3D打印技术在髋关节置换术后感染Ⅱ期翻修手术中应用  

Application of three dimensional printing technique in the second-stage revision postoperative infection after total hip replacement

作　　者：何勇[1] 刘欣伟[1] 张敬东[1] 韩文锋[1] 孔旭[1] 柳云恩[1] 侯明晓[1] HE Yong LIU Xin-wei ZHANG Jing-dong HAN Wen-feng KONG Xu LIU Yun-en HOU Ming-xiao(Department of Orthopedics, Army severe trauma treatment center,The General Hospital of Shenyang Military Command, Shenyang 110016, China)

机构地区：[1]沈阳军区总医院骨科全军重症战创伤救治中心,辽宁沈阳110016

出　　处：《临床军医杂志》2016年第10期999-1002,1005,共5页Clinical Journal of Medical Officers

基　　金：辽宁省科技攻关(2013225089)

摘　　要：目的探讨3D打印技术在髋关节置换术后感染Ⅱ期翻修手术中的应用。方法选择2013年6月至2015年12月收治的髋关节置换术后感染需行Ⅱ期翻修手术的患者14例为3D打印组。Ⅰ期已行感染清创、假体取出、抗生素骨水泥占位器植入术,且规范抗感染治疗3~4个月。复查炎性指标正常,髋关节腔穿刺细菌培养阴性后,Ⅱ期行人工髋关节翻修术。术前根据CT扫描得到的数据进行计算机三维建模,通过3D打印技术打印患侧髋臼、股骨及经镜像处理后的健侧股骨近端实体模型,术前预演并依据骨缺损的情况决定翻修假体的选择。同时,随机选取未采用3D打印技术行髋关节置换术后感染Ⅱ期翻修手术的患者14例为对照组。结果 3D打印组平均手术时间为（90.2±25.4）min,对照组为（126.6±28.8）min,3D打印组手术时间明显缩短,差异有统计学意义（P〈0.05）。患者均获随访,随访时间10~36个月,平均20.6个月。术后X线影像检查显示,关节假体位置正确、固定可靠,髋关节功能获得较大改善。3D打印组Harris评分从术前平均（36.8±6.2）分提高到末次随访的平均（84.2±9.6）分,差异有统计学意义（P〈0.05）。结论 3D打印技术在髋关节置换术后感染Ⅱ期翻修手术治疗中,具有实现术前个体化设计、进行手术预演、缩短手术时间、减少医源性损伤、提高手术效率等优点,方法可行,效果良好。Objective To investigate the 3D printing operation guiding in second-stage revision postoperative infection after total hip replacement effect. Methods A retrospective analysis was performed on 14 hip arthroplasty patients admitted in our department from June 2013 to December 2015. All the patients were treated with second stage revision. In the first operation,thorough debridement was perfumed and the prosthesis was removed. Then the prosthesis of antibiotic-loaded acrylic cement was implanted. After giving antibiotics intravenously for 3-4 months. The ESR and CRP were examined at regular time,and the second-stage revision surgery was perfumed when the ESR and CRP were normal. By using data obtained from CT scan for computer 3D modeling,3D printing was made after image processing of the contralateral acetabulum and femoral proximal entity model. Then made the prosthesis of antibiotic-loaded acrylic cement was implanted and second-stage revision surgery. Results The application of 3D printing technology to make complicated hip overhaul a holder and the selection of the prosthesis to be more accurate,greatly shorten the operation time,reduce trauma,all patients were followed up,time to 10-36 months,an average of 20. 6 months,postoperative X-ray shows joint prosthesis position correctly,fixed reliable,the hip joint function for bigger improvement. From preoperative Harris scoring average（ 36. 8 ± 6. 2） points to the average of the last follow-up（ 84. 2 ± 9. 6）（ P〈0. 05）. Conclusion 3D printing surgery can realize individualized preoperative design,preview,shorter the operation time,reducing iatrogenic injury and improving the operation efficiency. Not only to patients and doctors,but also to even the society,it has brought great help.

关 键 词：3D打印 骨缺损重建 髋关节翻修 术后感染 

分 类 号：R687.4[医药卫生—骨科学]