部分定制3D打印骨小梁金属块在修复严重髋臼骨缺损中的作用  

Role of partially customized 3D printed trabecular bone metal augment in repairing severe acetabular bone defects

作　　者：王建朋 张维杰[1] 马建兵[1] 姚舒馨[1] 郝阳泉[1] 赵光辉 肖琳[1] 孙相祥[1] WANG Jianpeng;ZHANG Weijie;MA Jianbing;YAO Shuxin;HAO Yangquan;ZHAO Guanghui;XIAO Lin;SUN Xiangxiang(Department of Joint Surgery,Xi'an Honghui Hospital,Xi'an Jiaotong University,Xi*an 710054,China)

机构地区：[1]西安交通大学附属红会医院关节外科,西安710054

出　　处：《中华骨与关节外科杂志》2023年第1期17-24,共8页Chinese Journal of Bone and Joint Surgery

摘　　要：目的:评估使用部分定制3D打印骨小梁金属块修复严重髋臼骨缺损的早期临床疗效。方法:本研究纳入2017年1月至2022年1月应用部分定制3D打印骨小梁金属块修复严重髋臼骨缺损的患者9例,收集术前资料、术中信息、治疗结果、并发症及影像学结果等,评估该项技术的有效性及安全性。结果:9例患者均获得随访,随访时间3~24个月,平均(13.1±7.4)个月。末次随访时,Harris髋关节功能评分61~94分,平均(84.1±9.6)分,较术前(47.9±9.8)分显著提高(P<0.001);疼痛视觉模拟评分(VAS)为0~4分,平均(1.6±1.2)分,较术前(6.4±1.0)分显著降低(P<0.001);双下肢长度差为2.3~26.8 mm,平均(10.30±6.73)mm,较术前(29.64±7.04)mm显著降低(P<0.001);髋关节旋转中心上移12.6~32.3 mm,平均(21.90±7.37)mm,较术前(38.46±7.73)mm显著下降(P=0.002)。所有患者术后均未发生深静脉血栓/肺栓塞、假体周围感染、假体周围骨折、二次再翻修等。1例患者术后1个月时出现髋关节假体脱位,予以手法复位治疗,效果良好。术后及末次随访X线检查示,骨小梁金属块、臼杯及其相接触的骨面之间未见放射性透亮线明显增加及可能的假体松动、移位等。结论:应用部分定制3D打印骨小梁金属块修复严重髋臼骨缺损的髋关节功能满意,并发症发生风险较低,是一种有效的治疗方式。Objective: To evaluate the early clinical efficacy of partially customized 3D printed trabecular metal augment in the repair of severe acetabular bone defects. Methods: Nine patients with severe acetabular bone defects which were repaired with partially customized trabecular metal augment using 3D printing technology from January 2017 to January 2022 were enrolled in this study. Preoperative and intraoperative information, clinical results, complications and radiographic results were collected to evaluate the effectiveness and safety of this technology. Results: All patients were followed up for 3-24 months, with an average of(13.1±7.4) months. At the last follow-up, the mean Harris hip score was 84.1±9.6(range, 61-94), which was significantly higher than that before operation(47.9±9.8, P<0.001). The mean visual analogue scale(VAS) score was 1.6±1.2(range, 0-4), which was significantly lower than that before operation(6.4±1.0, P<0.001). The mean limb-length discrepancy(LLD) was(10.30±6.73) mm(range, 2.3-26.8 mm), which was significantly lower than that before operation([29.64±7.04] mm, P<0.001). The mean up-shift of center of rotation(COR) was(21.90±7.37) mm(range, 12.6-32.3 mm), which was significantly lower than that before operation([38.46±7.73] mm, P=0.002). No deep vein thrombosis/pulmonary embolism, periprosthetic infection, periprosthetic fracture, or revision occurred. Dislocation of hip prosthesis occurred in 1 patient at 1 month postoperatively, and satisfied result was achieved with manual reduction. The postoperative X-ray examination at the last follow-up showed that no obvious radiolucent line was observed between the trabecular metal augments, the acetabular cups, or the host bone surfaces, and no sign of prosthesis loosening or displacement occurred. Conclusions: The application of partially customized 3D printed trabecular metal augment to repair the hip joint with severe acetabular bone defects is satisfactory, and the risk of complications is low. It is an effective treatment method.

关 键 词：部分定制 3D打印 髋臼骨缺损 

分 类 号：R687.4[医药卫生—骨科学]