CroweⅡ、Ⅲ型髋关节发育不良全髋关节置换一体化解剖重建髋臼假体的设计效率与精确性  

The accuracy and efficiency of design and development of 3D printed integral anatomical acetabular prosthesis in total hip arthroplasty for Crowe typeⅡandⅢdevelopmental dysplasia of the hip

作　　者：张衡 马晓东 李博闻 赵建宁 王家芹 周建生 Zhang Heng;Ma Xiaodong;Li Bowen;Zhao Jianning;Wang Jiaqin;Zhou Jiansheng(Department of Orthopedics,the First Affiliated Hospital of Bengbu Medical University,Tissue and Transplant Laboratory of Anhui Province,Bengbu Medical University,Bengbu 233004,China;Department of Orthopedics,Jinling Hospital,School of Medicine,Nanjing University,Nanjing 210002,China;School of Life Science,Bengbu Medical University,Bengbu 233030,China)

机构地区：[1]蚌埠医科大学第一附属医院骨科,组织移植安徽省重点实验室,蚌埠233004 [2]南京大学医学院附属金陵医院骨科,南京210002 [3]蚌埠医科大学生命科学学院,蚌埠233030

出　　处：《中华医学杂志》2024年第41期3815-3821,共7页National Medical Journal of China

基　　金：安徽省自然科学基金(2108085QH320);安徽省高校优秀青年人才支持计划(gxyq2022043);蚌埠医学院第一附属医院优秀青年科学基金(2021byyfyyq04)。

摘　　要：目的探讨模型研发法和软件研发法设计研发CroweⅡ、Ⅲ型髋关节发育不良(DDH)全髋关节置换术(THA)一体化解剖重建髋臼假体的效率和精准性。方法回顾性选择15例因“CroweⅡ、Ⅲ型DDH伴终末期骨性关节炎”于2015年1月至2023年6月就诊于蚌埠医学院第一附属医院骨科并行THA的患者,其中男1例(1髋),女14例(17髋);年龄(55.1±9.1)岁;CroweⅡ型12髋,CroweⅢ型6髋。假体设计研发基于患者术前骨盆三维CT数据。模型研发组应用3D打印技术打印出1∶1骨盆模型,按照THA常规操作方法磨锉髋臼,置入髋臼杯,用骨蜡填充髋臼杯上方的骨缺损;软件研发组应用Mimics及3-matic软件模拟整个手术过程,设计并置入一体化解剖重建髋臼假体。比较两种方法的操作时间、髋臼杯大小,髋臼骨缺损的体积和表面积,髋臼杯的外展角、前倾角、旋转中心水平距离和垂直距离。结果两组研究均基于15例患者的18髋数据。模型研发组和软件研发组旋转中心的水平和垂直距离分别为(32.08±1.80)mm比(32.17±2.40)mm和(14.36±1.53)mm比(15.11±1.45)mm(均P>0.05);模型研发组髋臼杯大小为(48.56±1.15)mm,软件研发组为(48.77±1.22)mm(P=0.160)。模型研发组髋臼假体前倾角和外展角分别为23.79°±6.31°和30.49°±11.03°,软件研发组则分别为15.17°±0.52°和40.24°±0.58°(均P<0.01)。模型研发组髋臼骨缺损的体积和表面积分别为(5.06±2.86)mm^(3)和(8.31±2.21)mm^(2),软件研发组则分别为(4.01±2.56)mm^(3)和(6.83±2.71)mm^(2)(均P<0.05)。模型研发组研发时间为(24.43±0.68)h,软件研发组为(0.47±0.12)h(P<0.001)。结论相对于3D打印的模型研发方法,应用Mimics及3-matic软件设计研发CroweⅡ、Ⅲ型DDH的THA一体化解剖重建髋臼假体更便捷、高效、精准。Objective To compare the accuracy and efficiency between the model development method and the software development method,which design and develop 3D printed integral anatomical acetabular prosthesis to be used in total hip arthroplasty(THA)for patients with Crowe typeⅡandⅢdevelopmental dysplasia of the hip(DDH).MethodsFifteen patients with end-stage hip osteoarthritis due to Crowe typeⅡandⅢDDH who underwent THA in the Orthopedics Department of the First Affiliated Hospital of Bengbu Medical College between January 2015 and June 2023 were selected in this study retrospectively.There were 1 male(1 hip)and 14 females(17 hips)with a mean age of(55.1±9.1)years.There were 12 hips with Crowe typeⅡ,6 hips with Crowe typeⅢ.The preoperative pelvis three-dimensional CT data in those patients were used to design integral anatomical acetabular prosthesis.The model development group used 3D printing technology to print life-size pelvis models.The acetabulum was reamed and the acetabulum cup was inserted into the socket according to conventional THA procedures.The bone defect above the acetabulum cup was filled with bone wax.The Mimics and 3-matic software were used to simulate the THA procedures,design and install the integrated anatomical acetabular prosthesis in the software development group.The operation time,the size of the acetabular cup,the volume and surface area of the acetabulum bone defect,the acetabular cup′s inclination and anteversion,the horizontal distance and the vertical distance of hip rotation center were compared between the two methods.ResultsThe study in the two groups were all based on the data of 18 hips in the 15 patients.The horizontal and vertical distances of rotation center in the model development group and software development group was(32.08±1.80)mm,(32.17±2.40)mm and(14.36±1.53)mm,(15.11±1.45)mm,respectively(both P>0.05).The cup size in model development group was(48.56±1.15)mm,and it was(48.77±1.22)mm in the software group(P=0.160).The anteversion and inclination of the

关 键 词：关节成形术 置换 髋 3D打印 定制假体 髋关节发育不良 数字化 

分 类 号：R687.3[医药卫生—骨科学]