3D打印定制假体治疗髋臼巨大骨缺损伴骨盆不连续

doi:10.3877/cma.j.issn.1674-134X.2021.04.018

中华关节外科杂志(电子版) ›› 2021, Vol. 15 ›› Issue (04) : 503 -506. doi: 10.3877/cma.j.issn.1674-134X.2021.04.018

个案报道

3D打印定制假体治疗髋臼巨大骨缺损伴骨盆不连续

刘金柱¹, 张超¹, 沈计荣¹^,^†(

)

^1. 210000　南京中医药大学附属医院（江苏省中医院）

收稿日期:2020-12-03 出版日期:2021-09-29
通信作者: 沈计荣

Case report on 3D printing custom prosthesis for the treatment of huge acetabular bone defect with pelvic discontinuity

Jinzhu Liu¹, Chao Zhang¹, Jirong Shen¹()

Received:2020-12-03 Published:2021-09-29
Corresponding author: Jirong Shen

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图1 患者术前骨盆X线片和髋关节CT。图A为骨盆正位片，示右髋髂坐线不连续，钛网移位内陷盆腔，股骨头后上脱位，髂骨翼骨折，坐骨、耻骨尚且完整，股骨侧大小转子无明显骨溶解缺损，未见股骨柄下沉；图B髋关节CT片，示钛网周围大量骨缺损，螺钉进入盆腔；图C为髋关节三维重建，见髋臼内壁、臼顶缺如，髂骨翼骨折，耻骨及坐骨骨量尚可

图2 术前假体设计图。图A~C为根据髋臼缺损部位CT数据经过计算机辅助设计出假体及安装效果图，示假体设计三个翼分别用螺钉固定在髂骨、耻骨、坐骨，从而实现三点支撑，增强假体稳定性，同时计算出螺钉拧入的最大安全深度，防止螺钉过长损伤周围组织；图D~G为1 ∶1比例打印半骨盆模型和假体，评估髋臼骨缺损程度，同时检查假体试模与缺损髋臼的匹配程度，确定假体三翼与髂骨、耻骨、坐骨位置关系

图3 术中取出的钛网及臼杯

图4 假体安装过程。图A试模与假体大小相同；图B~C示反复安装调整试模，寻找最佳匹配角度；图D为安装定制的骨小梁假体，用预先设定的螺钉长度固定髂骨、耻骨、坐骨，提供初始稳定性

图5 术后骨盆正位片，示髋臼周围大量松质骨填充，旋转中心恢复，外展角和前倾角良好，双下肢基本等长

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