季卫平 王波 何世杰范秋平 沈继全 陈金堂 沈慧芸 潘剑飞

[摘要] 目的 探討3D打印金属补块和髋臼杯在人工髋翻修中的应用价值。 方法 将2017年1月至2018年10月在丽水市人民医院需进行人工髋翻修的47例患者48侧髋纳入本研究。根据患者意愿及髋臼情况，将其分为实验组（3D打印钛）23例24髋和对照组（经典臼杯）24例，观察两组手术一般情况、视觉模拟评分（VAS）、临床功能评价及髋臼外展角。 结果 两组手术时间，术中失血和住院时间比较，差异无统计学意义（P>0.05）;术后两组Harris评分、VAS评分及髋臼外展角均得到了不同程度的改善;实验组术后3、6及12个月Harris评分显著高于对照组;实验组术后7 d及术后3个月的VAS评分显著低于对照组（P<0.05），但术后6个月，两组VAS评分比较，差异无统计学意义（P>0.05）;术后3个月，实验组髋臼外展角明显大于对照组（P<0.05）。 结论 3D打印补块和预设计型号髋臼杯假体进行人工髋翻修可减少疼痛，减少取自体骨量，促进功能恢复，使复杂人工髋翻修手术变得容易。

[关键词] 3D打印;髋关节;翻修;精准医学

[中图分类号] R687.4          [文献标识码] B          [文章编号] 1673-9701（2021）07-0089-06

Application of 3D printed metal patch and acetabular cup in renovation of artificial hip reversion

JI Weiping1   WANG Bo1   HE Shijie1   FAN Qiuping2   SHEN Jiquan2   CHEN Jintang2   SHEN Huiyun1   PAN Jianfei3

1.Department of Orthopedics， Lishui City People′s Hospital in Zhejiang Province， Lishui  323000， China; 2.Institute of Orthopedics， the First Affiliated Clinical Medical College of Lishui University， Lishui   323000， China; 3.Department of Joint Surgery， Wusujun Orthopedics Hospital of Songyang County in Zhejiang Province， Songyang   323400， China

[Abstract] Objective To investigate the application value of 3D printed metal patch and acetabular cup in reversion of artificial hip reversion. Methods A total of 48 hips of 47 patients who needed artificial hip renovation in Lishui City People′s Hospital from January 2017 to October 2018 were included in this study. According to patients′ attitudes and acetabular conditions， they were divided into the experimental group（patients n=23， hips n=24， 3D printing titanium） and the control group（patients n=24， classic acetabular cup）. The general operation situation， visual analogue scale（VAS）， clinical function evaluation and acetabular abduction angle of the two groups were observed. Results There were no significant differences in operation time， intraoperative hemorrhage and hospitalization time between the two groups（P>0.05）. Harris score， VAS score and acetabular abduction angle were improved in different degrees in both groups after operation. Harris score in the experimental group was significantly higher than that in the control group at 3， 6 and 12 months after operation. The VAS scores of the experimental group were significantly lower than those of the control group at 7 days and 3 months after operation（P<0.05）， but there was no difference between the two groups at 6 months after operation（P>0.05）. Three months after operation， the abduction angle of acetabulum in the experimental group was significantly greater than that in the control group（P<0.05）. Conclusion Reversion of artificial hip with 3D printed patch and pre-designed acetabular cup prosthesis can reduce pain， reduce bone mass taken from the body， promote functional recovery， and make reversion of complex artificial hip easy.

[Key words] 3D printed; Hip joint; Reversion; Precision medicine

随着时间流逝，人工髋术后因松动等原因需翻修患者越来越多，少数患者还经历多次翻修，每翻修一次均会导致骨缺损不同程度加重[1]。为了再装臼杯的稳定，髋臼侧骨缺损需要修补充填，临床上常用加强杯、同种异体库存骨、定制假体等，且有较高的并发症发生率。术前计划，如对髋臼周围骨质缺损如何进行精确测量，以选择相应合适假体，在应用3D打印技术之前，对医师是挑战。传统使用的骨科内植物如加强杯等，众所周知是锻造或铸造产品，这种方法生产的产品其优点是标准化和批量生产，这些产品作为内植物，在过去很长时间内都是临床骨科某些相关手术的不二选择[2-3]。然而……