La Camera Francesco, Di Matteo Vincenzo, Pisano Alessandro, Guazzoni Edoardo, Favazzi Carlo Maria, Chiappetta Katia, Morenghi Emanuela, Grappiolo Guido, Loppini Mattia
IRCCS Humanitas Research Hospital, 20089 Milan, Italy.
Fondazione Livio Sciutto Onlus, Campus Savona, Università degli Studi di Genova, 17100 Savona, Italy.
J Clin Med. 2024 Sep 17;13(18):5496. doi: 10.3390/jcm13185496.
The pre-operative three-dimensional (3D) assessment of acetabular bone defects may not be evaluated properly with conventional radiographic and computed tomography images. This paper reports mid-term clinical and radiographic outcomes of complex revision total hip arthroplasty (r-THA) based on a 3D life-sized printed model. Patients who underwent r-THA for septic or aseptic acetabular loosening with acetabular defects Paprosky types IIc, IIIa, and IIIb between 2019 and 2021 were included. The outcomes of the study were to determine clinical and radiographic assessment outcomes at the time of the last follow-up. 25 patients with mean age of 62.9 ± 10.8 (18-83) years old were included. The mean Harris hip score improved from 34.8 ± 8.1 pre-operative to 81.6 ± 10.4 points ( < 0.001). The mean visual analog scale decreased from 6.7 ± 1.4 points pre-operative to 2.4 ± 1.0 points ( < 0.001). The mean limb length discrepancy improved from -2.0 ± 1.2 cm pre-operative to -0.6 ± 0.6 cm ( < 0.001). The mean vertical position of the center of rotation (COR) changed from 3.5 ± 1.7 cm pre-operative to 2.0 ± 0.7 cm ( < 0.05). The mean horizontal COR changed from 3.9 ± 1.5 cm pre-operative to 3.2 ± 0.5 cm ( < 0.05). The mean acetabular component abduction angle changed from 59.7° ± 29.6° pre-operative to 46° ± 3.9 ( < 0.05). A three-dimensional-printed model provides an effective connection between the pre-operative bone defects' evaluation and the intraoperative findings, enabling surgeons to select optimal surgical strategies.
传统的X线片和计算机断层扫描图像可能无法准确评估髋臼骨缺损的术前三维（3D）情况。本文报告了基于3D实物打印模型的复杂翻修全髋关节置换术（r-THA）的中期临床和影像学结果。纳入了2019年至2021年间因感染性或无菌性髋臼松动伴Paprosky IIc型、IIIa型和IIIb型髋臼缺损而接受r-THA的患者。本研究的结果是确定最后一次随访时的临床和影像学评估结果。纳入了25例平均年龄为62.9±10.8（18 - 83）岁的患者。Harris髋关节平均评分从术前的34.8±8.1分提高到81.6±10.4分（P<0.001）。视觉模拟量表平均分从术前的6.7±1.4分降至2.4±1.0分（P<0.001）。肢体长度平均差异从术前的-2.0±1.2 cm改善至-0.6±0.6 cm（P<0.001）。旋转中心（COR）的平均垂直位置从术前的3.5±1.7 cm变为2.0±0.7 cm（P<0.05）。COR的平均水平位置从术前的3.9±1.5 cm变为3.2±0.5 cm（P<0.05）。髋臼假体平均外展角从术前的59.7°±29.6°变为46°±3.9°（P<0.05）。三维打印模型为术前骨缺损评估与术中发现提供了有效的联系，使外科医生能够选择最佳的手术策略。
