3D打印个体化定制假体在合并严重骨缺损髋关节翻修中的早期临床疗效  

Early clinical outcomes of 3D-printed individualised customised prostheses in hip revision combined severe bone defect

作　　者：王洪平 王明友 杨晓琴 唐茁栋 宋训洲 兰玉平[1] WANG Hong-ping;WANG Ming-you;YANG Xiao-qin;TANG Zhuo-dong;SONG Xun-zhou;LAN Yu-ping(Department of Orthopaedics,Panzhihua Central Hospital,Panzhihua 617000,Sichuan,China;Department of Hepatological Surgery,Panzhihua Central Hospital,Panzhihua 617000,Sichuan,China)

机构地区：[1]攀枝花市中心医院骨科,四川攀枝花617000 [2]攀枝花市中心医院肝胆外科,四川攀枝花617000

出　　处：《中国骨伤》2025年第2期163-169,共7页China Journal of Orthopaedics and Traumatology

基　　金：2023年四川省医学会骨科(尚安通)专项科研课题(编号:2023SAT14)。

摘　　要：目的:探讨3D打印个体化定制假体在合并严重骨缺损患者髋关节翻修中应用的早期临床效果。方法:回顾性分析2021年1月至2023年5月采用3D打印个性化定制假体行髋关节翻修术患者22例,男10例,女12例,年龄28~78(58.9±12.8)岁,所有患者合并严重骨缺损(ParproskyⅢ型),其中9例为假体周围感染患者,13例为无菌性假体松动患者。所有患者采用3D打印个性化定制假体的方案,其中假体周围感染患者为感染控制后的Ⅱ期翻修。记录患者手术时间、术前等待时间、术中及术后并发症,末次随访时采用疼痛视觉模拟评分法(visual analogue scale,VAS)、髋关节Harris评分评估临床疗效。结果:1例失访,另外21例术后均获得随访,时间10~15(12.91±1.44)个月。所有患者按计划完成手术,手术时间135~390(165.4±39.3)min,术前等待时间7~16(10.5±3.3)d。并发症:1例由于合并严重骨质疏松,术中出现严重股骨假体周围骨折;1例术中出现股骨大转子骨折。末次随访时所有患者定制假体位置良好且无假体松动等表现;所有患者伤口愈合良好,无局部红肿等表现。末次随访时Harris总分(85.86±7.04)分,较术前(44.86±2.36)分明显改善(P<0.001);末次随访时VAS(2.19±0.87)分,较术前(7.41±0.96)分明显改善(P<0.001)。结论:3D打印个性化定制假体在合并严重骨缺损髋关节翻修中的应用临床疗效满意,但由于该方案增加了患者术前等待时间,且存在一定的风险,故在临床中应用时需掌握一定的指征。Objective To explore the early clinical outcomes of 3D printed individualised customised prostheses for in hip revision in patients with combined severe bone defects.Methods Twenty-two patients from January 2021 to May 2023 underwent hip revision using 3D printed personalised customised prostheses were retrospective analyzed,including 10 males and 12 females,age 28 to 78 with a mean of(58.9±12.8)years old.All of patients were combined with severe bone defects(Parprosky typeⅢ).Among of them,9 patients had periprosthetic infections and 13 patients had aseptic prosthesis loosening.All patients were treated with a 3D printed personalised prosthesis protocol,patients with the periprosthetic infection received a second stage revision after infection control.The operation time,preoperative waiting time,intraoperative and postoperative complications were recorded,and the clinical efficacy were evaluated at the final follow-up using the visual analogue scale(VAS)for pain,the Harris hip score.Results One patient was lost to follow-up and the remaining 21 patients were followed up for 10 to 15 with a mean of(12.91±1.44)months after surgery.All patients completed surgery as planned,with an operative time of 135 to 390 with a mean of(165.4±39.3)minutes and a preoperative waiting time of 7 to 16 with a mean of(10.5±3.3)days.Regarding patient complications:one patient had a severe intraoperative periprosthetic femoral fracture due to the combination of severe osteoporosis;one patient had an intraoperative greater trochanteric femur fracture.At the latest follow-up,all patients had good position of the custom-made prosthesis and no loosening of the prosthesis;all patients had good wound healing and no local redness or swelling.The total Harris score at the final follow-up(85.86±7.04)was significantly improved compared to the preoperative(44.86±2.36),P<0.001.The VAS at the last follow-up(2.19±0.87)was significantly improved compared with preoperative(7.41±0.96),P<0.001.Conclusion The clinical efficacy of 3D-printed pers

关 键 词：3D打印 个体化定制 假体 严重骨缺损 髋关节翻修 临床疗效 

分 类 号：R687.42[医药卫生—骨科学]