Macák D, Džupa V, Krbec M
Ortopedicko-traumatologická klinika 3. lékařské fakulty Univerzity Karlovy a Fakultní nemocnice Královské Vinohrady, Praha.
Acta Chir Orthop Traumatol Cech. 2021;88(1):69-74.
The authors report on three cases in which a custom-made 3D printed titanium acetabular component of total hip arthroplasty was used to manage an advanced acetabular bone defect with pelvic discontinuity. The implant surface structure impeded long-term bone integration. Nonetheless, the stable bridging of the acetabular defect resulted in full integration of impacted bone allografts at the base of the implant. The pelvic continuity was restored within 12 months after surgery, and thus the acetabulum was prepared for potential further implantation of a standard revision acetabular component. Only one of the three female patients underwent a revision surgery at 18 months after surgery, the other two female patients were satisfied to such a degree with the clinical outcome at 6 years and 5 years, respectively, after surgery that they refused to undertake the revision surgery, despite X-ray images showing signs of loosening of the custom-made titanium acetabular component. The authors concluded that the implantation technique of three-point fixed custom-made 3D printed acetabular component made of titanium combined with impaction grafting of the acetabular base is a good alternative in managing the advanced bone defects of acetabulum with pelvic discontinuity after the failure of total hip arthroplasty. Even though inadequate surface porosity of the thus produced component did not allow its permanent osteointegration, the assembly was stable enough to allow the bone allografts to rebuild and restore continuity of the pelvis and facilitated future implantation of the standard revision acetabular component. Key words: 3D printing, individual acetabular component, titanium, total hip prosthesis, revision hip arthroplasty, acetabular reconstruction, custom-made implants.
作者报告了三例使用定制的3D打印钛全髋关节置换髋臼组件治疗髋臼严重骨缺损伴骨盆连续性中断的病例。植入物表面结构妨碍了长期骨整合。尽管如此,髋臼缺损的稳定桥接导致植入物底部的异体骨移植完全整合。术后12个月内骨盆连续性得以恢复,从而为髋臼准备好可能进一步植入标准翻修髋臼组件。三名女性患者中只有一名在术后18个月接受了翻修手术,另外两名女性患者对术后6年和5年的临床结果分别非常满意,尽管X线影像显示定制钛髋臼组件有松动迹象,但她们仍拒绝接受翻修手术。作者得出结论,三点固定的定制3D打印钛髋臼组件植入技术结合髋臼底部的打压植骨,是全髋关节置换失败后治疗髋臼严重骨缺损伴骨盆连续性中断的一种良好选择。即使由此生产的组件表面孔隙率不足,不允许其永久骨整合,但该组件足够稳定,能让异体骨重建并恢复骨盆连续性,并便于未来植入标准翻修髋臼组件。关键词:3D打印、个体化髋臼组件、钛、全髋关节假体、髋关节翻修置换术、髋臼重建、定制植入物