应用3D打印多孔金属髋臼双动头重建系统重建严重髋臼结构性骨缺损的早期疗效  

Effects of 3D-printed porous metal cup with hip dual-mobility revision system for reconstruction of severe acetabular ring defects in revision total hip arthroplasty

作　　者：雷鹏飞[1,2] 花龙 钱湖 文霆[1] 钟达 谢杰[1] 杨序程[1] 汪龙[1] 胡如印[4] 胡懿郃[1,2,5] Lei Pengfei;Hua Long;Qian Hu;Wen Ting;Zhong Da;Xie Jie;Yang Xucheng;Wang Long;Hu Ruyin;Hu Yihe(Department of Orthopaedics,Xiangya Hospital,Central South University,Changsha 410008,China;Hunan Engineering Research Center of Biomedical Metal and Ceramic Implants,Changsha 410008,China;Department of Orthopaedics,No.6 Affiliated Hospital of Xinjiang Medical University,Urumqi 830002,China;Department of Orthopaedics,People's Hospital of Guizhou,Guiyang 550002,China;Department of Orthopaedics,the First Affiliated Hospital,Medical College of Zhejiang University,Hangzhou 310003,China)

机构地区：[1]中南大学湘雅医院骨科,长沙410008 [2]金属与陶瓷医用植入体湖南省工程研究中心,长沙410008 [3]新疆医科大学第六附属医院骨科,乌鲁木齐830002 [4]贵州省人民医院骨科,贵阳550002 [5]浙江大学医学院附属第一医院骨科,杭州310003

出　　处：《中华骨科杂志》2021年第14期911-919,共9页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金(82002277);国家老年疾病临床医学研究中心临床研究基金(2020LNJJ15);湖南省高新技术产业科技创新引领计划项目(2020SK2008);湖南省自然科学基金(2018JJ3844,2019JJ40499);湖南省卫生健康委员会科技计划项目(B2019188)。

摘　　要：目的探讨3D打印多孔金属髋臼双动头重建系统(hip dual-mobility revision,HDR)治疗髋臼严重结构性骨缺损的早期临床疗效。方法回顾性分析2019年7月至2020年5月接受髋关节翻修术的严重髋臼结构性骨缺损患者17例,男7例、女10例,年龄(67.3±9.3)岁(范围42~80岁);体质指数(22.2±3.8)kg/m^(2)(范围17.7~33.3 kg/m^(2))。髋臼骨缺损Allan-Gross分型:4型15例、5型2例;Paprosky分型:2B型2例、3A型4例、3B型11例。术前下肢长度差为(42.9±31.1)mm(范围10~160 mm),1例患者Trendelenburg征阳性。术后随访时评估Harris髋关节评分、下肢长度差、影像学上髋臼假体的位置。结果全部病例获得随访,随访时间(12.1±3.0)个月(范围6~16个月)。术前Harris髋关节评分为(31.2±11.3)分,术后第3天为(63.5±10.0)分,术后第7天为(68.7±10.4)分,术后1个月为(70.2±10.1)分,末次随访时提高至(81.6±7.0)分,手术前后的差异有统计学意义(F=25.42,P<0.001)。术后即刻外杯外展角为48.1°±10.6°、前倾角为10.8°±6.0°,内杯外展角为45.0°±6.2°、前倾角为10.8°±3.7°,臼杯均处于Lewinnek安全区范围内。术后下肢长度差下降至(11.1±3.8)mm,与术前比较差异有统计学意义(t=4.327,P<0.001)。Trendelenburg征阳性患者术后即刻症状显著改善。随访期间所有髋臼组件在影像学上均稳定、无移位,未发现骨溶解或吸收,无感染、松动及神经损伤病例。结论3D打印多孔金属HDR可有效修复严重髋臼结构性骨缺损,翻修重建的假体初始稳定性高,能够提升术后早期髋关节功能。Objective To prospectively analyze the early clinical effects of 3D-printed porous metal cup with hip dual-mobility revision(HDR)system in treating severe acetabular bone defects.Methods A total of 17 patients with severe acetabular defects(15 patients in Allan-Gross type 4 and 2 patients in type 5;2 patients in Paprosky type 2B,4 patients in type 3A and 11 patients in type 3B)who underwent revision hip arthroplasty between July 2019 and May 2020 were analyzed.There were 7 males and 10 females(mean age 67.3±9.3 years;range 42-80 years).The average body mass index was 22.2±3.8 kg/m^(2)(range 17.7-33.3 kg/m^(2)).The preoperative mean leg length discrepancy(LLD)was 42.9±31.1 mm(range 10-160 mm).One patient presented positive Trendelenburg sign.The follow-up duration was 12.1±3.0 months(range 6-16 months).The clinical and radiographic hip scores in all patients were evaluated.Results The mean Harris Hip Score(HHS)was 31.2±11.3 points at preoperatively,63.5±10.0,68.7±10.4 and 70.2±10.1 points at 3 days,7 days and 1 month postoperatively.At the latest follow-up,HHS was increased to 81.6±7.0 points.The outer cup mean abduction angle was 48.1°±10.6°and the mean inclination angle was 10.8°±6.0°postoperatively.The inner cup mean abduction angle was 45.0°±6.2°and the mean inclination angle was 10.8°±3.7°.The mean LLD decreased to 11.1±3.8 mm(range:0-15 mm)after surgery.At the latest follow-up,all acetabular components were radiologically stable without displacement.No osteolysis or absorption was observed.There was no infection,loosening or nerve injury in all cases.Conclusion During short-term follow-up,the 3D-printed porous metal HDR system can effectively enhance the stability of implants with satisfied quality of life.It can provide a good result for the revision of total hip arthroplasty with severe acetabular defects.

关 键 词：打印 三维 髋假体 再手术 关节成形术 置换 髋 

分 类 号：R687.3[医药卫生—骨科学]