国产3D打印钛合金骨小梁臼杯在髋关节翻修术中的短期临床和影像学评价  

Short-term clinical and radiographic evaluation of domestic 3D printed trabecular titanium acetabular cup in revision hip arthroplasty

作　　者：陈果 张鹏[1] 王一臣 马邹 毕梦娜[1] 张上上[1] 鲁丽莎[1] 斯焱[1] CHEN Guo;ZHANG Peng;WANG Yi-chen;MA Zou;BI Meng-na;ZHANG Shang-shang;LU Li-sha;SI Yan(Department of Geriatric Orthopedics I,Sichuan Provincial Orthopedic Hospital,Chengdu 610041,Sichuan,China)

机构地区：[1]四川省骨科医院老年骨科I,四川成都610041

出　　处：《川北医学院学报》2023年第9期1191-1196,共6页Journal of North Sichuan Medical College

基　　金：四川省干部保健科研课题(川干研-2020-606);四川省骨科医院2020年度科研课题重点项目(20ZD01);四川省医学会(四川省医学科研青年创新课题,Q19011)。

摘　　要：目的:研究、评价计算机模拟及模型辅助下国产3D打印多孔钛合金骨小梁髋臼杯行髋关节翻修术后的短期临床、影像学结果。方法:回顾性分析应用计算机模拟及模型辅助下3D打印多孔骨小梁钛合金髋臼假体行髋关节翻修术的11例患者临床资料,评估该项技术的早期临床疗效。结果:所有患者平均随访(30.9±6.1)个月,其中6例患者共使用了7块髋臼垫块。85.7%(6/7)的垫块尺寸与术前设计一致,1例(14.3%)患者使用比术前设计大一号的垫块。术中选用髋臼尺寸与术前设计的符合率为81.8%(9/11)。末次随访,所有患者术侧髋功能HSS及WOMAC评分均较术前有提升(P<0.05)。术侧髋臼假体(聚乙烯内杯)外展角平均为(35.3±6.1)°,前倾角平均为(19.5±4.1)°。在安全区内的髋臼假体由术前的18.2%(2/11)增加到术后的81.8%(9/11)(P<0.05)。术后,手术侧垂直旋转中心(CORver)及水平旋转中心(CORhor)均较术前得到一定程度的修正和改善。髋臼假体(外杯)平均骨覆盖为(85.6±6.2)%。末次随访,所有臼杯均显示出良好的骨整合。结论:术前使用医工交互平台模拟3D重建方案,并于3D打印骨盆上预演手术,可提前预测和准备术中垫块的类型、大小、数量、位置,髋臼杯的大小、植入位置、角度、初始覆盖,及髋臼螺钉的植入轨迹。结合国产3D打印多孔钛合金骨小梁髋臼杯进行重建,为患者提供满意的短期临床及影像学结果。Objective:To study and evaluate the clinical and imaging outcomes of Chinese domestically manufactured 3D printing trabecular titanium acetabular cup for hip revision with the aid of computer simulation and model assistance.Methods:The clinical data of 11 patients who underwent hip joint revision surgery using a Chinese domestically manufactured 3D printing trabecular titanium acetabular cup with computer simulation and model assistance were retrospectively included,and the early clinical efficacy of this technology was evaluated.Results:The average follow-up period was(30.9±6.1)months.A total of 7 acetabular augments were used in 6 patients.85.7%(6/7)of the size was consistent with the preoperative design,and 1 patient(14.3%)used a augment one size larger than that of preoperative design.The coincidence rate of acetabular size was 81.8%(9/11).At the final follow-up,there was a significant improvement in hip function assessed by HHS and WOMAC scores compared to preoperative values in all patients(P<0.05).The average abduction angle of the acetabular prosthesis(polyethylene inner cup)on the operative side was(35.3±6.1)°,and the average anteversion angle was(19.5±4.1)°.The acetabular prosthesis,placed in the safe zone,increased from 18.2%(2/11)before operation to 81.8%(9/11)after operation(P<0.05).After the surgery,both the vertical center of rotation(CORver)and the horizontal center of rotation(CORhor)on the operative side were modified.The average bone coverage of the acetabular component(outer cup)was(85.6±6.2)%.At last follow-up,all cups showed good osseointegration.Conclusion:By using the medical-engineering interactive platform to simulate the 3D reconstruction plan and previewing the surgery on the 3D printing pelvis preoperatively can predict and prepare in advance the type,size,quantity,and position of the intraoperative augment,as well as the size,implantation position,angle,and initial coverage of the acetabular cup,and the implantation trajectory of the acetabular screw.Combined with a Chinese dom

关 键 词：髋关节翻修术 多孔钛合金 3D打印技术 虚拟现实技术 

分 类 号：R61[医药卫生—外科学]