Zhang H, Ma X D, Li B W, Zhao J N, Wang J Q, Zhou J S
Department of Orthopedics, the First Affiliated Hospital of Bengbu Medical University, Tissue and Transplant Laboratory of Anhui Province, Bengbu Medical University, Bengbu 233004, China.
Department of Orthopedics, Jinling Hospital, School of Medicine, Nanjing University, Nanjing 210002, China.
Zhonghua Yi Xue Za Zhi. 2024 Nov 5;104(41):3815-3821. doi: 10.3760/cma.j.cn112137-20240306-00501.
To compare the accuracy and efficiency between the model development method and the software development method, which design and develop 3D printed integral anatomical acetabular prosthesis to be used in total hip arthroplasty(THA) for patients with Crowe type Ⅱ and Ⅲ developmental dysplasia of the hip(DDH). Fifteen patients with end-stage hip osteoarthritis due to Crowe type Ⅱ and Ⅲ DDH who underwent THA in the Orthopedics Department of the First Affiliated Hospital of Bengbu Medical College between January 2015 and June 2023 were selected in this study retrospectively. There were 1 male (1 hip) and 14 females (17 hips) with a mean age of (55.1±9.1) years. There were 12 hips with Crowe type Ⅱ, 6 hips with Crowe type Ⅲ. The preoperative pelvis three-dimensional CT data in those patients were used to design integral anatomical acetabular prosthesis. The model development group used 3D printing technology to print life-size pelvis models. The acetabulum was reamed and the acetabulum cup was inserted into the socket according to conventional THA procedures. The bone defect above the acetabulum cup was filled with bone wax. The Mimics and 3-matic software were used to simulate the THA procedures, design and install the integrated anatomical acetabular prosthesis in the software development group. The operation time, the size of the acetabular cup, the volume and surface area of the acetabulum bone defect, the acetabular cup's inclination and anteversion, the horizontal distance and the vertical distance of hip rotation center were compared between the two methods. The study in the two groups were all based on the data of 18 hips in the 15 patients. The horizontal and vertical distances of rotation center in the model development group and software development group was (32.08±1.80) mm, (32.17±2.40) mm and (14.36±1.53) mm, (15.11±1.45) mm, respectively (both >0.05). The cup size in model development group was (48.56±1.15)mm, and it was (48.77±1.22) mm in the software group (=0.160). The anteversion and inclination of the acetabular cup in the model and software groups were 23.79°±6.31°, 30.49°±11.03° and 15.17°±0.52°, 40.24°±0.58°, respectively (both <0.01). The volume and surface area of the acetabulum bone defect in the model development group was (5.06±2.86) mm and (8.31±2.21) mm, respectively, while it was (4.01±2.56)mm and (6.83±2.71) mm, respectively, in the software development group (both <0.05). The work time in the model development group was (24.43±0.68) h and (0.47±0.12) h in the software development group, respectively (<0.001). Compared with the 3D printing model development method, the application of Mimics and 3-matic software to design and develop integrated anatomical acetabular prosthesis in total hip arthroplasty for Crowe type Ⅱ and Ⅲ DDH show advantages of convenience, high efficiency and more accuracy.
为比较模型开发方法与软件开发方法在设计和开发用于CroweⅡ型和Ⅲ型发育性髋关节发育不良（DDH）患者全髋关节置换术（THA）的3D打印整体解剖型髋臼假体方面的准确性和效率。本研究回顾性选取了2015年1月至2023年6月期间在蚌埠医学院第一附属医院骨科接受THA治疗的15例因CroweⅡ型和Ⅲ型DDH导致终末期髋骨关节炎的患者。其中男性1例（1髋），女性14例（17髋），平均年龄（55.1±9.1）岁。CroweⅡ型12髋，CroweⅢ型6髋。利用这些患者术前的骨盆三维CT数据设计整体解剖型髋臼假体。模型开发组使用3D打印技术打印真人大小的骨盆模型。按照传统THA手术步骤进行髋臼扩髓并将髋臼杯植入髋臼，髋臼杯上方的骨缺损用骨蜡填充。软件开发组使用Mimics和3-matic软件模拟THA手术步骤，在软件中设计并安装整体解剖型髋臼假体。比较两种方法的手术时间、髋臼杯尺寸、髋臼骨缺损的体积和表面积、髋臼杯的倾斜度和前倾角、髋关节旋转中心的水平距离和垂直距离。两组研究均基于15例患者的18髋数据。模型开发组和软件开发组旋转中心的水平和垂直距离分别为（32.08±1.80）mm、（32.17±2.40）mm和（14.36±1.53）mm、（15.11±1.45）mm（均>0.05）。模型开发组髋臼杯尺寸为（48.56±1.15）mm，软件组为（48.77±1.22）mm（P = 0.160）。模型组和软件组髋臼杯的前倾角和倾斜度分别为23.79°±6.31°、30.49°±11.03°和15.17°±0.52°、40.24°±0.58°（均<0.01）。模型开发组髋臼骨缺损的体积和表面积分别为（5.06±2.86）mm³和（8.31±2.21）mm²，软件开发组分别为（4.01±2.56）mm³和（6.83±2.71）mm²（均<0.05）。模型开发组的工作时间为（24.43±0.68）小时，软件开发组为（0.47±0.12）小时（<0.001）。与3D打印模型开发方法相比，在CroweⅡ型和Ⅲ型DDH全髋关节置换术中应用Mimics和3-matic软件设计和开发整体解剖型髋臼假体具有方便、高效和更准确的优点。
