans and classified according to Paprosky criteria of Radiolucent lines and periprosthetic gaps; implant mobilization and osteolysis were evaluated by X-ray. An ad hoc database was created and statistical analyses were performed with SPSS software(IBM SPSS Statistics for Windows, version 23.0). Statistical analyses were carried out using the Student's t test for independent and paired samples. A P value of < 0.05 was considered statistically significant and cumulative survival was calculated by the KaplanMeier method.RESULTS The mean follow-up was 87.6 ± 25.6 mo(range 3-120 mo). 25 cases(43.1%) were classified as minor defects, and 33 cases(56.9%) as major defects. The preoperative HHS rating improved significantly from a mean of 40.7 ± 6.1(range: 29-53) before revision, to a mean of 85.8 ± 6.1(range: 70-94) at the end of the follow-up(Student's t test for paired samples: P < 0.001). Considering HHS only at the end of follow-up, no statistically significant difference was observed between patients with a major or minor defect(Student's t test for independent samples: P > 0.05). Radiolucent lines were found in 4 implants(6.9%). Postoperative acetabular gaps were observed in 5 hips(8.6%). No signs of implant mobilization or areas of periprosthetic osteolysis were found in the x-rays at the final follow-up. Only 3 implants failed: 1 case of infection and 2 cases of instability. Defined as the end-point, cumulative survival at 10 years was 95%(for all reasons) and 100% for aseptic loosening of the acetabular component.CONCLUSION The medium-term use of prosthetic tantalum components in prosthetic hip revisions is safe and effective in a wide variety of acetabular bone defects.展开更多
目的:用对照法研究金属垫块和颗粒植骨在全髋关节翻修术中髋臼骨缺损的应用效果。方法:选取2014年1月-2018年12月在本院就诊治疗的全髋关节置换术(total hip replacement,THR)后髋臼骨缺损并需行髋关节翻修患者44例。按照随机数字表法...目的:用对照法研究金属垫块和颗粒植骨在全髋关节翻修术中髋臼骨缺损的应用效果。方法:选取2014年1月-2018年12月在本院就诊治疗的全髋关节置换术(total hip replacement,THR)后髋臼骨缺损并需行髋关节翻修患者44例。按照随机数字表法将其分为颗粒植骨组和金属垫块组,各22例(22髋)。比较两组围手术期情况、影像学评分、髋关节功能评分、并发症发生情况。结果:金属垫块组手术用时明显短于颗粒植骨组,术中出血量明显少于颗粒植骨组,差异均有统计学意义(P<0.05);金属垫块组术后各区影像学评分均明显高于颗粒植骨组,差异均有统计学意义(P<0.05);两组术后2周、3个月以及6个月的Harris评分均较术前有明显提高,且金属垫块组Harris评分均显著高于颗粒植骨组,差异均有统计学意义(P<0.05);金属垫块组并发症发生率低于颗粒植骨组(P<0.05)。结论:与颗粒植骨比较,金属垫块在治疗髋臼骨缺损中,能够有效缩短手术用时,减少术中出血量,改善患者髋功能,安全可靠。展开更多
基金This work is supported by National Key Research and Development Program of China(2016YFC1100600)the National Natural Science Foundation of China(81972058 and 81902194)the Multicenter Clinical Research Project of Shanghai Jiao Tong University School of Medicine(DLY201506).
文摘Complicated and large acetabular bone defects present the main challenges and difficulty in the revision of total hip arthroplasty(THA).This study aimed to explore the advantages of three-dimensional(3D)printing technology in the reconstruction of such acetabular bone defects.We retrospectively analyzed the prognosis of four severe bone defects around the acetabulum in three patients who were treated using 3D printing technology.Reconstruction of bone defect by conventional methods was difficult in these patients.In this endeavor,we used radiographic methods,related computer software such as Materialise's interactive medical image control system and Siemens NX software,and actual surgical experience to estimate defect volume,prosthesis stability,and installation accuracy,respectively.Moreover,a Harris hip score was obtained to evaluate limb function.It was found that bone defects could be adequately reconstructed using a 3D printing prosthesis,and its stability was reliable.The Harris hip score indicated a very good functional recovery in all three patients.In conclusion,3D printing technology had a good therapeutic effect on both complex and large bone defects in the revision of THA.It was able to achieve good curative effects in patients with large bone defects.
基金This work was supported by funding from China Postdoctoral Science Foundation(No:2020M670863)Jilin Scientific and Technological Development Program(No:20230203089SF).
文摘The biomechanical effects of acetabular revision with jumbo cups are unclear.This study aimed to compare the biomechanical effects of bionic trabecular metal vs.titanium jumbo cups for the revision of acetabular bone defects.We designed and reconstructed American Academy of Orthopaedic Surgeons(AAOS)type I–III acetabular bone defect models using computed tomography scans of a man without acetabular bone defects.The implantation of titanium and trabecular metal jumbo cups was simulated.Stress distribution and relative micromotion between the cup and host bone were assessed using finite element analysis.Contact stress on the screws fixing the cups was also analyzed.The contact stress analysis showed that the peak contact stress between the titanium jumbo cup and the host bone was 21.7,20.1,and 23.8 MPa in the AAOS I–III models,respectively;the corresponding values for bionic tantalum jumbo cups decreased to 4.7,6.7,and 11.1 MPa.Analysis of the relative micromotion showed that the peak relative micromotion between the host bone and the titanium metal cup was 10.2,9.1,and 11.5μm in the AAOS I–III models,respectively;the corresponding values for bionic trabecular metal cups were 17.2,18.2,and 31.3μm.The peak contact stress on the screws was similar for the 2 cup types,and was concentrated on the screw rods.Hence,acetabular reconstruction with jumbo cups is biomechanically feasible.We recommend trabecular metal cups due to their superior stress distribution and higher relative micromotion,which is within the threshold for adequate bone ingrowth.
文摘Acetabular component revision in the presence of severe bone loss is difficult for reconstructing an acetabular component in the anatomical hip center. Various treatment options are available, although often the acetabular defect cannot be corrected with a single option alone. Precise assessment of the bone loss and a suitable combination of methods are needed. Here we report a case of multiple failures with impaction bone grafting reconstruction for an acetabular bone defect of American Academy of Orthopedic Surgeons classification type III. We finally reconstructed the acetabulum with three femoral head allografts and a Kerboull-type acetabular reinforcement device. The allograft was a casted, jet-type helmet-like shape. A year later the patient was able to walk without a cane and perform light agricultural work. Accurate evaluation of the acetabular bone loss and appropriate reconstruction is important.
文摘目的:深入研究全髋关节置换术(total hip arthroplasty,THA)治疗髋臼骨折继发创伤性关节炎的临床疗效。方法:回顾性分析2019年10月至2022年6月,采用THA治疗15例髋臼骨折继发创伤性关节炎患者,男8例,女7例,年龄40~76(59.20±9.46)岁。记录术前及术后假体松动、髋关节脱位、髋关节活动度、神经损伤等情况,采用Harris评分、视觉模拟评分(visual analogue scale,VAS)、影像学检查评价髋关节功能及手术疗效。结果:15例均顺利完成手术,术中无神经、血管损伤,术后切口均Ⅰ期甲级愈合,无感染。随访时间6~39(18.33±9.27)个月。其中1例术后半年发生髋臼侧假体松动,经过翻修手术后恢复良好;1例髋关节脱位,经切开复位处理后治愈,无不良后果。术后末次随访Harris评分(88.60±4.01)分,与术前(47.20±11.77)分相比,差异有统计学意义(P<0.05)。术后末次随访VAS评分1(1)分,与术前8(2)分相比,差异有统计学意义(P<0.05)。末次随访时,本组所有患者疼痛症状减轻或消失,关节功能满意;末次随访影像学资料显示关节假体贴合良好,无异位骨化发生,假体无松动。结论:THA治疗髋臼骨折继发创伤性关节炎疗效可靠,能有效提高患者的生活质量。术前对患者全面评估、骨缺损评估,术中髋臼、股骨、内固定物与骨缺损的处理是手术成功的关键因素。
文摘AIM To evaluate the clinical and X-ray results of acetabular components and tantalum augments in prosthetic hip revisions.METHODS Fifty-eight hip prostheses with primary failure of the acetabular component were reviewed with tantalum implants. The clinical records and X-rays of these cases were retrospectively reviewed. Bone defect evaluations were based on preoperative CT scans and classified according to Paprosky criteria of Radiolucent lines and periprosthetic gaps; implant mobilization and osteolysis were evaluated by X-ray. An ad hoc database was created and statistical analyses were performed with SPSS software(IBM SPSS Statistics for Windows, version 23.0). Statistical analyses were carried out using the Student's t test for independent and paired samples. A P value of < 0.05 was considered statistically significant and cumulative survival was calculated by the KaplanMeier method.RESULTS The mean follow-up was 87.6 ± 25.6 mo(range 3-120 mo). 25 cases(43.1%) were classified as minor defects, and 33 cases(56.9%) as major defects. The preoperative HHS rating improved significantly from a mean of 40.7 ± 6.1(range: 29-53) before revision, to a mean of 85.8 ± 6.1(range: 70-94) at the end of the follow-up(Student's t test for paired samples: P < 0.001). Considering HHS only at the end of follow-up, no statistically significant difference was observed between patients with a major or minor defect(Student's t test for independent samples: P > 0.05). Radiolucent lines were found in 4 implants(6.9%). Postoperative acetabular gaps were observed in 5 hips(8.6%). No signs of implant mobilization or areas of periprosthetic osteolysis were found in the x-rays at the final follow-up. Only 3 implants failed: 1 case of infection and 2 cases of instability. Defined as the end-point, cumulative survival at 10 years was 95%(for all reasons) and 100% for aseptic loosening of the acetabular component.CONCLUSION The medium-term use of prosthetic tantalum components in prosthetic hip revisions is safe and effective in a wide variety of acetabular bone defects.
文摘目的:用对照法研究金属垫块和颗粒植骨在全髋关节翻修术中髋臼骨缺损的应用效果。方法:选取2014年1月-2018年12月在本院就诊治疗的全髋关节置换术(total hip replacement,THR)后髋臼骨缺损并需行髋关节翻修患者44例。按照随机数字表法将其分为颗粒植骨组和金属垫块组,各22例(22髋)。比较两组围手术期情况、影像学评分、髋关节功能评分、并发症发生情况。结果:金属垫块组手术用时明显短于颗粒植骨组,术中出血量明显少于颗粒植骨组,差异均有统计学意义(P<0.05);金属垫块组术后各区影像学评分均明显高于颗粒植骨组,差异均有统计学意义(P<0.05);两组术后2周、3个月以及6个月的Harris评分均较术前有明显提高,且金属垫块组Harris评分均显著高于颗粒植骨组,差异均有统计学意义(P<0.05);金属垫块组并发症发生率低于颗粒植骨组(P<0.05)。结论:与颗粒植骨比较,金属垫块在治疗髋臼骨缺损中,能够有效缩短手术用时,减少术中出血量,改善患者髋功能,安全可靠。
