3D打印个性化手术导航模板在成人发育性髋脱位髋臼重建中的应用  

Clinic application of three-dimensional printing personalized operation navigation template for reconstruction of acetabulum using total hip replacement in treatment for developmental dysplasia of the hip

作　　者：涂强[1] 曹露[1] 丁焕文[1] 章凯[1] 黄敏强[1] 王虹[1] 沈健坚[1] 刘辉亮[1] 陈志源[1] 滕强[1] 区永亮[1] 

机构地区：[1]广州军区广州总医院骨科医院,全军创伤骨科研究所,骨关节疾病医学评估与防治中心,广东省骨科矫形技术及植入材料重点实验室,全军热区创伤救治与组织修复重点实验室,510010

出　　处：《临床外科杂志》2017年第4期295-299,共5页Journal of Clinical Surgery

基　　金：广东省科技计划资助项目(2013B021800055);广州市科技计划资助项目(2013J4100065)

摘　　要：目的评估3D打印个性化手术导航模板在发育性髋脱位髋臼重建中的应用价值。方法成人发育性髋脱位患者19例19髋,Crowe分级Ⅲ级14髋,Ⅳ级5髋。术前模拟手术,制定手术方案,所有病例均采用全髋关节置换术,将3D打印个性化手术导航模板应用于髋臼重建中。结果 19例患者中1例失访,18例随访3~60个月,平均随访23.1个月。术前Harris评分为(35.3±3.9)分,随访时评分为(86.75±4.6)分,差异有统计学意义(P<0.01)。术后患肢短缩畸形、跛行步态显著改善。3D打印的个性化髋臼重建手术导航模板具有良好的匹配性,术中与髋臼骨面完全贴附。术中按照导航模板的指引,快速地确定了真臼的位置,按导航模板确定的方向及角度打磨髋臼,假体与打磨好的髋臼窝完全匹配。X线片提示所有病例均显示髋臼假体位于真臼位置,与周围骨床结合紧密。结论 3D打印手术导航模板的应用为发育性髋脱位全髋关节置换髋臼重建的精确定位、定向提供一种新的个性化手术方案。Objective To evaluate the value of three-dimensional（3D）printing personalized operation navigation template in precise reconstruction of acetabulum using total hip replacement in treatment for developmental dysplasia of the hip（DDH）.Methods 19 patients（19 hips）with DDH ,according to Crowe grade：Ⅲgrade14hips,Ⅳgrade 5 hips,were examined by lamellar CT.Preoperative sham operations were performed and operatin projects were formulated.Prosthesis were simulated to replacement.All patients were treated with total hip replacement.Navigation template was designed according to the anatomic features of the injured side acetabulum.3D-printing personalized operation navigation template was exactly manufacted by rapid prototyping and was applied in the patient.Results 1 patient was lost to fo llow-up,and 18 patients were followed up for an average of 23.1 months（rang e：3 months to 5 years）.Preoperative Harris score was 35.3±3.9,and follow-up Harris score was 86.75±4.6.Preoperative and follow-up Harris scores had a significant difference（P〈0.01）.Crispation and claudication of the operated leg were obviously improved.3D-printing personalized operation navigation template was found to be highly accurate.The navigation template was sterilized and used intraoperatively to assist with surgical navigation and the replacement of prosthesis of acetabulum.The prosthesis was matched to acetabulum.Postoperative X-ray display that prosthesis of acetabulum was replaced in anatomic acetabulum.Conclusion 3D-printing personalized operation navigation template may be a useful method in the replacement of prosthesis of acetabulum in patient with DDH.By the navigation template,individual operation project was provided.Navigation template may have a broad perspective of clinic application in total hip replacement of DDH.

关 键 词：发育性髋脱位 关节成形术 置换 髋 3D打印 导航模板 

分 类 号：R687.4[医药卫生—骨科学]