个体化3D打印定制假体在严重Paprosky Ⅲ型髋臼侧骨缺损中的应用

帅垒 李; 昊 柴; 永强 孙

doi:10.7507/1002-1892.202409099

. 2025 Jan;39(1):13–19. [Article in Chinese] doi: 10.7507/1002-1892.202409099

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个体化3D打印定制假体在严重Paprosky Ⅲ型髋臼侧骨缺损中的应用

帅垒李 ¹, 昊柴 ¹, 永强孙 ^1,^*

PMCID: PMC11757953 PMID: 39848710

Abstract

目的

探讨个体化3D打印定制假体重建严重Paprosky Ⅲ型髋臼侧骨缺损的近期疗效及安全性。

方法

回顾性分析2023年1月—2024年6月收治且符合选择标准的8例严重Paprosky Ⅲ型髋臼侧骨缺损患者临床资料。男3例，女5例；年龄56～73岁，平均64.6岁。初次置换假体均为非骨水泥型，包含陶瓷-陶瓷界面1例、陶瓷-聚乙烯界面1例、金属-聚乙烯界面6例。初次置换至翻修时间4 d～18年。翻修原因：无菌性松动5例，旷置后翻修2例，反复脱位1例。术前Harris评分为（39.5±3.7）分，疼痛视觉模拟评分（VAS）为（7.1±0.8）分。记录患者手术时间、术中出血量、住院时间及并发症发生情况，采用Harris评分评价髋关节功能，VAS评分评价疼痛程度；X线片测量髋臼杯外展角、前倾角、旋转中心高度、大转子高度及股骨偏心距。

结果

手术时间95～223 min，平均151.13 min；术中出血量 600～3 500 mL，平均1 250.00 mL；住院时间13～20 d，平均16.88 d。8例患者均获随访，随访时间2～12个月，平均6.4个月。术后1例出现切口愈合不良，经积极对症处理后愈合良好；1例出现下肢肌间静脉血栓形成，末次随访时未见血栓；随访期间均未发生无菌性松动、感染、脱位及假体周围骨折等严重并发症。末次随访时Harris评分为（72.0±6.2）分，VAS评分为（1.8±0.7）分，与术前比较差异均有统计学意义（t=−12.011，P<0.001；t=16.595，P<0.001）。术后第2天测量髋臼杯外展角为40°～49°，平均44.18°；前倾角为19°～26°，平均21.36°，均在“Lewinneck安全区”范围内。健、患侧旋转中心高度、大转子高度和股骨偏心距比较差异均无统计学意义（P>0.05）。

结论

采用个体化3D打印定制假体重建严重Paprosky Ⅲ型髋臼侧骨缺损，能够缓解疼痛、改善髋关节功能，且假体位置良好，无严重并发症，安全性较好。

Keywords: 3D打印, 骨缺损, Paprosky分型, 定制假体, 髋关节翻修

Abstract

Objective

To analyze the short-term effectiveness and safety of personalized three-dimensional (3D) printed customized prostheses in severe Paprosky type Ⅲ acetabular bone defects.

Methods

A retrospective analysis was conducted on 8 patients with severe Paprosky type Ⅲ acetabular bone defects and met the selection criteria between January 2023 and June 2024. There were 3 males and 5 females, with an average age of 64.6 years ranged from 56 to 73 years. All primary replacement prostheses were non-cemented, including 1 ceramic-ceramic interface, 1 ceramic-polyethylene interface, and 6 metal-polyethylene interfaces. The time from the primary replacement to the revision was 4 days to 18 years. The reasons for revision were aseptic loosening in 5 cases, revision after exclusion in 2 cases, and repeated dislocation in 1 case. The preoperative Harris score was 39.5±3.7 and the visual analogue scale (VAS) score was 7.1±0.8. The operation time, intraoperative blood loss, hospital stay, and complications were recorded. The hip function was evaluated by Harris score, and the degree of pain was evaluated by VAS score. The acetabular cup abduction angle, anteversion angle, rotational center height, greater trochanter height, and femoral offset were measured on X-ray film.

Results

The operation time was 95-223 minutes, with an average of 151.13 minutes. The intraoperative blood loss was 600-3 500 mL, with an average of 1 250.00 mL. The hospital stay was 13-20 days, with an average of 16.88 days. All 8 patients were followed up 2-12 months, with an average of 6.4 months. One patient had poor wound healing after operation, which healed well after active symptomatic treatment. One patient had lower limb intermuscular vein thrombosis, but no thrombosis was found at last follow-up. No serious complications such as aseptic loosening, infection, dislocation, and periprosthetic fracture occurred during the follow-up. At last follow-up, the Harris score was 72.0±6.2 and the VAS score was 1.8±0.7, which were significantly different from those before operation (t=−12.011, P<0.001; t=16.595, P<0.001). On the second day after operation, the acetabular cup abduction angle ranged from 40° to 49°, with an average of 44.18°, and the acetabular cup anteversion angle ranged from 19° to 26°, with an average of 21.36°, which were within the “Lewinneck safety zone”. There was no significant difference in the rotational center height, greater trochanter height, and femoral offset between the healthy side and the affected side (P>0.05).

Conclusion

The use of personalized 3D printed customized prostheses for the reconstruction of severe Paprosky type Ⅲ acetabular bone defects can alleviate pain and enhances hip joint function, and have good postoperative prosthesis position, without serious complications and have good safety.

Keywords: Three-dimensional printing, bone defect, Paprosky classification, customized prostheses, hip revision

人工全髋关节置换术（total hip arthroplasty，THA）是治疗终末期髋关节疾病的有效方法。随着接受THA患者增多，各种原因导致的术后假体失败发生率也在不断上升。Bayliss等^[1]研究提示THA术后10年生存率高达95.6%，20年生存率为85.0%；70岁以上患者需要翻修的风险为5%，而70岁以下患者翻修风险明显增加。研究指出，无菌性松动是导致人工髋关节假体翻修的最常见原因，尤以髋臼侧骨缺损最难处理^[2]。因此，如何安全、有效地重建严重髋臼侧骨缺损，实现牢固的初始稳定和长期生物学稳定，是临床亟需解决的难题。

对于关节外科医生来说，髋臼侧骨缺损程度直接关系着重建方式和预后效果。目前Paprosky分型是确定骨缺损位置和程度最常用的分型系统，其中Paprosky Ⅲ型是髋臼翻修中最复杂、最严重的骨缺损^[3]。Johanson等^[4]报道在髋关节翻修术中合并髋臼侧骨缺损的失败率高达30%。髋臼侧骨缺损主要由骨溶解、应力遮挡或假体移位导致，处理方式不同直接影响重建假体的稳定性和远期结局。而髋臼重建的关键在于对骨缺损的精确评估，以保证假体与宿主骨足够的接触面积，进而获得良好初始稳定。既往关于Paprosky Ⅲ型骨缺损重建的方法有同种异体骨植骨联合Cage、金属垫块结合骨小梁多孔杯、大臼杯联合多孔金属垫块、Cup-cage技术、Cup-in-cup技术、Cup-on-cup技术等，但存在植骨来源有限、植骨吸收、机械失效、医源性加重骨缺损等不足^[5-6]。

3D打印技术的应用能够在一定程度上解决上述问题，尤其是对于髋臼侧骨缺损，3D打印的定制假体形态与骨缺损基本一致，能完美匹配患者髋臼缺损的位置、程度，解决了假体与患者宿主骨之间的匹配问题，从而能够获得良好初始稳定性，且其表面的骨小梁多孔结构与松质骨相似，有良好的骨长入效果，有利于假体远期稳定^[7-8]。现回顾分析2023年1月—2024年6月我科收治并采用个体化3D打印定制假体进行重建的8例Paprosky Ⅲ型髋臼侧骨缺损患者临床资料，探讨3D打印定制假体用于髋臼侧翻修的近期疗效。报告如下。

1. 临床资料

1.1. 一般资料

患者纳入标准：① 影像学及临床症状表现符合无菌性松动且需要翻修的THA术后患者^[9]；② 存在Paprosky Ⅲ型髋臼侧骨缺损^[10]；③ 髋关节假体感染后行扩创+抗生素骨水泥占位器旷置超过3个月，感染已被控制，入院前血常规、C反应蛋白和红细胞沉降率检测结果连续3次无明显异常，且术前关节腔穿刺细菌培养结果阴性。排除标准：① 髋关节存在活动性感染；② 临床数据及随访资料不全；③ 3个月内新发严重心、脑血管疾病及严重肝、肾功能不全难以耐受手术者；④ 依从性差、患有精神类疾病者。2023年1月—2024年6月共8例患者符合选择标准纳入研究。

本组男3例，女5例；年龄56～73岁，平均64.6岁。左髋4例，右髋4例。初次置换假体均为非骨水泥型，包含陶瓷-陶瓷界面1例、陶瓷-聚乙烯界面1例、金属-聚乙烯界面6例。初次置换至翻修时间4 d～18年。翻修原因：无菌性松动5例，旷置后翻修2例，反复脱位1例。术前Harris评分为（39.5±3.7）分，疼痛视觉模拟评分（VAS）为（7.1±0.8）分。患者临床资料见表1。

表 1.

Clinical data of patients

患者临床资料

序号 No.	性别 Gender	年龄（岁） Age (years)	侧别 Side	假体类型 Type of prosthesis	初次置换至翻修时间 Time from primary replacement to revision	翻修原因 Causes of revision	手术时间（min） Operation time (minutes)	术中出血量（mL） Intraoperative blood loss (mL)	住院时间（d） Hospital stay (days)	随访时间（月） Follow-up time (months)
1	女	63	左	陶瓷-聚乙烯	7个月	无菌性松动	146	600	20	4
2	女	56	右	金属-聚乙烯	14年	无菌性松动	155	1 100	19	10
3	男	67	右	金属-聚乙烯	12年	旷置后翻修	223	3 500	13	6
4	女	70	左	金属-聚乙烯	15年	无菌性松动	175	900	16	5
5	男	64	右	陶瓷-陶瓷	4 d	反复性脱位	130	600	17	9
6	男	64	左	金属-聚乙烯	9年	无菌性松动	127	700	15	3
7	女	73	左	金属-聚乙烯	8年	旷置后翻修	158	1 100	17	12
8	女	60	右	金属-聚乙烯	18年	无菌性松动	95	1 500	18	2

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1.2. 术前处理

所有患者髋臼侧假体均采用金属3D打印技术加工的个体化假体，由北京爱康宜诚医疗器械有限公司（以下简称“爱康公司”）生产。首先，术前行髋关节CT扫描，扫描层厚和间距要求轴向平面切片保证1.25 mm×1.25 mm及以下；视窗大小200～250 mm，扫描过程中保持不变；CT扫描前设置设备参数为120 kVp、160 mAs或更高。将DICOM格式CT数据发送至由爱康公司定制医工交互中心进行术前规划，数据导入Mimics 15.0软件重建患者髋臼侧骨缺损三维模型结构。将重建后的三维模型数据转化为STL格式文件并导入3D打印机中，打印髋臼骨缺损实体模型，直观评估骨缺损类型；同时设计手术方案及假体类型，医生评估后完善方案设计，而后建立三维数字模型，设置假体孔隙率和孔径等参数后，使用电子束熔融金属3D打印机采用钛合金粉末打印一体式或分体式生物髋臼杯。

1.3. 手术方法

本组手术均由同一组关节外科团队完成。患者于全身麻醉下取健侧卧位。取患侧髋关节后外侧入路，切开皮肤、皮下组织至关节囊，保护坐骨神经，切除关节周围增生组织，显露髋臼边缘，用专用器械取出髋臼假体，再次彻底清除炎性增生和瘢痕组织。所有患者髋臼侧均行双氧水、生理盐水反复冲洗，聚维酮碘溶液浸泡10 min。重新消毒后再次显露髋臼侧，评估骨缺损情况。寻找髋臼旋转中心，使用髋臼锉小心锉磨髋臼至表面均匀渗血。按照术前规划置入3D打印定制假体，根据骨质情况及规划植入螺钉；必要时臼杯与宿主骨之间进行颗粒植骨（本组患者均未植骨）。术中根据股骨侧松动情况决定是否更换股骨假体，若松动则选用爱康CL型股骨柄（5例）。

1.4. 术后处理及疗效评价指标

术后常规静脉滴注头孢唑啉钠注射液预防感染，皮下注射低分子肝素钙注射液预防血栓形成，静脉滴注维生素类药物补充营养；积极镇痛，返回病房后即开始主动踝泵活动，主动行股四头肌力量锻炼、直腿抬高锻炼，根据术中情况评估下床时间；术后8～12周根据复查结果开始逐步负重行走。所有患者术后定期门诊复查。

记录患者手术时间、术中出血量、住院时间及并发症发生情况，采用Harris评分评价髋关节功能，VAS评分评价疼痛程度。术后第2天复查骨盆X线片，应用Massin法^[11]评估假体松动及移位情况，其中假体移位超过2 mm或螺钉断裂判定为松动，假体周围出现1 mm以上透亮线判定为可疑松动。于X线片上测量以下影像学指标^[12]：① 外展角：双侧泪滴最低点连线与髋臼轮廓长轴的夹角；② 前倾角：髋臼杯口椭圆形投影轮廓的短轴长度为d，长轴长度为D，前倾角=arcsin（d/D）；③ 旋转中心高度：髋关节旋转中心至双侧泪滴最低点连线的垂直距离；④ 大转子高度：大转子顶端至双侧泪滴最低点连线的垂直距离；⑤ 股骨偏心距：髋关节旋转中心至同侧股骨髓腔轴线的垂直距离。以上指标测量由2名高年资医师完成。比较健、患侧旋转中心高度、大转子高度和股骨偏心距差异。

1.5. 统计学方法

采用SPSS23.0统计软件进行分析。计量资料经Shapiro⁃Wilk正态性检验，符合正态分布，数据以均数±标准差表示，各指标手术前后比较及健、患侧间比较采用配对t检验；检验水准取双侧α=0.05。

2. 结果

本组手术时间95～223 min，平均151.13 min；术中出血量 600～3 500 mL，平均1 250.00 mL；住院时间13～20 d，平均16.88 d。8例患者均获随访，随访时间2～12个月，平均6.4个月。术后1例出现切口愈合不良，经积极对症处理后愈合良好；1例出现下肢肌间静脉血栓形成，末次随访时未见血栓；随访期间均未发生无菌性松动、感染、脱位及假体周围骨折等严重并发症。末次随访时Harris评分为（72.0±6.2）分，VAS评分为（1.8±0.7）分，与术前比较差异均有统计学意义（t=−12.011，P<0.001；t=16.595，P<0.001）。术后第2天测量髋臼杯外展角为40°～49°，平均44.18°；前倾角为19°～26°，平均21.36°，均在“Lewinneck安全区”^[13]范围内。健、患侧旋转中心高度、大转子高度和股骨偏心距比较差异均无统计学意义（P>0.05）。见表2，图1～3。

表 2.

Comparison of radiographic indicators between healthy side and affected side after operation (n=8, x±s, mm)

术后健、患侧各影像学指标比较（n=8，x±s，mm）

指标 Indicator	健侧 Healthy side	患侧 Affected side	统计值 Statistical value	P值 P value
旋转中心高度	25.63±3.91	22.84±5.59	t=−1.156	0.269
大转子高度	20.01±4.29	17.91±7.14	t=−0.713	0.490
股骨偏心距	38.28±8.02	33.65±8.38	t=−1.128	0.278

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3. 讨论

髋臼侧严重骨缺损的外科重建难度与骨缺损程度和部位相关。当髋臼结构支撑遭到破坏时，重建变得十分困难。对于严重Paprosky Ⅲ型髋臼侧骨缺损，其范围广、缺损形状和力学性能复杂，以往多种重建方法虽然能够方便操作，提高手术效率，但也存在一定局限性，且术后并发症发生率较高。Lee等^[14]研究发现74例翻修髋关节中，15例因同种异体骨植骨失败而进一步翻修，术后15～20年假体存活率仅为8%。有研究表明，Cage 联合同种异体骨进行翻修的5年总体成功率为55%，失败主要归因于假体松动^[15-16]。近年来，3D打印技术的兴起和发展，为解决这一问题提供了新思路^[17-18]。

3D打印技术是一种以数字模型为基础，运用金属粉末或塑料等可黏合材料，通过逐层打印方式来构造物体的技术；它无需机械加工或任何模具，可直接由计算机数据制作任何形状的部件^[19]。由于个体化设计，其在复杂初次THA和翻修手术中的应用日益广泛。3D打印技术不仅能够实现个体化假体的空间结构设计，还能实现假体的运动分析和力学分析，结合计算机软件、医学影像及后续处理技术，可建立骨缺损打印模型，并进一步设计假体的稳定结构；同时，定制假体表面的多孔微结构具有良好孔径和孔隙率、更高摩擦系数，且拥有更接近骨组织的弹性模量，大大增加了假体的初始稳定性和骨整合效果，也为远期稳定创造了条件^[20]。

本研究中8例患者髋臼侧均存在严重骨缺损，且缺损周围骨量较少，重建时存在稳定性较差的风险，采用常规假体及技术难以完成重建。为降低术后假体松动风险，我们在术前重点研究了骨缺损精准评估和假体优化设计，并采用3D打印技术在计算机中实现骨缺损重建，制定个体化定制方案，以最大限度增加假体与宿主骨接触面积，同时依据骨质情况优化设计螺钉位置和数量，从而保证假体的初始稳定性。Li等^[21]使用3D打印技术制作含有髂骨翼、坐骨翼和耻骨翼的Cage治疗24例Paprosky ⅢB型髋臼骨缺损患者，末次随访时Harris评分较术前明显改善，髋关节旋转中心接近于解剖中心位置，中、远期疗效满意。丁育健等^[22]通过对10例患者的回顾性分析发现，3D打印定制带翼臼杯重建髋臼侧严重骨缺损，可改善髋关节功能、重建髋臼旋转中心及维持假体早期稳定性，临床疗效良好。Berasi等^[23]描述了28例Paprosky ⅢB型骨缺损患者中，有4例髋关节重建失败，但失败原因都不是无菌性松动。本研究结果也表明，3D打印定制假体能改善髋关节功能，缓解疼痛，无严重并发症发生，且术后假体位置良好，旋转中心与健侧基本一致；患者随访期间均未出现假体松动或移位。由此可见，3D打印技术可对髋臼侧骨缺损进行更精确测量，从而制定更合理的手术方案和个性化假体，为人工髋关节翻修手术实现个体化、精准化带来希望。但该技术也存在一定缺点，包括使用CT扫描的辐射暴露、高昂费用和较长规划时间，但其成本与Cage、金属骨小梁垫块、同种异体骨、多孔臼杯等的联合应用相类似^[24]。此外，由于术前骨缺损的严重性和术中医源性骨丢失的不确定性，3D打印定制假体的安装可能存在困难，因此需要充分的术前评估、灵活的术中策略以及经验丰富的外科团队。

综上述，结合既往文献及本研究结果，从长期获益来看，3D打印定制假体技术能够更精确的匹配骨缺损，增加初始稳定性，为严重髋臼侧骨缺损的重建提供可行之道。但本研究也存在一定局限：① 纳入样本量相对较小，随访时间较短，缺少远期疗效评估；② 观察指标存在不可避免的系统性误差；③ 回顾性研究可能存在偏倚，证据等级较低。有待下一步研究纳入更多病例，延长随访时间，以获得更高级别的临床证据。

志谢　感谢北京爱康医疗提供技术支持

利益冲突　在课题研究和文章撰写过程中不存在利益冲突；经费支持没有影响文章观点和对研究数据客观结果的分析及其报道

伦理声明　研究方案经河南省洛阳正骨医院（河南省骨科医院）伦理委员会批准；患者及家属术前签署知情同意书

作者贡献声明　李帅垒：论文撰写、数据分析；柴昊：数据收集、整理；孙永强：审查、修改论文

Funding Statement

2023年度河南省重点研发与推广专项（科技攻关）项目（232102310513）

2023 Henan Province Key Research and Development and Promotion Project (Science and Technology Research) (232102310513)

References

1.Bayliss LE, Culliford D, Monk AP, et al The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study. Lancet. 2017;389(10077):1424–1430. doi: 10.1016/S0140-6736(17)30059-4. [DOI] [PMC free article] [PubMed] [Google Scholar]
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3.康鹏德, 裴福兴髋关节翻修中骨盆不连续的评估与重建. 中华骨科杂志. 2020;40(9):614–624. [Google Scholar]
4.Johanson NA, Driftmier KR, Cerynik DL, et al Grading acetabular defects: the need for a universal and valid system. J Arthroplasty. 2010;25(3):425–431. doi: 10.1016/j.arth.2009.02.021. [DOI] [PubMed] [Google Scholar]
5.Morales De Cano JJ, Guillamet L, Perez Pons A Acetabular reconstruction in Paprosky type Ⅲ defects. Acta Ortop Bras. 2019;27(1):59–63. doi: 10.1590/1413-785220192701187313. [DOI] [PMC free article] [PubMed] [Google Scholar]
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7.Tack P, Victor J, Gemmel P, et al Do custom 3D-printed revision acetabular implants provide enough value to justify the additional costs? The health-economic comparison of a new porous 3D-printed hip implant for revision arthroplasty of Paprosky type 3B acetabular defects and its closest alternative. Orthop Traumatol Surg Res. 2021;107(1):102600. doi: 10.1016/j.otsr.2020.03.012. [DOI] [PubMed] [Google Scholar]
8.郭宇, 冯德宏, 王凌, 等 3D打印技术在髋关节置换中的应用及价值. 中国组织工程研究. 2020;24(12):1962–1968. [Google Scholar]
9.Anil U, Singh V, Schwarzkopf R Diagnosis and detection of subtle aseptic loosening in total hip arthroplasty. J Arthroplasty. 2022;37(8):1494–1500. doi: 10.1016/j.arth.2022.02.060. [DOI] [PubMed] [Google Scholar]
10.Paprosky WG, Perona PG, Lawrence JM Acetabular defect classification and surgical reconstruction in revision arthroplasty. A 6-year follow-up evaluation. J Arthroplasty. 1994;9(1):33–44. doi: 10.1016/0883-5403(94)90135-x. [DOI] [PubMed] [Google Scholar]
11.Massin P, Schmidt L, Engh CA Evaluation of cementless acetabular component migration. An experimental study. J Arthroplasty. 1989;4(3):245–251. doi: 10.1016/S0883-5403(89)80020-8. [DOI] [PubMed] [Google Scholar]
12.张帅, 刘成, 孔祥朋, 等机器人辅助全髋关节置换术的临床疗效. 中华骨科杂志. 2023;43(17):1137–1145. [Google Scholar]
13.Lewinnek GE, Lewis JL, Tarr R, et al. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg (Am), 1978, 60(2): 217-220.
14.Lee PT, Clayton RA, Safir OA, et al Structural allograft as an option for treating infected hip arthroplasty with massive bone loss. Clin Orthop Relat Res. 2011;469(4):1016–1023. doi: 10.1007/s11999-010-1673-1. [DOI] [PMC free article] [PubMed] [Google Scholar]
15.Berend ME, Berend KR, Lombardi AV, et al. The patient-specific Triflange acetabular implant for revision total hip arthroplasty in patients with severe acetabular defects: planning, implantation, and results. Bone Joint J, 2018, 100-B(1 Supple A): 50-54.
16.Kieser DC, Ailabouni R, Kieser SCJ, et al The use of an Ossis custom 3D-printed tri-flanged acetabular implant for major bone loss: minimum 2-year follow-up. Hip Int. 2018;28(6):668–674. doi: 10.1177/1120700018760817. [DOI] [PubMed] [Google Scholar]
17.Li Q, Chen X, Lin B, et al Three-dimensional technology assisted trabecular metal cup and augments positioning in revision total hip arthroplasty with complex acetabular defects. J Orthop Surg Res. 2019;14(1):431. doi: 10.1186/s13018-019-1478-1. [DOI] [PMC free article] [PubMed] [Google Scholar]
18.Wan L, Wu G, Cao P, et al Curative effect and prognosis of 3D printing titanium alloy trabecular cup and pad in revision of acetabular defect of hip joint. Exp Ther Med. 2019;18(1):659–663. doi: 10.3892/etm.2019.7621. [DOI] [PMC free article] [PubMed] [Google Scholar]
19.Hao YQ, Wang L, Jiang WB, et al 3D printing hip prostheses offer accurate reconstruction, stable fixation, and functional recovery for revision total hip arthroplasty with complex acetabular bone defect. Engineering. 2020;6(11):1285–1290. doi: 10.1016/j.eng.2020.04.013. [DOI] [Google Scholar]
20.He S, Zhu J, Jing Y, et al Effect of 3D-printed porous titanium alloy pore structure on bone regeneration: a review. Coatings. 2024;14(3):253. doi: 10.3390/coatings14030253. [DOI] [Google Scholar]
21.Li H, Qu X, Mao Y, et al Custom acetabular cages offer stable fixation and improved hip scores for revision THA with severe bone defects. Clin Orthop Relat Res. 2016;474(3):731–740. doi: 10.1007/s11999-015-4587-0. [DOI] [PMC free article] [PubMed] [Google Scholar]
22.丁育健, 冯德宏, 王凌, 等髋关节翻修术中应用数字设计3D打印定制带翼臼杯重建髋臼严重骨缺损. 中华骨科杂志. 2023;43(2):97–103. doi: 10.3760/cma.j.cn121113-20220929-00588. [DOI] [Google Scholar]
23.Berasi CC, Berend KR, Adams JB, et al. Are custom triflange acetabular components effective for reconstruction of catastrophic bone loss? Clin Orthop Relat Res, 2015, 473(2): 528-535.
24.张衡, 马晓东, 李博闻, 等 3D打印定制假体及其在髋关节翻修髋臼重建应用中的研究进展. 中国修复重建外科杂志. 2024;38(11):1414–1420. doi: 10.7507/1002-1892.202406002. [DOI] [PMC free article] [PubMed] [Google Scholar]

[b1] 1.Bayliss LE, Culliford D, Monk AP, et al The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study. Lancet. 2017;389(10077):1424–1430. doi: 10.1016/S0140-6736(17)30059-4. [DOI] [PMC free article] [PubMed] [Google Scholar]

[b2] 2.Kahlenberg CA, Swarup I, Krell EC, et al Causes of revision in young patients undergoing total hip arthroplasty. J Arthroplasty. 2019;34(7):1435–1440. doi: 10.1016/j.arth.2019.03.014. [DOI] [PubMed] [Google Scholar]

[b3] 3.康鹏德, 裴福兴髋关节翻修中骨盆不连续的评估与重建. 中华骨科杂志. 2020;40(9):614–624. [Google Scholar]

[b4] 4.Johanson NA, Driftmier KR, Cerynik DL, et al Grading acetabular defects: the need for a universal and valid system. J Arthroplasty. 2010;25(3):425–431. doi: 10.1016/j.arth.2009.02.021. [DOI] [PubMed] [Google Scholar]

[b5] 5.Morales De Cano JJ, Guillamet L, Perez Pons A Acetabular reconstruction in Paprosky type Ⅲ defects. Acta Ortop Bras. 2019;27(1):59–63. doi: 10.1590/1413-785220192701187313. [DOI] [PMC free article] [PubMed] [Google Scholar]

[b6] 6.von Hertzberg-Boelch SP, Wagenbrenner M, Arnholdt J, et al Custom made monoflange acetabular components for the treatment of Paprosky type Ⅲ defects. J Pers Med. 2021;11(4):283. doi: 10.3390/jpm11040283. [DOI] [PMC free article] [PubMed] [Google Scholar]

[b7] 7.Tack P, Victor J, Gemmel P, et al Do custom 3D-printed revision acetabular implants provide enough value to justify the additional costs? The health-economic comparison of a new porous 3D-printed hip implant for revision arthroplasty of Paprosky type 3B acetabular defects and its closest alternative. Orthop Traumatol Surg Res. 2021;107(1):102600. doi: 10.1016/j.otsr.2020.03.012. [DOI] [PubMed] [Google Scholar]

[b8] 8.郭宇, 冯德宏, 王凌, 等 3D打印技术在髋关节置换中的应用及价值. 中国组织工程研究. 2020;24(12):1962–1968. [Google Scholar]

[b9] 9.Anil U, Singh V, Schwarzkopf R Diagnosis and detection of subtle aseptic loosening in total hip arthroplasty. J Arthroplasty. 2022;37(8):1494–1500. doi: 10.1016/j.arth.2022.02.060. [DOI] [PubMed] [Google Scholar]

[b10] 10.Paprosky WG, Perona PG, Lawrence JM Acetabular defect classification and surgical reconstruction in revision arthroplasty. A 6-year follow-up evaluation. J Arthroplasty. 1994;9(1):33–44. doi: 10.1016/0883-5403(94)90135-x. [DOI] [PubMed] [Google Scholar]

[b11] 11.Massin P, Schmidt L, Engh CA Evaluation of cementless acetabular component migration. An experimental study. J Arthroplasty. 1989;4(3):245–251. doi: 10.1016/S0883-5403(89)80020-8. [DOI] [PubMed] [Google Scholar]

[b12] 12.张帅, 刘成, 孔祥朋, 等机器人辅助全髋关节置换术的临床疗效. 中华骨科杂志. 2023;43(17):1137–1145. [Google Scholar]

[b13] 13.Lewinnek GE, Lewis JL, Tarr R, et al. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg (Am), 1978, 60(2): 217-220.

[b14] 14.Lee PT, Clayton RA, Safir OA, et al Structural allograft as an option for treating infected hip arthroplasty with massive bone loss. Clin Orthop Relat Res. 2011;469(4):1016–1023. doi: 10.1007/s11999-010-1673-1. [DOI] [PMC free article] [PubMed] [Google Scholar]

[b15] 15.Berend ME, Berend KR, Lombardi AV, et al. The patient-specific Triflange acetabular implant for revision total hip arthroplasty in patients with severe acetabular defects: planning, implantation, and results. Bone Joint J, 2018, 100-B(1 Supple A): 50-54.

[b16] 16.Kieser DC, Ailabouni R, Kieser SCJ, et al The use of an Ossis custom 3D-printed tri-flanged acetabular implant for major bone loss: minimum 2-year follow-up. Hip Int. 2018;28(6):668–674. doi: 10.1177/1120700018760817. [DOI] [PubMed] [Google Scholar]

[b17] 17.Li Q, Chen X, Lin B, et al Three-dimensional technology assisted trabecular metal cup and augments positioning in revision total hip arthroplasty with complex acetabular defects. J Orthop Surg Res. 2019;14(1):431. doi: 10.1186/s13018-019-1478-1. [DOI] [PMC free article] [PubMed] [Google Scholar]

[b18] 18.Wan L, Wu G, Cao P, et al Curative effect and prognosis of 3D printing titanium alloy trabecular cup and pad in revision of acetabular defect of hip joint. Exp Ther Med. 2019;18(1):659–663. doi: 10.3892/etm.2019.7621. [DOI] [PMC free article] [PubMed] [Google Scholar]

[b19] 19.Hao YQ, Wang L, Jiang WB, et al 3D printing hip prostheses offer accurate reconstruction, stable fixation, and functional recovery for revision total hip arthroplasty with complex acetabular bone defect. Engineering. 2020;6(11):1285–1290. doi: 10.1016/j.eng.2020.04.013. [DOI] [Google Scholar]

[b20] 20.He S, Zhu J, Jing Y, et al Effect of 3D-printed porous titanium alloy pore structure on bone regeneration: a review. Coatings. 2024;14(3):253. doi: 10.3390/coatings14030253. [DOI] [Google Scholar]

[b21] 21.Li H, Qu X, Mao Y, et al Custom acetabular cages offer stable fixation and improved hip scores for revision THA with severe bone defects. Clin Orthop Relat Res. 2016;474(3):731–740. doi: 10.1007/s11999-015-4587-0. [DOI] [PMC free article] [PubMed] [Google Scholar]

[b22] 22.丁育健, 冯德宏, 王凌, 等髋关节翻修术中应用数字设计3D打印定制带翼臼杯重建髋臼严重骨缺损. 中华骨科杂志. 2023;43(2):97–103. doi: 10.3760/cma.j.cn121113-20220929-00588. [DOI] [Google Scholar]

[b23] 23.Berasi CC, Berend KR, Adams JB, et al. Are custom triflange acetabular components effective for reconstruction of catastrophic bone loss? Clin Orthop Relat Res, 2015, 473(2): 528-535.

[b24] 24.张衡, 马晓东, 李博闻, 等 3D打印定制假体及其在髋关节翻修髋臼重建应用中的研究进展. 中国修复重建外科杂志. 2024;38(11):1414–1420. doi: 10.7507/1002-1892.202406002. [DOI] [PMC free article] [PubMed] [Google Scholar]

PERMALINK

个体化3D打印定制假体在严重Paprosky Ⅲ型髋臼侧骨缺损中的应用

Application of personalized three-dimensional printed customized prostheses in severe Paprosky type Ⅲ acetabular bone defects

帅垒李

昊柴

永强孙

Abstract

目的

方法

结果

结论