Csernátony Zoltán, Manó Sándor, Szabó Dániel, Soósné Horváth Hajnalka, Kovács Ágnes Éva, Csámer Loránd
Department of Orthopaedics and Traumatology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary.
Laboratory of Biomechanics, Department of Orthopaedics and Traumatology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary.
Bioengineering (Basel). 2023 Sep 18;10(9):1095. doi: 10.3390/bioengineering10091095.
Surgeries of severe periacetabular bone defects (Paprosky ≥ 2B) are a major challenge in current practice. Although solutions are available for this serious clinical problem, they all have their disadvantages as well as their advantages. An alternative method of reconstructing such extensive defects was the use of a cup with a stem to solve these revision situations. As the instrumentation offered is typically designed for scenarios where a significant bone defect is not present, our unique technique has been developed for implantation in cases where reference points are missing. Our hypothesis was that a targeting device designed based on the CT scan of a patient's pelvis could facilitate the safe insertion of the guiding wire.
Briefly, our surgical solution consists of a two-step operation. If periacetabular bone loss was found to be more significant during revision surgery, all implants were removed, and two titanium marker screws in the anterior iliac crest were percutaneously inserted. Next, by applying the metal artifact removal (MAR) algorithm, a CT scan of the pelvis was performed. Based on that, the dimensions and positioning of the cup to be inserted were determined, and a patient-specific 3D printed targeting device made of biocompatible material was created to safely insert the guidewire, which is essential to the implantation process.
In this study, medical, engineering, and technical tasks related to the design, the surgical technique, and experiences from 17 surgical cases between February 2018 and July 2021 are reported. There were no surgical complications in any cases. The implant had to be removed due to septic reasons (independently from the technique) in a single case, consistent with the septic statistics for this type of surgery. There was not any perforation of the linea terminalis of the pelvis due to the guiding method. The wound healing of patients was uneventful, and the implant was fixed securely. Following rehabilitation, the joints were able to bear weight again. After one to four years of follow-up, the patient satisfaction level was high, and the gait function of the patients improved a lot in all cases.
Our results show that CT-based virtual surgical planning and, based on it, the use of a patient-specific 3D printed aiming device is a reliable method for major hip surgeries with significant bone loss. This technique has also made it possible to perform these operations with minimal X-ray exposure.
严重髋臼周围骨缺损（Paprosky≥2B）的手术是当前临床实践中的一项重大挑战。尽管针对这一严重临床问题有多种解决方案，但它们都各有优缺点。一种重建如此广泛缺损的替代方法是使用带柄髋臼杯来解决这些翻修情况。由于现有的器械通常是为不存在显著骨缺损的情况设计的，我们开发了独特的技术用于在缺少参考点的病例中进行植入。我们的假设是，基于患者骨盆CT扫描设计的靶向装置能够促进导丝的安全插入。
简而言之，我们的手术方案包括两步操作。如果在翻修手术中发现髋臼周围骨丢失更为严重，则取出所有植入物，并经皮在前髂嵴插入两枚钛标记螺钉。接下来，应用金属伪影去除（MAR）算法对骨盆进行CT扫描。在此基础上，确定待插入髋臼杯的尺寸和位置，并制作由生物相容性材料制成的患者特异性3D打印靶向装置，以安全插入导丝，这对植入过程至关重要。
本研究报告了2018年2月至2021年期间17例手术病例在设计、手术技术以及医学、工程和技术方面的任务及经验。所有病例均无手术并发症。有1例因感染原因（与技术无关）不得不取出植入物，这与此类手术的感染统计数据一致。由于导向方法，未发生骨盆终末线穿孔。患者伤口愈合顺利，植入物固定牢固。康复后，关节能够再次负重。经过1至4年的随访，患者满意度较高，所有病例患者的步态功能均有显著改善。
我们的结果表明，基于CT的虚拟手术规划以及在此基础上使用患者特异性3D打印瞄准装置是一种用于严重骨丢失的主要髋关节手术的可靠方法。该技术还使得能够在最小X射线暴露的情况下进行这些手术。
