3D打印导航模板辅助髓芯减压植骨治疗ARCOⅡ期非创伤性股骨头坏死  

Three-dimensional printed navigation template assisted core decompression and bone grafting for treatment of ARCO stage Ⅱ non-traumatic femoral head necrosis

作　　者：陈冬冬 郝阳泉[2] 张高魁 李欢欢 王秋霞 鲁超 Chen Dongdong;Hao Yangquan;Zhang Gaokui;Li Huanhuan;Wang Qiuxia;Lu Chao(Shaanxi University of Chinese Medicine,Xianyang 712000,Shaanxi Province,China;Honghui Hospital Affiliated to Xi’an Jiaotong University,Xi’an 710000,Shaanxi Province,China)

机构地区：[1]陕西中医药大学,陕西省咸阳市712000 [2]西安交通大学附属红会医院,陕西省西安市710000

出　　处：《中国组织工程研究》2020年第27期4322-4327,共6页Chinese Journal of Tissue Engineering Research

基　　金：陕西省自然科学基础研究计划面上项目(2017JM8118),项目名称:3D打印导航模板在髓芯减压植骨术治疗股骨头缺血性坏死中的应用,项目负责人:鲁超。

摘　　要：背景:髓芯减压植骨是治疗ARCOⅡ期非创伤性股骨头坏死的主要术式,但是存在定位不准确,坏死骨清除不彻底或过多的风险。目的:观察3D打印导航模板辅助髓芯减压植骨治疗ARCOⅡ期非创伤性股骨头坏死的精确性和安全性。方法:收集2017年1至11月西安交通大学附属红会医院收治的80例(96髋)ARCOⅡ期非创伤性股骨头坏死患者,将其随机分为2组,3D组40例(48髋)行3D打印导航模板辅助髓芯减压植骨;对照组40例(48髋)行传统髓芯减压植骨,即未使用导航模板。2组患者对治疗方案均知情同意,且得到医院伦理委员会批准。分别记录2组手术时间、术中透视次数、术中失血量,观察术后第3,6,12,24个月X射线片复查结果,评估股骨头存活率、髋关节Harris评分、疼痛目测类比评分等指标,进行疗效对比。结果与结论:(1)3D组与对照组比较,手术时间由(132.57±14.86)min缩短至(82.63±10.31)min,术中透视次数由(16.80±2.15)次降低至(4.93±1.36)次,失血量由(143.23±17.98)m L降低至(75.64±16.23)m L,3D组在手术时间、透视次数、失血量方面均优于对照组(P<0.05);(2)术后24个月影像学随访结果显示,3D组仅2例股骨头发生塌陷,但髋关节功能尚可,未行人工髋关节置换,股骨头存活率为96%;对照组中有9例股骨头发生塌陷,其中4例因髋关节活动受限行人工全髋置换,股骨头存活率为81%;3D组股骨头存活率高于对照组(P=0.024);(3)与对照组比较,3D组在Harris评分、目测类比评分方面均有所改善(P<0.05);(4)提示将3D打印导航模板应用于髓芯减压植骨治疗ARCOⅡ期非创伤性股骨头坏死,可减少手术时间、术中透视次数及出血量,提高术中定位的精确性和安全性。BACKGROUND: Core decompression and bone grafting is the main postoperative method in the treatment of ARCO stage II non-invasive necrosis of the femoral head, but there are risks of inaccurate location, incomplete or excessive removal of necrotic bone. OBJECTIVE: To observe the accuracy and safety of three-dimensional(3 D) printed navigation template assisted core decompression and bone grafting in the treatment of ARCO stage II non-traumatic femoral head necrosis. METHODS: Eighty patients(96 hips) of ARCO stage II non-traumatic femoral head necrosis were enrolled from January to November 2017 in Honghui Hospital Affiliated to Xi’an Jiaotong University. The patients were randomly divided into two groups. In the 3 D group, 40 cases(48 hips) received 3 D printed navigation template assisted core decompression and bone grafting. In the control group, 40 cases(48 hips) received core decompression and bone grafting(no navigation template). All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. The operation time, intraoperative fluoroscopy, and intraoperative blood loss were recorded, and X-ray examination results at 3, 6, 12, and 24 months after operation were observed. The femoral head survival rate, hip Harris score, and pain visual analogue scale score were evaluated. The efficacy was compared. RESULTS AND CONCLUSION:(1) Compared with the control group, the operation time was shortened from(132.57±14.86) minutes to(82.63±10.31) minutes;the number of intraoperative fluoroscopy was reduced from(16.80±2.15) times to(4.93±1.36) times;blood loss was reduced from(143.23±17.98) mL to(75.64± 16.23) mL in the 3 D group. Operation time, number of fluoroscopy, and blood loss were superior in the 3 D group than in the control group(P < 0.05).(2) The 24-month follow-up of imaging showed that only 2 cases of the femoral head collapsed in the 3 D group, but the hip joint function was acceptable. There was no artificial hip arthroplasty and the femoral head survival rate was 96

关 键 词：非创伤性股骨头坏死 3D打印导航模板 髓芯减压 植骨 术中透视 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学]