验证3D打印制备个体化导板在初次全髋关节置换术(THA)中的应用可行性。

纳入在青岛大学附属医院行初次全髋关节置换的患者40例，分为导板组20例和对照组20例。导板组术前行髋关节三维CT扫描，应用Mimics 16.0软件建立髋关节模型，模拟THA手术过程，并设计出假体植入相关的髋臼及股骨近端个体化的制备导板，以Visijet M3 Crystal为材料打印出制备导板，将导板应用于THA中，对照组不应用导板。通过卡方检验、t检验、Fisher确切概率法比较两组患者手术前后的临床结果。

两组患者在一般资料、术前Harris评分、术前髋臼外展角和前倾角方面差异无统计学意义(均为P>0.05)。术后假体位置，包括髋臼外展角(t＝5.276，P<0.001)、前倾角(t＝8.653，P<0.001)和偏心距(t＝3.680，P<0.001)的偏差值、下肢不等长发生率(P<0.05)方面，导板组均低于对照组；但手术时间(t＝1.988)、术中出血量(t＝1.333)、术后4周Harris评分(t＝1.124)、股骨柄内外翻发生率(均为P>0.05)方面差异无统计学意义。

利用3D打印制备的患者制备个体化导板在THA中有较高的准确性，有利于改善术后假体位置，提高手术质量。

To testify the application of customized templates made by three-dimensional(3D) printing technology in the primary total hip arthroplasty.

Forty patients treated with primary total hip arthroplasty in the Affiliated Hospital of Qingdao University were recruited in this study. Twenty patients were operated with the aid of customized templates, and other patients by routine procedure. In the template group, the patients underwent scanning of the hip joint with spiral CT preoperatively. Three-dimensional CT image data of the hip joint were transferred to a computer workstation, and three-dimensional models of hip joints were reconstructed by use of Mimics software. The simulation of operation procedure and patient-specific templates were designed, and manufactured using Visijet M3 Crystal on a rapid prototyping machine. The templates were used to prepare the acetabulum and femoral canal during surgery in the template group, while in the control group, all the preparation of the joint was only based on the surgeon’s experience. Clinical results before and after the operation were collected and compared. Chi-square test, t test, and Fisher exact probability test were made to compare clinical outcomes between and after surgery.

There was no statistical significant difference between groups in terms of the patients’ general information, preoperative Harris score, abduction angle and anteversion angle of acetabular cup, and offset of the hip joint before surgery (P>0.05). In the template group, the deviation of the cup abduction angle (t=5.276) and anteversion (t=8.653) angle, offset (t=3.680) and discrepancy of both leg length (all P<0.05) were better than that in the control group. There was no statistically significant difference in terms of the operation time (t=1.988), blood loss (t=1.333), postoperative Harris score (t=1.124), and rate of varus or valgus angle of the stem (all P>0.05) at four weeks.

By using 3D manufactured, patient-specific hip templates, better position of the hip prosthesis can be obtained, which is in favor of enhance the accuracy and quality of the arthroplasty.