3D打印臼杯-垫块复合假体在髋关节翻修术中的应用六例报告  

Application of 3D-printing customized acetabular cup-augment composite prosthesis in hip revision: a report of 6 cases

作　　者：冯德宏[1] 刘仪[1] 王凌[1] 丁育健 顾晓峰[1] 高剑锐[1] 李雅欣 郭宇[1] FENG De-hong;LIU Yi;WANG Ling;DING Yu-jian;GU Xiao-feng;GAO Jian-rui;LI Ya-xin;GUO Yu(Department of Joint Surgery,The Affiliated Wuxi People’s Hospital of Nanjing Medical University,Wuxi,Jiangsu,214043,China)

机构地区：[1]南京医科大学附属无锡市人民医院关节外科,江苏214043

出　　处：《中国骨与关节杂志》2020年第2期129-134,共6页Chinese Journal of Bone and Joint

基　　金：无锡市社会发展科技示范工程(N20192006).

摘　　要：目的探讨3D打印定制臼杯-垫块复合假体在伴有髋臼侧骨缺损人工髋关节翻修术中的应用价值。方法采用3D打印定制臼杯-垫块复合假体对伴有PaproskyⅡB和ⅢA型髋臼侧骨缺损病例6例(6髋)行髋关节翻修术,男2例,女4例;年龄64~83岁,平均78.2岁。术前Harris髋关节评分(32.3±5.1)分。髋臼骨缺损Paprosky分型:ⅡB型2例,ⅢA型4例;AAOS分型均为Ⅲ型。术前行髋关节薄层CT扫描,数据逆向重建髋臼侧骨缺损三维影像,设计臼杯-垫块复合假体并调整其位置,打印骨盆和假体树脂试模体,安装调试无误后打印钛合金假体。按术前计划植入假体完成髋臼重建。结果切口均一期愈合,未发生切口感染、皮肤坏死、深静脉血栓形成等并发症。6例获17.8 (13.0~25.5)个月随访。术后连续影像学检查显示所有患髋旋转中心基本解剖重建,假体位置良好,无松动、断裂及关节脱位,术后末次随访Harris评分为(82.7±7.1)分。结论 3D打印定制臼杯-垫块复合假体用于髋臼侧PaproskyⅡB型和ⅢA型骨缺损病例的髋关节翻修,结合定向螺钉和翼板更易达到术中初始稳定,有利于其表面骨小梁结构与宿主骨的生物学整合。Objective To investigate the value of 3 D-printing customized cup-augment composite prosthesis in hip revision. Methods Six patients( 2 males and 4 females) with Paprosky IIB and IIIA acetabular bone defect underwent hip revision using 3 D-printing customized cup-augment composite prostheses. The average age was 78.2 years( range: 64-83 years). The preoperative Harris hip score was( 32.3 ± 5.1). Paprosky classification of the acetabular bone defect: 2 cases of type IIB, 4 cases of type IIIA;AAOS classification: All of type III. Thin-layer CT scan of the hip was performed preoperatively and three-dimensional images of the acetabular bone defect were reconstructed by reverse data. The cup-augment composite prosthesis was designed and its position was adjusted. The Titanium prosthesis was printed following installation test in vitro using printed resin pelvis and prosthesis models. Acetabular reconstruction was performed with prosthesis according to the preoperative plan. Results All incisions healed at the first stage without complications of wound infection, skin necrosis or deep venous thrombosis. All patients were followed up for an average of 17.8 months( range: 13.0-25.5 months). Continuous image examinations showed that all the hip rotation centers were reconstructed at good positions, while no loosening, rupture or joint dislocation happened. The Harris score of the latest follow-up was( 82.7 ± 7.1). Conclusions 3 D-printing customized cupaugment composite is an appropriate option for the reconstruction of Paprosky type IIB and IIIA acetabular defect. Combining the fixing screws and flange skills, acetabular prosthesis can achieve initial stability that is conducive to the long-term biological integration of its surface trabecular structure with the host bone.

关 键 词：打印 三维 髋关节 再手术 髋臼成形术 矫形外科手术 骨缺损 

分 类 号：R687.4[医药卫生—骨科学]