3D打印辅助重建重度骨缺损翻修患者髋臼旋转中心的疗效

摘要
图/表
参考文献
相关文章 (15)

全文: PDF (3120 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的探讨应用个体化3D打印钛合金臼杯重建重度骨缺损髋臼旋转中心病例的早期临床效果。方法选取2017年1月至2018年12月安徽医科大学附属宿州医院收治的应用个体化3D打印钛合金臼杯重建重度骨缺损髋臼旋转中心的10例患者。其中男4例，女6例；年龄36~67岁，平均(54.71±10.23)岁。术前Paprosky髋臼骨缺损分型，ⅡB型3例，ⅢA型7例。记录手术时间、术中出血量；手术前后及随访期间的骨盆X线片髋关节旋转中心(hip joint center，HJC)的位置信息；髋关节的Harris功能评分和术后并发症等，评估该项技术的早期临床效果。结果 10例患者手术时间为1.51~3.12 h，平均(1.81±0.82)h。术中出血量为650~1 750 mL，平均(983.43±459.22)mL。随访时间为13~26个月，平均(18.35±4.51)个月。患者术后髋臼旋转中心恢复至较理想位置。髋关节Harris功能评分：术前26~45分，平均(34.02±14.91)分；末次随访时78~97分，平均(84.31±9.71)分，两者比较差异有统计学意义(P＜0.01)。10例患者随访至今未见假体关节脱位、假体关节感染、假体周围骨折等并发症。术后随访期间骨盆X线片均未见个体化3D打印臼杯与其宿主骨之间放射性透光线和假体松动。术后6个月随访时X线片示3D臼杯周围骨组织结合紧密、固定可靠，有较好的骨长入。结论应用个体化3D打印钛合金臼杯能够重建重度骨缺损髋臼的旋转中心，术后肢体长度和髋关节功能均有显著改善，3D臼杯与缺损的宿主骨匹配佳，早期随访临床疗效好。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	许康永
	童也
	汤瑞新
	周烨

关键词 ： 3D打印, 髋臼旋转中心, 髋臼骨缺损, 髋关节翻修

Abstract：Objective To study the early clinical outcomes of individualized 3D-printed titanium alloy socket cups in reconstruction of acetabular rotation center in patients with severe bone defects.Methods Ten patients admitted to our hospital from January 2017 to December 2018 accepted individualized 3D-printed titanium alloy cups to reconstruct the acetabular rotation centre of severe bone defects.4 males and 6 females were included.The patients aged 36 to 67 years，with an average of(54.71±10.23).According to Paprosky acetabular defects classification，there were 3 cases of ⅡB，7 cases of ⅢA.The intraoperative bleeding and operating time，the position of the hip joint center(HJC) on pelvic radiographs before and after surgery and the Harris functional score of the hip joint and postoperative complications were collected to evaluate the early clinical results of this technique.Results The operative time of the 10 patients ranged from 1.51 to 3.12 h，with a mean of (1.81±0.82)h.The intraoperative bleeding volume ranged from 650 to 1750 mL，with a mean of (983.43±459.22)mL.The follow-up period ranged from 13 to 26 months，with a mean of(18.35±4.51)months.The patient's postoperative acetabular centre of rotation improved significantly.Hip Harris function scores were 26 to 45 points before surgery，with an average of (34.02±14.91)points.And hip Harris function scores were 78 to 97 points at the last follow-up，with an average of (84.31±9.71)points.The difference was statistically significant (P＜0.01).10 patients had no complications such as prosthetic joint dislocation，prosthetic joint infection or periprosthetic fracture during the follow-up period.No radiolucent lines between the individual 3D printed socket cup and its host bone and no loosening of the prosthesis were observed on any of the pelvic radiographs during the postoperative follow-up period.At the 6-month postoperative follow-up，radiographs showed that the bone tissue around the 3D-printed cup was tightly integrated and reliably fixed，with good bone ingrowth.Conclusion The use of individualized 3D-printed titanium cups was able to reconstruct the centre of rotation of the acetabulum with severe bone defects，and there was significant improvement in limb length and hip function after surgery.

Key words： 3D printing acetabular centre of rotation acetabular bone defect hip revision

基金资助:安徽医科大学校科研基金(2020xkj262)

作者简介: 许康永(1980－ )，男，副主任医师，安徽医科大学附属宿州医院骨科，234000。

引用本文:

许康永，童也，汤瑞新，周烨. 3D打印辅助重建重度骨缺损翻修患者髋臼旋转中心的疗效[J]. 实用骨科杂志, 2021, 27(9): 779-789.
Xu Kangyong，Tong Ye，Tang Ruixin，et al. Study on the Efficacy of 3D Printing Assisted Acetabular Rotation Center Reconstruction in Revision Patients with Severe Bone Defects. sygkzz, 2021, 27(9): 779-789.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2021/V27/I9/779

［1］Ranawat CS，Dorr LD，Inglis AE.Total hip arthroplasty in protrusio acetabuli of rheumatoid arthritis［J］.J Bone Joint Surg(Am)，1980，62(7)：1059-1065.
［2］王晓永，李成学，宋扬，等.钽金属Jumbo臼杯联合同种异体骨植骨在髋关节翻修术中的应用［J］.创伤外科杂志，2021，23(4)：292-295.
［3］林天烨，张庆文，何伟，等.同种异体骨颗粒填塞植骨联合Jumbo臼杯在中重度髋臼骨缺损髋关节翻修中的应用［J］.中国骨与关节杂志，2019，8(6)：459-464.
［4］陈雷雷，洪郭驹，林天烨，等.同种异体颗粒骨打压植骨联合不同类型假体在严重髋臼骨缺损翻修中的应用［J］.中国修复重建外科杂志，2020，34(3)：341-346.
［5］Iwase T，Ito T，Morita D.Massive bone defect compromises postoperative cup survivorship of acetabular revision hip arthroplasty with impaction bone grafting［J］.J Arthrop，2014，29(12)：2424-2429.
［6］郭宇，王凌，丁育健，等.3D打印钛合金骨小梁金属臼杯联合植骨重建髋臼骨缺损的早期疗效［J］.实用骨科杂志，2020，26(6)：491-494.
［7］Lingaraj K，Teo YH，Bergman N.The management of severe acetabular bone defects in revision hip arthroplasty using modular porous metal components［J］.J Bone Joint Surg(Br)，2009，91(12)：1555-1560.
［8］Borland WS，Bhattacharya R，Holland JP，et al.Use of porous trabecular metal augments with impaction bone grafting in management of acetabular bone loss［J］.Acta Orthop，2012，83(4)：347-352.
［9］曹国定，裴豫琦，李旭升，等.髋关节翻修中髋臼骨缺损的处理现状及3D打印的应用［J］.实用骨科杂志，2020，26(9)：811-815.
［10］Weber M，Witzmann L，Wieding J，et al.Customized implants for acetabular Paprosky Ⅲ defects may be positioned with high accuracy in revision hip arthroplasty［J］.Int Orthop，2019，43(10)：2235-2243.
［11］Horas K，Arnholdt J，Steinert AF，et al.Acetabular defect classification in times of 3D imaging and patient-specific treatment protocols［J］.Orthopade，2017，46(2)：168-178.
［12］Li QT，Chen XP，Lin BF，et al.Three-dimensional technology assisted trabecular metal cup and augments positioning in revision total hip arthroplasty with complex acetabular defects［J］.J Orthop Surg Res，2019，14(1)：431.
［13］Migaud H，Common H，Girard J，et al.Acetabular reconstruction using porous metallic material in complex revision total hip arthroplasty：A systematic review［J］.Orthop Traumatol Surg Res，2019，105(1s)：S53-S61.
［14］Banerjee S，Issa K，Kapadia BH，et al.Systematic review on outcomes of acetabular revisions with highlyporous metals［J］.Int Orthop，2014，38(4)：689-702.
［15］Gelaude F，Clijmans T，Delport H.Quantitative computerized assessment of the degree of acetabular bone deficiency：total radial acetabular bone loss(TrABL)［J］.Adv Orthop，2011(2011)：494382.