3D技术辅助钽金属块植入修复严重髋臼骨缺损的早期疗效

目的探讨髋关节翻修术中应用3D技术辅助植入钽金属块治疗PaproskyⅢ型髋臼骨缺损的早期临床疗效。方法回顾性分析2013年5月至2017年7月收治的伴有PaproskyⅢ型髋臼骨缺损的髋关节翻修术16例(18髋),男11例,女5例;年龄(58.06±8.29)岁(范围44~69岁)。感染性松动3髋,无菌性松动15髋;PaproskyⅢA型骨缺损13髋,ⅢB型骨缺损5髋。术前使用3D技术进行精确规划,术中应用钽金属块和臼杯修复髋臼骨缺损。测量并比较手术前后髋关节臼杯的前倾角、外展角、患侧与对侧旋转中心垂直距离比值、旋转中心水平距离比值、股骨偏心距比值的差异,比较手术前后臼杯位于Lewinnek安全区内的比例,观察术后髋关节影像学松动的表现。采用Harris髋关节评分评价术后6个月及末次随访时的髋关节功能。结果臼杯位于lewinnek安全区内的比例由术前的22%(4/18)提高至术后的61%(11/18),差异有统计学意义(P=0.018)。术后患侧髋臼前倾角为11.99°±6.91°(范围1.71°~26.36°),外展角为44.91°±5.93°(范围35.6°~56.0°);患侧与对侧旋转中心垂直距离比值为1.10±0.20(范围0.87~1.62)、水平距离比值为1.00±0.18(范围0.69~1.46)、股骨偏心距比值为1.01±0.66(范围0.51~3.56)。所有患者均获得随访,随访时间为(27.72±12.18)个月(范围14~53个月)。术后6个月Harris髋关节评分为(77.28±4.80)分(范围65~85分),末次随访时为(80.9±5.2)分(范围69~89分)。随访期间所有患者均未出现假体周围感染、脱位及无菌性松动等并发症。结论3D技术辅助钽金属块植入修复严重髋臼骨缺损能够提高髋关节假体安放的准确性,术后早期假体稳定无松动,有利于髋关节功能的恢复。

Early clinical effects of severe acetabular bone defects with 3D technology assisted tantalum augment

Objective To investigate the early clinical effects of tantalum augment assisted with 3D technology in treating acetabular bone defects of Paprosky type III in revision total hip arthroplasty(THA).Methods From May 2013 to July 2017,a total of 16 patients(18 hips)undergoing revision THA were retrospectively analyzed,including 11 males and 5 females aged 58.06±8.29 years(range 44-69 years).There were 3 cases with infective loosening and 15 cases with aseptic loosening,13 cases with Paprosky IIIA type bone defects and 5 cases with IIIB type bone defects.3D technology was used for precise planning before operation.The tantalum augment and cup were used to repair acetabular bone defects during operation.Cup anteversion,abduction angle,ratio of the lateral and contralateral vertical distance of the center of rotation,ratio of the lateral and contralateral horizontal distance of the center of rotation and femoral offset were measured preoperatively and postoperatively.The percentages of hips located in Lewinnek safe zone were calculated preoperatively and postoperatively.Postoperative radiographic evidence of loosening and Harris score were collected at the end of the follow-up.Results The percentage of the hips located in Lewinnek safe zone increased from 22%(4/18)preoperatively to 61%(11/18)postoperatively.The mean anteversion of the operative side was 11.99°±6.91°(range 1.71°-26.36°)postoperatively.The mean abduction angle of the operative side was 44.91°±5.93°(range 35.6°-56.0°).The mean ratio of the lateral and contralateral vertical distance of the center of rotation was 1.10±0.20(range 0.87-1.62).The mean ratio of the lateral and contralateral horizontal distance of the center of rotation was 1.00±0.18(range 0.69-1.46)and the mean ratio of the lateral and contralateral femoral offset was 1.01±0.66(range 0.51-3.56).All the patients were followed-up for an average of 27.72±12.18 months(range 14-53 months).No complications,such as periprosthetic joint infection,dislocation or aseptic loosening,were observed in all patients.The mean Harris score was 77.28±4.80(range 65-85)at 6 months postoperatively and 80.9±5.2(range 69-89)at the end of the follow-up.Conclusion Using tantalum augmentassisted with 3D technology to re construct Paprosky type Ⅲ severe bone defects of the hip can increase the accuracy of the acetabular cup positioning.The short-term outcomes are satisfying and no early prosthetic loosening was observed.