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.
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: Paprosky classification; Three-dimensional printing; bone defect; customized prostheses; hip revision.