3D打印技术在自体骨植骨的全髋关节置换术治疗髋关节发育不良继发骨性关节炎中的应用  

Application of 3D Printing Technology in Total Hip Arthroplasty with Autogenous Bone Grafting for Osteoarthritis Secondary to Developmental Dysplasia of the Hip

作　　者：裴方 赵蕤[2] 姚圣城 仇尚 PEI Fang;ZHAO Rui;YAO Shengcheng;QIU Shang(The Affiliated Hospital of Xuzhou Medical University,Xuzhou 221000,China;不详)

机构地区：[1]徐州医科大学附属医院,江苏徐州221000 [2]江苏省徐州市第一人民医院

出　　处：《中国医学创新》2023年第34期12-17,共6页Medical Innovation of China

基　　金：徐州医科大学附属医院2021年度院级科研项目(2021ZA20)。

摘　　要：目的:探讨3D打印技术在自体骨植骨的全髋关节置换术(THA)治疗髋关节发育不良(DDH)继发骨性关节炎中的应用价值。方法:回顾性分析徐州医科大学附属医院2017年1月—2021年12月收治的初次行自体骨植骨THA重建髋臼治疗的48例CroweⅡ~Ⅳ型成人DDH继发骨性关节炎患者的临床资料,按照随机数字表法分为观察组和对照组,各24例。观察组利用3D打印技术制作骨盆模型及导航模板进行术前规划和指导术中操作。对照组根据影像学资料进行术前规划和术中操作。比较两组围手术期相关指标(手术时间、术中出血量、髋臼假体覆盖率、移植骨覆盖率及臼杯位置合格率)、术后影像学相关测量指标(髋臼假体大小、外展角、前倾角、旋转中心垂直距离及水平距离与术前手术计划的差值),Harris髋关节功能评分、并发症发生情况(静脉血栓、坐骨神经损伤、异位骨化),三维步态参数(步频、步幅、步速及髋、膝关节运动角度)。结果:观察组手术时间短于对照组,术中出血量明显少于对照组,髋臼假体覆盖率及移植骨覆盖率均明显高于对照组,差异均有统计学意义(P<0.05);两组臼杯位置合格率比较,差异无统计学意义(P>0.05)。术后1周观察组髋臼假体大小、外展角、前倾角、旋转中心垂直距离及水平距离与术前手术计划的差值均明显小于对照组,差异均有统计学意义(P<0.05);术后1周,两组Harris髋关节功能评分均较术前升高,差异均有统计学意义(P<0.05),但组间比较差异无统计学意义(P>0.05)。术后6、12个月,观察组三维步态参数(步速、步频、步长及髋、膝关节运动角度)均优于对照组,差异均有统计学意义(P<0.05)。结论:采用3D打印技术辅助自体骨植骨的THA治疗成人DDH继发骨性关节炎与传统THA均可取得较好的修复效果,但3D打印技术能明显减少手术时间和术中出血,提高全髋关节置换的精确度,有Objective:To investigate the application of 3D printing technology in total hip arthroplasty(THA)with autogenous bone grafting in the treatment of osteoarthritis secondary to developmental dysplasia of the hip(DDH).Method:The clinical data of 48 patients with osteoarthritis secondary to Crowe typeⅡ-Ⅳadult DDH who underwent THA with autogenous bone grafting reconstruction acetabular therapy for the first time in the Affiliated Hospital of Xuzhou Medical University from January 2017 to December 2021 were retrospectively analyzed.According to the random number table method,they were divided into an observation group and a control group,with 24 cases in each group.In the observation group,3D printing technology was used to make pelvic models and navigation templates for preoperative planning and intraoperative operation guidance.In the control group,preoperative planning and intraoperative operation were performed according to imaging data.The perioperative related indicators(operation time,intraoperative blood loss,acetabular component coverage rate,bone graft coverage rate,and qualified rate of cup position)and postoperative imaging related measurement indicators(the difference values between the acetabular component size,abduction angle,anteversion angle,vertical and horizontal distance of the center of rotation and the preoperative surgical plan),Harris hip function score,complications(venous thrombosis,sciatic nerve injury,heterotopic ossification),and three-dimensional gait parameters(stride frequency,stride length,gait speed,and knee joint motion angles),were compared between the two groups.Result:The operation time of the observation group was shorter than that of the control group,the intraoperative blood loss was significantly less than that of the control group,the acetabular component coverage rate and bone graft coverage rate were significantly higher than those of the control group,the differences were statistically significant(P<0.05);there was no significant difference in the qualified rate of cup

关 键 词：3D打印技术 全髋关节置换术 髋关节发育不良 

分 类 号：R687.4[医药卫生—骨科学]