髋关节翻修术中应用数字设计3D打印定制带翼臼杯重建髋臼严重骨缺损  

Digital design and 3D-printed customized flanged cups in hip revision with severe acetabular bone defects

作　　者：丁育健 冯德宏[1] 王凌[1] 郭宇[1] 刘仪[1] 周一逸 郭苏童 钱正瑛[2] 许奎雪 张朝峰 Ding Yujian;Feng Dehong;Wang Ling;Guo Yu;Liu Yi;Zhou Yiyi;Guo Sutong;Qian Zhengying;Xu Kuixue;Zhang Zhaofeng(Department of Joint Surgery,Wuxi People's Hospital affiliated to Nanjing Medical University,Wuxi 214043,China;Department of Medical Engineering,Wuxi People's Hospital Affiliated to Nanjing Medical University,Wuxi 214043,China;Beijing Artificial Joint Engineering Laboratory,Beijing 101112,China)

机构地区：[1]南京医科大学附属无锡市人民医院关节外科,无锡214043 [2]南京医科大学附属无锡市人民医院医学工程处,无锡214043 [3]北京市人工关节工程实验室,北京101112

出　　处：《中华骨科杂志》2023年第2期97-103,共7页Chinese Journal of Orthopaedics

基　　金：无锡市社会发展科技示范工程(N20192006);江苏省自然科学基金面上项目(BK20181135)。

摘　　要：目的探讨髋关节翻修术中应用数字设计3D打印定制带翼臼杯重建髋臼严重骨缺损的早中期疗效。方法回顾性分析2017年2月至2021年8月无锡市人民医院关节外科在髋关节翻修术中应用数字设计3D打印定制带翼臼杯重建髋臼严重骨缺损10例患者的资料,男5例、女5例,年龄(73.6±8.1)岁(范围62~87岁),左、右侧各5例。髋臼严重骨缺损Paprosky分型:ⅢA型2例、ⅢB型8例。术前薄层CT数据逆向重建数字骨盆,计算机设计一体式带翼臼杯5例、分体式带翼臼杯5例,其中复合一体式垫块3例。翻修手术中严格按照设计方案进行臼杯放置及固定。记录手术时间、术中出血量、血管和神经损伤、术后感染及脱位等并发症发生情况,随访时评估髋关节Harris功能评分,通过骨盆X线片测量旋转中心高度、水平位置,并评估假体稳定性。结果术中臼杯放置及固定过程顺利,手术时间为(147.9±48.3)min(范围96~212 min),术中出血量为(730.4±262.6)ml(范围500~1300 ml)。随访时间为(40.8±18.7)个月(范围16~70个月)。术前髋关节Harris功能评分为(28.60±8.40)分,至末次随访时提高至(83.80±6.73)分,差异有统计学意义(t=16.84,P<0.001);优4例、良5例,可1例,优良率90%(9/10)。末次随访时患侧髋关节旋转中心高度由术前(46.24±7.74)mm降低至(15.54±2.54)mm,差异有统计学意义(t=14.61,P<0.001);较健侧(13.81±1.48)mm轻度上移,差异无统计学意义(t=1.83,P=0.100);水平距离由术前(33.79±5.27)mm增加至(40.53±4.50)mm,差异有统计学意义(t=3.62,P=0.006);与健侧(38.54±3.46)mm比较无统计学意义(t=1.28,P=0.232)。无一例出现血管及神经损伤、感染、假体脱位等并发症,切口均一期愈合,随访期间假体均未出现松动、移位、螺钉断裂等情况。结论髋关节翻修术中应用数字设计3D打印定制带翼臼杯重建髋臼严重骨缺损,可改善髋关节功能、重建髋臼旋转中心及维持假体早中期稳定性,�Objective To investigate the effect of 3D-printed customized flanged cup in hip revision with severe acetabular bone defects.Methods Since February 2017,10 cases of 3D-printed customized flanged cups were used in hip revision with severe acetabular bone defects,including 2 cases of Paprosky type IIIA and 8 cases of Paprosky type IIIB.There were 5 males and 5 females,mean age 73.6±8.1 yrs(range,62-87 yrs),5 left and 5 right cases.The preoperative thin-layer CT scan was preformed to reverse reconstruct digital pelvis.Five cases of one-piece flanged cups and 5 cases of decomposed flanged cups,including 3 cases of composite one-piece cups were designed by computer.The surgery was performed strictly according to the plan.Postoperative follow-up was performed to evaluate the Harris score.Operation time,intraoperative bleeding and other complications such as vascular and nerve injury,postoperative infection,and dislocation were counted.Pelvic X-ray was used to assess the height and horizontal position of the center of rotation and the stability of the prosthesis.Results The surgical procedure was successful,with an average operative time of 147.9±48.3 min(range,96-212 min)and an average intraoperative bleeding of 730.4±262.6 ml(range,500-1300 ml).The mean time of final follow-up was 40.8±18.7 months(range,16-70 months)after surgery.At the last follow-up,the average Harris score was 83.80±6.73,with 4 cases excellent,5 cases good,and 1 case fair.The excellent and good rate was 90%.The last Harris score was significantly higher than that before operation 28.60±8.40(t=16.84,P<0.001).The height of affected hip joint rotation center decreased from 46.24±7.74 mm before operation to 15.54±2.54 mm after operation with significant difference(t=14.61,P<0.001).It was slightly higher than the opposite side(13.81±1.48 mm),which had no significant difference(t=1.83,P=0.100).The horizontal distance of affected hip joint rotation center increased from 33.79±5.27 mm before operation to 40.53±4.50 mm after operation with signif

关 键 词：计算机辅助设计 髋假体 关节成形术 置换 髋 再手术 

分 类 号：R687.4[医药卫生—骨科学]