3D打印导航模块辅助髓芯减压植骨治疗早期股骨头坏死
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摘要
目的探讨运用3D打印导航模块技术联合自体松质骨及异体腓骨对于治疗早期股骨头坏死的临床疗效。方法选取我院2016年1月至2018年8月收治股骨头坏死国际骨循环研究会(the association research circulation osseous,ARCO)分期为Ⅰ、Ⅱ期的26例患者为研究对象,根据患者随机自愿选择分为3D打印导航模块辅助髓芯减压植骨组和传统减压植骨组。统计分析传统髓芯减压组与3D打印导航模块辅助减压组在术前及术后Harris评分、手术时间、手术切口长度、术后引流量及术中透视频次等相关临床数据。结果全部病例均获得随访,随访时间1～24个月,平均(9.83±2.34)个月。临床资料统计分析发现两组手术方式术前及术后Harris评分差异均有统计学意义(P<0.05),基线资料比较差异无统计学意义(P>0.05);3D打印组和传统手术组在手术时间和术中透视频次方面差异有统计学意义(P<0.05),而在术后血浆引流量及切口长度方面差异无统计学意义(P>0.05)。结论 3D打印导航模块技术辅助髓芯减压植骨较传统减压植骨手术临床效果较好,能提高患者生活质量及预后,在缩短手术时间及减少术中透视次数方面有明显优势,值得临床推广运用。
Objective To explore the efficacy of employing 3 D printing technique combined with allogeneic fibula to treat early stage necrosis of femur head.Methods Materials of 26 patients admitted to our department between January 2016 and August 2018 with images classification of stage Ⅰand stageⅡ according to Association Research Circulation Osseous classification were categorized into 3 D printing group and conventional non-3 D printing group based on the type of surgery procedure.The factors of Harris scores before and afteroperation,intraoperation time,incision length,drainage and X-ray frequency were meticulously collected and statistically analysed.Results All patients were followed up and the follow-up duration were(9.83±2.34)months(range1 to 24).Statistical analyses showed that the Harris scores before operation and after operationofthe two groups hadsignificant differences(P<0.05),but the baselines between the two groups were actually the same with no significant differences.We also found that operation time and X-ray frequency were different between the 3 D pringting group and non-3 D conventional group(P<0.05),but the drainage volume and incision length hadnostatistically differences(P>0.05).Conclusion 3 D printingassisted navigation technique systems could have the same comparatively clinic outcomes and efficacy to non-3 D conventional groups for the treatment of early stage of femur head necrosis,and can improve the quality of patient life,prevent the progression of femur head necrosis and improve the prognosis of these disease,and advantages of this technique in shortening operation time and reducing X-ray frequency are also apparent.Thus,this 3 D printing mould assisted technique should be promoted and utilized in clinic and could make benefit to the patients.
Objective To explore the efficacy of employing 3 D printing technique combined with allogeneic fibula to treat early stage necrosis of femur head.Methods Materials of 26 patients admitted to our department between January 2016 and August 2018 with images classification of stage Ⅰand stageⅡ according to Association Research Circulation Osseous classification were categorized into 3 D printing group and conventional non-3 D printing group based on the type of surgery procedure.The factors of Harris scores before and afteroperation,intraoperation time,incision length,drainage and X-ray frequency were meticulously collected and statistically analysed.Results All patients were followed up and the follow-up duration were(9.83±2.34)months(range1 to 24).Statistical analyses showed that the Harris scores before operation and after operationofthe two groups hadsignificant differences(P<0.05),but the baselines between the two groups were actually the same with no significant differences.We also found that operation time and X-ray frequency were different between the 3 D pringting group and non-3 D conventional group(P<0.05),but the drainage volume and incision length hadnostatistically differences(P>0.05).Conclusion 3 D printingassisted navigation technique systems could have the same comparatively clinic outcomes and efficacy to non-3 D conventional groups for the treatment of early stage of femur head necrosis,and can improve the quality of patient life,prevent the progression of femur head necrosis and improve the prognosis of these disease,and advantages of this technique in shortening operation time and reducing X-ray frequency are also apparent.Thus,this 3 D printing mould assisted technique should be promoted and utilized in clinic and could make benefit to the patients.
引文
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[11]陈雷雷,洪志楠,洪郭驹,等.打压支撑植骨术治疗股骨头坏死的中长期疗效与影响因素分析[J].中华骨科杂志,2018,38(7):403-410.
[12]Liu ZJ,Jia J,Zhang YG,et al.Internal fixation of complicated acetabular fractures directed by preoperative surgery with 3Dprinting models[J].Orthop Surg,2017,9(2):257-260.
[13]张剑锋,杨雄刚,魏悦,等.3D打印技术在骨肿瘤外科中的应用研究---前沿综述[J].中华骨科杂志,2018,38(2):120-128.
[14]Cha YH,Lee KH,Ryu HJ,et al.Ankle-foot orthosis made by 3Dprinting technique and automated design software[J].Appl Bionics Biomech,2017,21(7):1-6.
[2]Luo P,Gao F,Han J,et al.The role of autophagy in steroid necrosis of the femoral head:a comprehensive research review[J].Int Orthop,2018,42(7):1747-1753.
[3]Ren X,Fan W,Shao Z,et al.A metabolomic study on early detection of steroid-induced avascular necrosis of the femoral head[J].Oncotarget,2018,9(8):7984-7995.
[4]Yu YX,Yi CQ,Ma JZ,et al.Comparison of the effect of total hip arthroplasty through mini invasive direct anterior approach during learning curve period and posterolateral approach for the treatment of femoral head necrosis[J].Zhongguo Gushang,2016,29(8):702-707.
[5]Tu Y,Chen Z,Lineaweaver WC,et al.Different recipient vessels for free microsurgical fibula flaps in the treatment of avascular necrosis of the femoral head:A systematic review and meta-analysis[J].Ann Plast Surg,2017,79(6):583-589.
[6]Calori GM,Mazza E,Colombo A,et al.Core decompression and biotechnologies in the treatment of avascular necrosis of the femoral head[J].EFORTOpen Rev,2017,2(2):41-50.
[7]张剑锋,杨雄刚,魏悦,等.3D打印技术在骨肿瘤外科中的应用研究---前沿综述[J].中华骨科杂志,2018,38(2):120-128.
[8]Li R,Chen KL,Wang Y,et al.Establishment of a 3Dprinting system for bone tissue engineering scaffold fabrication and the evaluation of its controllability over macro and micro structure precision[J].Beijing Daxue Xuebao Yixueban,2019,51(1):115-119.
[9]Krenn V,Muller S,Krenn VT,et al.Pathophysiology of aseptic femoral head necrosis:Pathogenesis and histopathological differential diagnosis[J].Orthopade,2018,47(9):710-716.
[10]Ancelin D,Reina N,Cavaignac E,et al.Total hip arthroplasty survival in femoral head avascular necrosis versus primary hip osteoarthritis:Case-control study with a mean 10-year follow-up after anatomical cementless metal-on-metal 28-mm replacement[J].Orthop Traumatol Surg Res,2016,102(8):1029-1034.
[11]陈雷雷,洪志楠,洪郭驹,等.打压支撑植骨术治疗股骨头坏死的中长期疗效与影响因素分析[J].中华骨科杂志,2018,38(7):403-410.
[12]Liu ZJ,Jia J,Zhang YG,et al.Internal fixation of complicated acetabular fractures directed by preoperative surgery with 3Dprinting models[J].Orthop Surg,2017,9(2):257-260.
[13]张剑锋,杨雄刚,魏悦,等.3D打印技术在骨肿瘤外科中的应用研究---前沿综述[J].中华骨科杂志,2018,38(2):120-128.
[14]Cha YH,Lee KH,Ryu HJ,et al.Ankle-foot orthosis made by 3Dprinting technique and automated design software[J].Appl Bionics Biomech,2017,21(7):1-6.