混合式固定3D打印多孔钽块修复全膝关节置换术中巨大骨缺损的早期研究  

Hybrid fixation strategy using 3D-printed porous tantalum augments for severe bone defects in total knee arthroplasty:an early follow-up study

作　　者：雷鹏飞 朱晓波 张驰[1] 梁丰 楼险峰[1] 谢杰 文霆 钟达[2] 赵凤朝 凌志恒[1] 胡懿郃 Lei Pengfei;Zhu Xiaobo;Zhang Chi;Liang Feng;Lou Xianfeng;Xie Jie;Wen Ting;Zhong Da;Zhao Fengchao;Ling Zhiheng;Hu Yihe(Department of Orthopaedics,the First Affiliated Hospital,School of Medicine,Zhejiang University,Hangzhou 310003,China;Department of Orthopaedics,Xiangya Hospital of Central South University,Changsha 410008,China)

机构地区：[1]浙江大学医学院第一附属医院骨科,杭州310003 [2]中南大学湘雅医院骨科,长沙410008

出　　处：《中华骨科杂志》2024年第22期1457-1463,共7页Chinese Journal of Orthopaedics

基　　金：国家重点研发计划(2023YFC2412605,2023YFC2412604);浙江省"尖兵领雁+X"研发攻关计划项目支持(2024C03079)。

摘　　要：目的探讨混合式固定3D打印多孔钽块修复全膝关节置换术中巨大骨缺损的早期效果和安全性。方法回顾性分析2019年8月至2023年9月,浙江大学医学院第一附属医院(11例)和中南大学湘雅医院(9例)采用混合式固定3D打印多孔钽块修复20例(21膝)巨大骨缺损患者的临床资料,男6例(6膝)、女14例(15膝),年龄(61.05±11.23)岁(范围42~80岁),左侧7例、右侧14例;均为安德森骨科研究所(Anderson Orthopaedic Research Institute,AORI)分型的3型。单侧19例、双侧1例,包括5膝为复杂初次置换(Charcot关节病3膝、梅毒关节病1膝、严重外翻膝1膝)、16膝为翻修手术(无菌性松动13膝、感染3膝)。术前常规行CT扫描并进行数字化三维重建,对巨大干骺端缺损(超过干骺端区域的50%)或>10 mm厚度的骨缺损,使用3D打印标准化多孔钽块进行修复;对巨大空腔性骨缺损或严重干骺端缺损(干骺部的内外侧均出现缺损或某一侧超过干骺端区域的80%,骨量的残留无法支持使用螺钉固定标准化补块),使用3D打印个性化定制多孔钽块混合式固定修补。比较患者手术前后的影像学资料(假体位置,并发症)、膝关节活动度(range of motion,ROM)、疼痛视觉模拟评分(visual analogue scale,VAS)和美国膝关节协会评分(Knee Society score,KSS)。结果使用3D打印标准化多孔钽块进行修复17膝,使用3D打印个性化定制多孔钽块混合式固定修补4膝。所有患者均获得随访,随访时间(26.5±15.0)个月(范围12~62个月)。膝关节ROM从术前72.8°±31.9°提升至术后12个月的113.2°±6.8°(P<0.05);VAS评分从术前的(6.6±1.4)分降至术后12个月的(2.5±1.0)分(P<0.05);KSS评分从术前(52.8±6.4)分提升至术后12个月的(80.7±7.9)分(P<0.05)。术后无一例出现假体位置偏移、骨整合不佳及感染等相关并发症。结论应用混合式固定3D打印多孔钽块可填充复杂初次人工膝关节置换或翻修术中的巨大骨缺损,多孔钽�ObjectiveTo explore the early effects and safety of using a hybrid fixation strategy with 3D-printed porous tantalum metal augments to reconstruct substantial bone defects in complex primary total knee arthroplasty(TKA).MethodsA retrospective analysis was performed on the clinical data from August 2019 to September 2023,encompassing 20 patients(21 knees)with significant bone loss who underwent hybrid fixation with 3D-printed porous tantalum augments.The procedures were conducted at two medical centers:the First Affiliated Hospital,School of Medicine,Zhejiang University(11 cases)and Xiangya Hospital of Central South University(9 cases).The study cohort comprised 6 males(6 knees)and 14 females(15 knees),with a mean age of 61.05±11.23 years(range,42-80 years).The distribution of cases was 7 on the left side and 14 on the right side.All cases were categorized as type 3 according to the Anderson Orthopaedic Research Institute(AORI)classification system.The cohort included 19 unilateral and 1 bilateral case,with 5 involving complex primary replacements(3 with Charcot arthropathy,1 with syphilitic arthropathy,and 1 with severe valgus deformity)and 16 revision surgeries(13 for aseptic loosening and 3 for infection).Preoperative assessments included routine CT scans and digital three-dimensional reconstructions to identify large metaphyseal defects exceeding 50%of the metaphyseal area or those thicker than 10 mm.For such defects,3D-printed standardized porous tantalum augments were implemented.In cases of extensive cavitary bone defects or severe metaphyseal defects where the medial and lateral defects collectively exceeded 80%of the metaphyseal region or where the residual bone stock was insufficient for screw fixation of standardized augments,3D-printed personalized custom-made porous tantalum augments were employed for hybrid fixation and repair.Comparative analyses were conducted on pre-and postoperative imaging data(prosthesis positioning and complications),knee range of motion(ROM),visual analogue scale(VAS)for pai

关 键 词：关节成形术 置换 膝 打印 三维 骨缺损 

分 类 号：R687.4[医药卫生—骨科学]