个性化3D打印补块修复髋臼大范围骨缺损在髋臼骨折延期人工髋关节置换术中的初步应用  

Customized 3D printed acetabular augment for repair of large acetabular bone defects in delayed total hip arthroplasty after failed treatment of acetabular fractures

作　　者：赵春鹏[1] 肖鸿鹄 曹奇勇[1] 卑明健 杨明辉[1] 吴新宝[1] Zhao Chunpeng;Xiao Honghu;Cao Qiyong;Bei Mingjian;Yang Minghui;Wu Xinbao(Department of Orthopaedic Trauma,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院创伤骨科,北京100035

出　　处：《中华创伤骨科杂志》2023年第6期470-477,共8页Chinese Journal of Orthopaedic Trauma

基　　金：北京市科技计划项目(Z201100005420033);北京市自然科学基金(19L2011)。

摘　　要：目的探讨个性化定制3D打印髋臼补块修复髋臼大范围骨缺损在髋臼骨折延期人工髋关节置换术中的初步应用效果。方法回顾性分析2021年7月至2023年1月期间北京积水潭医院创伤骨科采用个性化定制3D打印补块重建髋臼骨缺损并行全髋关节置换术的6例髋臼骨折保守治疗或手术治疗失败患者资料。均为男性;年龄(51.3±15.0)岁;Paprosky分型:ⅡB型2例,ⅡC型1例,ⅢA型3例。记录患者的手术时间、术中出血量、住院时间及末次随访时疼痛视觉模拟评分、改良Merle d'Aubigné&Postel评分、髋关节Harris评分及双下肢长度差等。结果6例患者的手术时间为(222.5±46.9)min,术中出血量为1100(1000,2625)mL,住院时间为(9.0±4.5)d,随访时间为(11.8±7.9)个月。末次随访时6例患者的疼痛视觉模拟评分[(2.5±1.0)分]较术前[(6.2±0.8)分]显著降低,改良Merle d'Aubigné&Postel评分[(13.2±2.1)分]、髋关节Harris评分[(67.8±15.3)分]较术前[(6.7±0.8)、(34.2±8.4)分]显著升高,髋关节旋转中心至双侧泪滴连线的垂直距离[(22.5±5.2)mm]和水平距离[(40.7±2.6)mm]较术前[(38.1±14.2)、(53.1±10.0)mm]显著减少,差异均有统计学意义(P<0.05)。末次随访时6例患者的双下肢长度差为(6.2±3.6)mm,与术前[(18.7±1.7)mm]比较差异无统计学意义(P>0.05)。末次随访时X线片未见髋臼假体、补块与骨界面之间存在透亮线,以及可能的假体松动、移位表现。结论对于髋臼骨折保守治疗或手术治疗失败患者,应用个性化定制3D打印补块修复髋臼大范围骨缺损的全髋关节置换术可以重建正常的髋关节旋转中心,为臼杯假体稳定提供可靠保证,使患者髋关节功能获得明显改善。Objective To investigate the early clinical effectiveness of using customized 3D printed acetabular augment to repair large acetabular bone defects in delayed total hip arthroplasty after failed treatment of acetabular fractures.Methods A retrospective study was conducted to analyze the 6 patients who had undergone 3D printed acetabular augment to reconstruct acetabular bone defects in delayed total hip replacement from July 2021 to January 2023 after failed treatment of acetabular fractures.They were all males,with an age of(51.3±15.0)years.Paprosky classification:2 cases of typeⅡB,1 case of typeⅡC,and 3 cases of typeⅢA.Recorded were surgical time,intraoperative bleeding,hospitalization time,and visual analogue scale(VAS),and modified Merle d'Aubigné&Postel score,Harris hip score,and leg length discrepancy at the last follow-up.Results For the 6 patients,the mean surgical time was(222.5±46.9)min,the mean intraoperative bleeding 1,100(1,000,2,625)mL,the mean hospitalization time(9.0±4.5)d,and the mean follow-up time(11.8±7.9)months.At the last follow-up,the VAS[(2.5±1.0)points]significantly decreased compared with the preoperative value[(6.2±0.8)points],the modified Merle d'Aubigné&Postel score[(13.2±2.1)points]and Harris hip score[(67.8±15.3)points]significantly increased compared with the preoperative values[(6.7±0.8)and(34.2±8.4)points],the vertical position of center of rotation[(22.5±5.2)mm]and the horizontal position of center of rotation[(40.7±2.6)mm]were significantly reduced compared with the preoperative values[(38.1±14.2)and(53.1±10.0)mm](P<0.05).At the last follow-up,the leg length discrepancy was(6.2±3.6)mm,showing no statistically significant difference from the preoperative value[(18.7±1.7)mm](P>0.05).At the last follow-up,no clear line at the cup-bone or augment-bone interface,or no possible prosthetic loosening or displacement was observed on the X-ray films.Conclusion In delayed total hip arthroplasty after failed treatment of acetabular fractures,the customized 3D printe

关 键 词：髋臼 骨折 骨缺损 关节成形术 置换 髋 3D打印技术 

分 类 号：R687.4[医药卫生—骨科学]