摘要
背景:既往的手术技术和方法在重度髋臼骨缺损的解剖重建和精确匹配方面有一定的局限性,个性化3D打印多孔钛合金加强块的出现解决了上述问题。目的:报道个性化3D打印多孔钛合金加强块重建重度髋臼骨缺损病例的早期临床疗效。方法:选取我院关节外科2016年1月至2017年10月应用个性化3D打印多孔钛合金加强块重建重度髋臼骨缺损的11例患者,收集一般资料、术中信息、影像学资料、功能评分和并发症等,评估该项技术的早期临床疗效。结果:术前双下肢长度差(limb-length discrepancy,LLD)为16~92 mm,平均(36.1±22.6)mm;术后LLD为1~21 mm,平均(7.7±6.6)mm,两者比较差异有统计学意义(P<0.01);末次随访时LLD为0~18 mm,平均(7.0±5.7)mm。术前患侧髋关节旋转中心(hip center of rotation,HCOR)上移距离为24~92 mm,平均(51.0±19.3)mm,术后HCOR上移距离为6~40 mm,平均(22.6±10.4)mm,两者比较差异有统计学意义(P<0.01);末次随访时HCOR上移距离为6~41 mm,平均(22.8±10.2)mm。术后随访期间骨盆X线片示,加强块和髋臼臼杯与其接触骨面之间无放射性透光线和假体松动。术后6个月随访时CT扫描示,加强块与髋臼周围骨组织结合紧密、牢固固定,有良好的骨长入,匹配率为92.3%±2.5%。HHS功能评分:术前26~71分,平均(44.0±14.9)分,末次随访时68~97分,平均(84.3±9.7)分,两者比较差异有统计学意义(P<0.01)。术后随访期间未见髋关节脱位、假体周围感染、假体周围骨折、再翻修等并发症。结论:应用个性化3D打印多孔钛合金加强块重建重度髋臼骨缺损的手术操作简便,加强块与缺损骨面和臼杯匹配良好,术后LLD和HCOR均恢复到满意,HHS评分末次随访时改善明显,早期随访临床疗效好。
Background： Previous surgical techniques and methods have certain limitations in the anatomical reconstruction and accurate match of severely acetabular defects. 3 D printed porous Ti6 Al4 V augment is designed to solve these problems.Objectives： To report the early clinical outcomes of patients with severe acetabular bone defect reconstructed by 3 D printed porous Ti6 Al4 V augment. Methods： Clinical data of 11 patients with severe acetabular bone defect reconstructed by 3 D printed porous Ti6 Al4 V augment from January 2016 to October 2017 including general information, intra-operative data,imaging data, functional scores and complications were analyzed. Results： The average limb-length discrepancy（LLD） was（36.1 ± 22.6） mm（range： 16-92 mm） preoperatively,（7.7 ± 6.6） mm（range： 1-21 mm） postoperatively（P〈0.01） and（7.0±5.7） mm（range： 0-18 mm） at latest follow-up. The mean vertical position of hip center of rotation（HCOR） from the inter teardrop line changed from（51.0±19.3） mm（range： 24-92 mm） preoperatively to（22.6±10.4） mm（range： 6-40 mm） postoperatively（P〈0.01） and（22.8±10.2） mm（range： 6-41 mm） at latest follow-up. No radiolucencies and radiological loosening of the acetabular components and augments were found at follow-up. The bone ingrowth was observed by CT scans at follow-up and the matching degree between postoperative augment and designed augment was 92.3% ± 2.5%. The average HHS was improved from（44.0±14.9）（range： 26-71） preoperatively to（84.3±9.7）（range： 68-97） at the final follow-up（P〈0.01）. Follow-up data showed no hip dislocation, periprosthetic joint infection, fracture, re-revision and other complications.Conclusions： Surgical technique of 3 D printed porous Ti6 Al4 V augment in treatment of reconstruction of severely acetabular bone defect has such advantages as simple operation, well match of porous augment with the defect bone surface and the acetabular component, ideal recovery of LLD and HCOR after operation, significant improvement of HHS score at final follow-up and good clinical outcomes at early follow-up.
作者
付君
倪明
陈继营
李想
柴伟
张国强
卢强
郝立波
周勇刚
FU Jun;NI Ming;CHEN Jiying;LI Xiang;CHAI Wei;ZHANG Guoqiang;LU Qiang;HAO Libo;ZHOU Yonggang(Department of Orthopedics, Chinese People＇s Liberation Army General Hospital, Beijing 100853, China)
出处
《中华骨与关节外科杂志》
2018年第6期401-407,共7页
Chinese Journal of Bone and Joint Surgery
基金
解放军总医院转化医学重点项目(2016TM-004)
关键词
关节成形术
置换
髋
再手术
钛合金
多孔
Total Hip Arthroplasty
Reoperation
Titanium Alloy
Porosity
