3D打印钛合金骨小梁金属臼杯联合植骨重建髋臼骨缺损的早期疗效

目的探讨髋关节翻修术中应用3D打印定制钛合金骨小梁金属(titanium trabecular metal,TTM)臼杯联合植骨重建髋臼骨缺损的早期疗效。方法回顾性分析2017年2月至2018年8月南京医科大学附属无锡人民医院使用3D打印TTM臼杯联合植骨治疗全髋置换术后骨缺损患者8例。其中男3例,女5例;年龄64~87岁,平均年龄(78.1±7.0)岁。Paprosky髋臼骨缺损ⅡB型2例,ⅡC型1例,ⅢA型3例,ⅢB型2例。采用3D打印技术,根据髋臼骨缺损形态设计并制作TTM臼杯,结合植骨技术,重建髋臼骨缺损。随访时以Harris髋关节评分评估疗效,摄X线片评价假体位置、稳定性和植骨愈合情况。结果随访18~36个月,平均(25.0±6.1)个月。Harris髋关节评分从术前(36.3±8.5)分提高至末次随访时的(82.8±6.3)分。术后髋关节旋转中心基本位于解剖位置,翻修侧髋关节旋转中心垂直距离与健侧相差(0.5±2.7)mm,水平距离与健侧相差(-2.0±6.1)mm。末次随访假体位置良好,随访期间假体周围未见进行性透亮线,无假体松动、移位及螺钉断裂,植骨愈合良好,无再次翻修病例。结论应用3D打印TTM臼杯联合植骨进行髋关节翻修重建髋臼骨缺损,可恢复髋关节旋转中心,改善髋关节功能,假体初始稳定性好,近期疗效满意。

Short-term Outcomes of 3D Printed Titanium Trabecular Metal Acetabular Cups and Bone Allograft for Revision Hip Arthroplasty with Acetabular Bone Deficiency

Objective To investigate the short-term outcomes of 3D printed titanium trabecular metal(TTM)acetabular cups in treatment of revision hip arthroplasty with acetabular bone deficiency.Methods The clinical data of 8 patients with acetabular bone deficiency using 3D printed TTM acetabular cups and bone allograft at Wuxi People’s Hospital from February 2017 to August 2018 were retrospectively analyzed.There were 3 males and 5 females,with an average age of(78.1±7.0)years(64~87 years).According to Paprosky acetabular defect classification,2 hadⅡB defects,1 hadⅡC defects,3 hadⅢA defects and 2 hadⅢB defects.The acetabular defect was reconstructed by TTM acetabular cups and bone grafting technique.The TTM acetabular cups were designed and fabricated according to each patient’s bone defects using 3D printing technology.During the follow-up,Harris hip score was recorded to assessed the efficacy,and X-rays were performed to evaluate the acetabular prosthesis position,migration,and graft incorporation.Results The mean follow-up was(25.0±6.1)months(18~36 months).The Harris hip score improved from(36.3±8.5)preoperatively to(82.8±6.3)postoperatively.TTM cups resulted in generally reliable restoration of the hip center.The difference of vertical distance and horizontal distance between bilateral sides was(0.5±2.7)mm and(-2.0±6.1)mm,respectively.Acetabular component loosening was not found,effective bone incorporation was achieved in all cases,and no re-revisions had been conducted at last follow-up.Conclusion 3D printed titanium trabecular metal acetabular cups combined with bone allograft for revision hip arthroplasty with acetabular bone deficiency canprovide early stability,improve hip scores and reconstruct the rotation center in short-term follow-up.