3D打印金属垫块或一体化髋臼假体重建髋关节翻修术中骨缺损  

3D-printed metal augment or integrated acetabular prosthesis for reconstruction of bone defects in hip revision

作　　者：孙博 李科伟[1] 王少华[1] 王爱国[1] 梅伟[1] 王金良[1] Sun Bo;Li Kewei;Wang Shaohua;Wang Aiguo;Mei Wei;Wang Jinliang(Department of Joint Disease,Zhengzhou Orthopaedics Hospital,Zhengzhou 450000,China)

机构地区：[1]郑州市骨科医院关节病科,郑州450000

出　　处：《中华骨科杂志》2025年第2期94-101,共8页Chinese Journal of Orthopaedics

基　　金：河南省医学科技攻关计划项目(LHGJ20220894)。

摘　　要：目的探讨3D打印金属垫块或一体化髋臼假体重建髋关节翻修术中骨缺损的临床疗效。方法回顾性分析2021年6月至2023年7月于郑州市骨科医院行全髋关节翻修的11例患者资料。男5例、女6例,年龄(64.8±10.7)岁(范围58~75岁),体质指数(23.3±4.8)kg/m 2(范围21~27 kg/m 2)。髋臼骨缺损Paprosky分型:ⅡA型3例、ⅡB型4例、ⅢA型3例、ⅢB型1例。翻修原因:无菌性松动8例、感染旷置术后3例。使用3D打印金属垫块9例(无菌性松动8例、感染旷置术后1例),使用3D打印一体化髋臼2例(感染旷置术后)。初次置换至翻修的时间为(11.8±5.6)年(范围5~17年)。采用Harris髋关节评分及疼痛视觉模拟评分(visual analogue scale)评估髋关节功能改善及疼痛恢复情况。于骨盆正位X线片上测量双下肢长度差、髋关节旋转中心垂直高度及旋转中心水平位置。结果所有患者均顺利完成手术,手术时间为(145.9±35.5)min(范围110~159 min),术中出血量为(950.5±310.8)ml(范围680~1450 ml)。患者术后Harris髋关节功能评分均升高,与术前比较差异有统计学意义(F=554.085,P<0.001);术后1年Harris髋关节功能评分为(74.36±5.16)分,大于术前的(32.18±4.07)分,差异有统计学意义(P<0.05)。患者术后VAS评分均下降,与术前比较差异有统计学意义(F=177.717,P<0.001);术后1年VAS评分为(1.27±0.65)分,小于术前的(6.18±1.17)分,差异有统计学意义(P<0.05)。术前双下肢长度差为(1.97±0.71)cm,大于末次随访的(0.69±0.52)cm,差异有统计学意义(t=4.824,P<0.001)。术后患侧髋关节旋转中心垂直高度为(1.88±0.46)cm,健侧为(1.67±0.35)cm,差异无统计学意义(t=1.205,P=0.242);术后患侧髋关节旋转中心水平位置为(3.48±0.55)cm,健侧为(3.54±0.32)cm,差异无统计学意义(t=-0.313,P=0.758)。1例术中出现股骨大转子骨折,经复位内固定后3个月愈合。所有患者均获得随访,随访时间为(21.3±9.5)个月(范围15~31个月)。切口均一期�ObjectiveTo investigate the clinical efficacy of 3D-printed metal augment or integrated acetabular prostheses for reconstruction of bone defects in hip revision.MethodsA total of 11 patients who underwent total hip revision in Zhengzhou Orthopaedic Hospital from June 2021 to July 2023 were retrospectively analysed.There were 5 males and 6 females,age 64.8±10.7 years(range,58-75 years),and body mass index 23.3±4.8 kg/m 2(range,21-27 kg/m 2).Paprosky classification of acetabular bone defects:3 cases of type IIA,4 cases of type IIB,3 cases of type IIIA,1 case of type IIIB.Reasons for revision:8 cases of aseptic loosening,3 cases after infection exclusion procedure.A 3D-printed metal augment was used in 9 cases(8 cases of aseptic loosening and 1 case of infected exclusion procedure)and a 3D-printed integrated acetabulum was used in 2 cases(infected exclusion procedure).The time from primary total hip arthroplasty to revision was 11.8±5.6 years(range,5-17 years).Harris hip score and visual analogue scale(VAS)were used to evaluate the improvement of hip function and pain recovery.The leg length discrepancy,vertical height and horizontal position of the hip rotation center were measured on pelvic anteroposterior X-ray films.ResultsAll patients successfully completed the operation.The operation time was 145.9±35.5 min(range,110-159 min),and the intraoperative blood loss was 950.5±310.8 ml(range,680-1,450 ml).The postoperative Harris hip function score was significantly higher than that before operation(F=554.085,P<0.001).One year after operation,the Harris hip function score was 74.36±5.16,which was higher than that before operation 32.18±4.07,and the difference was statistically significant(P<0.05).The VAS scores of all patients decreased after operation,and the difference was statistically significant compared with that before operation(F=177.717,P<0.001).The VAS score at 1 year after operation was 1.27±0.65,which was lower than that before operation 6.18±1.17,and the difference was statistically significant(P

关 键 词：关节成形术 置换 髋 再手术 假体失效 打印 三维 

分 类 号：R68[医药卫生—骨科学]