3D打印假体翻修置换伴复杂髋臼缺损的假体失败

3D printed prosthesis for revision replacement of previous prosthetic failure complicated with complex acetabular bone de⁃ fects

摘要:

［目的］介绍 3D 打印个性化假体翻修置换伴复杂髋臼缺损假体失败的手术技术及临床疗效。［方法］应用个性化髋臼假体对 11 例复杂髋臼缺损患者实施髋关节翻修术。所有患者术前常规进行髋部薄层 CT 扫描，建立 3D 数字模型，设计制作个性化假体。并进行术前 3D 模型手术模拟。术中显露并取出松动的假体，置入个性化 3D 打印假体。螺钉多维度加压固定髋臼假体并重建其解剖对位关系，假体和宿主骨残留间隙用异体颗粒骨填塞植骨。［结果］11 例患者均顺利完成手术，无严重并发症。平均随访时间 （39.18±3.37） 个月。末次随访时 VAS 评分显著降低 （P<0.05），而髋关节功能 Harris 评分显著增加 （P< 0.05）。术后 36 个月定制髋臼假体的生存率达到 100%。［结论］ 3D 打印个性化假体在髋翻修术中治疗复杂髋臼缺损的临床疗效良好。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical outcomes of 3D printed personalized prosthesis re- vision replacement of previous prosthetic failure complicated with complex acetabular bone defect. [Methods] A total of 11 patients under- went revision arthroplasty using 3D printed personalized acetabular prosthesis for previous prosthetic failure complicated with complex ace- tabular bone defects. As all patients were routinely taken thin-slice CT scan of the hip preoperatively, 3D digital model was established, and then personalized prosthesis was designed and made. In addition, a surgical simulation was performed on the real 3D printed models preoperatively. During the operation, the loosened prosthesis was exposed and removed, the personalized 3D printed personalized prosthe- sis was placed with multi-dimensional screw fixation of the acetabular component to reconstruct the anatomical position relationship, and the residual space between the prosthesis and the host bone was filled with granular bone allograft. [Results] All the 11 patients had the re- vision THA performed successfully without serious complications. As time went during the follow-up lasted for (39.18±3.37) months, the VAS scores decreased significantly (P＜0.05) , whereas the Harris score significantly increased (P＜0.05) , with survival rate of the custom- ized acetabular prosthesis of 100% 36 months after surgery. [Conclusion] The 3D printed personalized prosthesis has good clinical efficacy in revision of previous failure with complex acetabular bone defects.