摘要目的:探讨3D打印金属垫块或一体化髋臼假体重建髋关节翻修术中骨缺损的临床疗效。方法:回顾性分析2021年6月至2023年7月于郑州市骨科医院行全髋关节翻修的11例患者资料。男5例、女6例，年龄（64.8±10.7）岁（范围58~75岁），体质指数（23.3±4.8）kg/m 2（范围21~27 kg/m 2）。髋臼骨缺损Paprosky分型：ⅡA型3例、ⅡB型4例、ⅢA型3例、ⅢB型1例。翻修原因：无菌性松动8例、感染旷置术后3例。使用3D打印金属垫块9例（无菌性松动8例、感染旷置术后1例），使用3D打印一体化髋臼2例（感染旷置术后）。初次置换至翻修的时间为（11.8±5.6）年（范围5~17年）。采用Harris髋关节评分及疼痛视觉模拟评分（visual analogue scale）评估髋关节功能改善及疼痛恢复情况。于骨盆正位X线片上测量双下肢长度差、髋关节旋转中心垂直高度及旋转中心水平位置。 结果:所有患者均顺利完成手术，手术时间为（145.9±35.5）min（范围110~159 min），术中出血量为（950.5±310.8）ml（范围680~1 450 ml）。患者术后Harris髋关节功能评分均升高，与术前比较差异有统计学意义（ F=554.085， P<0.001）；术后1年Harris髋关节功能评分为（74.36±5.16）分，大于术前的（32.18±4.07）分，差异有统计学意义（ P<0.05）。患者术后VAS评分均下降，与术前比较差异有统计学意义（ F=177.717， P<0.001）；术后1年VAS评分为（1.27±0.65）分，小于术前的（6.18±1.17）分，差异有统计学意义（ P<0.05）。术前双下肢长度差为（1.97±0.71）cm，大于末次随访的（0.69±0.52）cm，差异有统计学意义（ t=4.824， P<0.001）。术后患侧髋关节旋转中心垂直高度为（1.88±0.46）cm，健侧为（1.67±0.35）cm，差异无统计学意义（ t=1.205， P=0.242）；术后患侧髋关节旋转中心水平位置为（3.48±0.55）cm，健侧为（3.54±0.32）cm，差异无统计学意义（ t=-0.313， P=0.758）。1例术中出现股骨大转子骨折，经复位内固定后3个月愈合。所有患者均获得随访，随访时间为（21.3±9.5）个月（范围15~31个月）。切口均一期愈合，术后3个月均完全负重。末次随访时无一例出现假体松动、脱位及感染；4例有轻度跛行、1例出现异位骨化，患者髋关节屈伸功能均良好，不影响日常生活而未行进一步处理。 结论:3D打印金属垫块或一体化髋臼假体重建髋臼骨缺损临床疗效满意，可恢复正常髋关节旋转中心，术后并发症发生率低。

abstractsObjective:To investigate the clinical efficacy of 3D-printed metal augment or integrated acetabular prostheses for reconstruction of bone defects in hip revision.Methods:A total of 11 patients who underwent total hip revision in Zhengzhou Orthopaedic Hospital from June 2021 to July 2023 were retrospectively analysed. There were 5 males and 6 females, age 64.8±10.7 years (range, 58-75 years), and body mass index 23.3±4.8 kg/m 2 (range, 21-27 kg/m 2). Paprosky classification of acetabular bone defects: 3 cases of type IIA, 4 cases of type IIB, 3 cases of type IIIA, 1 case of type IIIB. Reasons for revision: 8 cases of aseptic loosening, 3 cases after infection exclusion procedure. A 3D-printed metal augment was used in 9 cases (8 cases of aseptic loosening and 1 case of infected exclusion procedure) and a 3D-printed integrated acetabulum was used in 2 cases (infected exclusion procedure). The time from primary total hip arthroplasty to revision was 11.8±5.6 years (range, 5-17 years). Harris hip score and visual analogue scale (VAS) were used to evaluate the improvement of hip function and pain recovery. The leg length discrepancy, vertical height and horizontal position of the hip rotation center were measured on pelvic anteroposterior X-ray films. Results:All patients successfully completed the operation. The operation time was 145.9±35.5 min (range, 110-159 min), and the intraoperative blood loss was 950.5±310.8 ml (range, 680-1,450 ml). The postoperative Harris hip function score was significantly higher than that before operation ( F=554.085, P<0.001). One year after operation, the Harris hip function score was 74.36±5.16, which was higher than that before operation 32.18±4.07, and the difference was statistically significant ( P<0.05). The VAS scores of all patients decreased after operation, and the difference was statistically significant compared with that before operation ( F=177.717, P<0.001). The VAS score at 1 year after operation was 1.27±0.65, which was lower than that before operation 6.18±1.17, and the difference was statistically significant ( P<0.05). The preoperative leg length discrepancy was 1.97±0.71 cm, which was greater than 0.69±0.52 cm at the last follow-up, and the difference was statistically significant ( t=4.824, P<0.001). The vertical height of the hip rotation center was 1.88±0.46 cm on the affected side and 1.67±0.35 cm on the healthy side, showing no significant difference ( t=1.205, P=0.242). The postoperative horizontal position of the hip rotation center was 3.48±0.55 cm on the affected side and 3.54±0.32 cm on the healthy side, and the difference was no statistically significant ( t=-0.313, P=0.758). One case had an intraoperative greater trochanteric fracture that healed 3 months after reduction and internal fixation. All patients were followed up for 21.3±9.5 months (range, 15-31 months). All incisions healed in one stage, and all patients were fully weight-bearing at 3 months after operation. At the last follow-up, there was no case of loosening, dislocation or infection of the prosthesis; 4 cases had mild claudication, 1 case had heterotopic ossification, and the patients had good hip flexion and extension functions, which did not affect daily life without further treatment. Conclusion:The clinical efficacy of 3D-printed metal augment or integrated acetabular prosthesis for reconstruction of acetabular bone defects is satisfactory, which can restore the normal center of rotation of the hip joint and has a low incidence of postoperative complications.