3D打印技术在成人DDH人工全髋关节置换术中的临床应用研究

目的 探讨3D打印技术在成人发育性髋关节发育不良(DDH)行全髋关节置换术中的应用及意义。 方法 选择8例髋关节发育不良(Crowe各型成人DDH终末期骨性关节炎)患者，其中男性3例，女性5例；年龄45～63岁，平均年龄53.6岁。其中CroweⅠ型1例，CroweⅡ型3例，CroweⅢ型3例，CroweⅣ型1例，术前应用3D打印技术打印髋关节模型，确定髋臼硬化及缺损部位、缺损范围、卵圆窝骨赘增生情况，制定术前计划、模拟手术操作，术前确定真正的髋臼中心、假体模型的大小。实施手术操作，记录术中所见髋臼硬化及缺损部位、缺损范围、卵圆窝骨赘增生情况，记录髋臼打磨的范围，记录所选用假体的大小，记录手术时间及出血量，术后对患者髋关节活动进行评价。 结果 8例患者术中所见髋臼缺损及硬化部位、缺损部位大小、术中对髋臼假体打磨的范围、术中确定髋臼中心位置与3D打印假体模型完全一致，手术时间、出血量较过去传统手术明显减少，术前准备假体大小与术中所用一致，术后髋关节功能改善明显，活动良好。 结论 3D打印技术降低了成人髋关节发育不良行全髋关节置换的手术难度，手术时间及出血量减少，术后患髋活动良好，具有广泛的临床意义。 

Clinical application of 3D printing technology in adult DDH total hip arthroplasty

Objective To explore the application and significance of 3D printing technology in total hip replacement surgery in patients with developmental dysplasia of hip (DDH) in adults. Methods Eight cases of DDH (end-stage osteoarthritis of types of adult DDH by Crowe),including 3 males and 5 females;aged 45-63 years with a mean age of 53.6 years,were enrolled into this study.1 case of Crowe I,3 cases of Crowe Ⅱ,3 cases Crowe Ⅲ,and 1 case of Crowe Ⅳ.3D printing technology was performed before the operation to print hip model,and based on the model,we determined acetabular sclerosis and defect,defect range,oval fossa osteophytosisn,development of pre-operative planning,simulated surgical procedure,preoperative acetabular determine the true center,the size of the acetabular prosthesis model.Then the surgery operation was performed,and the intraoperative findings of the sclerosis and acetabular defect,defect range,oval fossa osteophytes hyperplasia were documented,and the acetabular grinding range and the selected size of the prosthesis,operation time and blood loss were recorded.The hip joint activities were evaluated after the surgery. Results The intraoperative findings of acetabular defect and hardened parts,defect size,intraoperative acetabular prosthesis polished range and the determined acetabular surgery center position were fully consistent with the 3D printed prosthesis model.The operative time and blood loss significantly reduced as compared with the traditional surgery.The size of the prosthesis prepared before the surgery was full fit with intraoperative prosthesis.The hip function was improved significantly after the operation with good activity. Conclusion 3D printing technology can reduce the difficulty of total hip replacement for DDH.By using this technology in total hip replacement for DDH,we can decrease the operation time and amount of bleeding,and improve the postoperative hips activity.