背景:在翻修全髋关节置换术(THA)中,带有3D扫描计划的多孔定制三法兰髋臼植入物的出现为提高植入准确性和旋转中心(COR)的解剖学恢复提供了新的视角。这个问题是使用CT扫描作为测量工具进行调查的,但是在有限的系列(±10例)中,并且没有调查可能影响定位错误的因素。因此,我们进行了一项回顾性研究,旨在:(1)评估此类植入物相对于术前计划的放置准确性,(2)检查为了应用植入物而要切除的骨的体积是否对这种准确性有影响,(3)评估手术中的位置错误是否对功能有任何影响,并发症和生存。
目的:当植入多孔定制髋臼植入物时,可以准确地再现术前计划,方法:这项单中心回顾性研究包括20例使用多孔定制髋臼植入物进行THA翻修的患者。平均随访时间为17.9个月±9.4[2-45.1]。使用3D扫描图建模进行术前计划。进行了术后CT扫描,以评估定向和COR恢复方面的植入准确性。人口统计数据,牛津成绩,记录并发症和生存率.
结果:倾斜与术前计划的平均偏差,前倾和旋转分别为4.3°±2.5、6.1°±4.7和7°±4.6。COR的恢复显示前后平均偏差为2.1±1.3mm,内侧2.5±2mm,内侧2.2±1.3mm。总的来说,45%(9/20)的植入物被定位为取向(±10°)和COR(±5mm)的完美恢复。平均计划骨切除为8.1±4.9cm3,当要切除的骨体积超过2.7cm3时,放置精度和COR恢复显着降低。发现一个位错(5%,1/20)。最后一次随访时的生存率为100%,随访时的平均牛津评分为31.7±7.9[16-52],不受位置错误或COR恢复原状的影响。
结论:总共45%的植入物按计划恢复了取向和COR,特别是当要切除的骨的体积小于2.7cm3时。虽然这些都是有大量骨质流失的复杂病例,3D制造可以给我们带来更高精度的希望。更好的精度和低骨切除量之间的联系可能是与制造商一起开发的领域,以改善结果。
方法:III;在横向回顾性研究中使用CT进行诊断。
BACKGROUND: In revision total hip arthroplasty (THA), the advent of porous custom-made triflange acetabular implants with 3D scan planning offers a new perspective to improve implantation accuracy and anatomical restoration of the center of rotation (COR). This issue was investigated using CT-scan as the measurement tool, but in limited series (±10 cases) and without investigating the factors that may influence errors in positioning. Therefore we performed a retrospective study aiming to: (1) assess the placement accuracy of such implants with respect to the preoperative planning, (2) examine whether the volume of bone to be resected in order to apply the implant had an impact on this accuracy, (3) assess if errors in position at surgery had any influence on function, complications and survival.
OBJECTIVE: Preoperative planning could be accurately reproduced when implanting porous custom-made acetabular implants, and that accuracy would decrease in proportion to the volume of bone to be resected METHOD: Twenty patients undergoing THA revision with porous custom-made acetabular implants were included in this single-center retrospective study. Mean follow-up was 17.9 months ± 9.4 [2-45.1]. Preoperative planning was performed using 3D scanographic modeling. A post-operative CT scan was performed to assess implantation accuracy in terms of orientation and COR restitution. Demographic data, Oxford scores, complications and survival were recorded.
RESULTS: Mean deviation from the preoperative planning in inclination, anteversion and rotation were 4.3 ° ± 2.5, 6.1 ° ± 4.7, and 7 ° ± 4.6, respectively. Restoration of the COR showed a mean deviation of 2.1 ± 1.3 mm anteroposteriorly, 2.5 ± 2 mm mediolaterally and 2.2 ± 1.3 mm proximodistally. In total, 45% (9/20) of implants were positioned with perfect restoration of orientation (±10 °) and COR (±5 mm). The mean planned bone resection was 8.1 ± 4.9 cm3, with placement accuracy and COR restitution decreasing significantly when the volume of bone to be resected exceeded 2.7 cm3. One dislocation was found (5%, 1/20). Survival at last follow-up was 100%, the mean Oxford score at follow-up was 31.7 ± 7.9 [16-52], without being influenced by errors in position or COR restitution.
CONCLUSIONS: In total 45% of the implants restored an orientation and a COR as planned, particularly when the volume of bone to be resected is less than 2.7 cm3. Although these are complex cases with large amounts of bone loss, 3D manufacturing could give us hope of greater precision. The link between better precision and low bone resection volume could be an area to develop with the manufacturer in order to improve results.
METHODS: III; diagnostic using CT in transversal retrospective study.