3D打印技术辅助下全髋关节置换术在髋臼骨折术后继发病变中的应用  

Application of 3D printing assisted total hip arthroplasty in secondary lesions after acetabular fractures

作　　者：黄程军 张元松 孙加伟 陈欣 范华全 郑小龙 杨柳 陈光兴 HUANG Cheng-jun;ZHANG Yuan-song;SUN Jia-wei;CHEN Xin;FAN Hua-quan;ZHENG Xiao-long;YANG Liu;CHEN Guang-xing(Center for Joint Surgery,the First Affiliated Hospital of Army Medical University,Chongqing 400038,China;Department of Emergency,the First Affiliated Hospital of Army Medical University,Chongqing 400038,China)

机构地区：[1]陆军军医大学第一附属医院关节外科中心,重庆400038 [2]陆军军医大学第一附属医院急救部,重庆400038

出　　处：《创伤外科杂志》2020年第10期751-756,共6页Journal of Traumatic Surgery

摘　　要：目的探讨3D打印技术辅助下全髋关节置换术在髋臼骨折术后继发病变治疗中的应用效果。方法回顾性分析2015年10月—2019年7月在陆军军医大学第一附属医院关节外科中心治疗的髋臼骨折术后继发病变患者20例,按照手术方法不同分为常规组和3D组,各10例。常规组行常规全髋关节置换术,3D组在3D打印技术辅助下行全髋关节置换术,比较两组患者术中出血量、手术时间、术中植骨、内固定取出及并发症发生情况;比较两组患者Harris髋关节评分(HHS)、VAS评分及假体外展角情况。结果两组患者在性别、年龄、病种组成、随访时间、臼杯大小等方面比较差异无统计学意义(P>0.05);两组患者均顺利手术,术中使用臼杯均为生物型臼杯,假体安放位置均较好。常规组手术时间(145.30±19.97)min、术中出血量(225.00±32.74)mL、术中植骨6例、内固定完全取出8例;3D组手术时间(102.90±20.66)min、术中出血量(155.00±72.30)mL、术中植骨1例、内固定完全取出1例,两组比较,差异有统计学意义(P<0.05)。术后随访显示两组患者髋关节功能均恢复较好,无相关并发症发生。术后随访6个月,常规组髋关节Harris评分(93.60±3.47)分、VAS评分(0.40±0.52)分、假体外展角(50.70±5.25)°;3D组分别为(95.30±1.77)分、(0.20±0.42)分、(43.30±3.06)°,两组髋关节Harris评分、VAS评分比较差异无统计学意义(P>0.05),3D组假体外展角显著小于常规组,差异有统计学意义(P<0.05)。结论在髋臼骨折术后继发病变治疗中,3D打印辅助技术在全髋置换手术时,有助于术者更好地了解髋臼形态及内固定位置特点,术前制订内固定取出及植骨计划,缩短手术时间,减少术中出血量,降低手术难度,可提高术后效果。Objective To explore the application effect of 3D printing assisted total hip arthroplasty(THA)in secondary lesions after acetabular fracture.Methods A total of 20 patients with postoperative secondary lesions after acetabular fracture in our center from Oct.2015 to Jul.2019 were selected and retrospectively analyzed.They were divided into two groups,with 10 cases in each group;the routine group was treated with conventional THA,and the 3D group was treated with THA under the assistance of 3D printing technology.The amount of intraoperative bleeding,operation time,intraoperative bone grafting cases,internal fixation removal cases and complications were compared between the two groups;the Harris hip score(HHS),visual analogue scale(VAS)score and abduction angle were compared between the two groups.Results There was no significant difference in gender,age,disease composition,follow-up time,and molar cup size between the two groups(P>0.05);the operations of the two groups were all successful,the cups used were all biological cup,and the prostheses were all placed in good position.In the routine group,the operation time was(145.30±19.97)min,the intraoperative bleeding was(225.00±32.74)mL,6 cases had intraoperative bone grafting,and 8 cases had complete removal of internal fixation;in the 3D group,the operation time was(102.90±20.66)min,the intraoperative bleeding was(155.00±72.30)mL,1 case had intraoperative bone grafting and 1 case had complete removal of internal fixation;the routine group were significantly higher in the above indicators than those in the 3D group(P<0.05).During the follow-up,the hip joint function of the two groups recovered well,and no related complications occurred.At 6 months of follow-up,the Harris score was(93.60±3.47)points,the VAS score was(0.40±0.52)points,and the abduction angle of the prosthesis was(50.70±5.25)°in the routine group;the Harris score was(95.30±1.77)points,the VAS score was(0.20±0.42)points,and the abduction angle of the prosthesis was(43.30±3.06)°in the 3D gro

关 键 词：髋臼骨折 全髋关节置换 3D打印 并发症 

分 类 号：R683.42[医药卫生—骨科学]