The Clinical Study Of 3D Printing-assisted Total Hip Arthroplasty In The Treatment Of Adult Crowe TypeⅢ/Ⅳ Developmental Dysplaisa Of The Hip

Objective:Through the retrospective analysis of adult Crowe type Ⅲ/Ⅳ developmental dysplasia of the hip,to explore the clinical effect of 3D printing assisted total hip arthroplasty in the treatment of Crowe type Ⅲ/Ⅳ dysplasia of hip in adults and 3D printing guide plate can be more accurate reconstruction of hip joint,reduce the incidence of intraoperative and postoperative complications related to improve joint arthroplasty in patients with functional score.Method:A retrospective analysis of 16 patients who were admitted to our hospital from January 2017 to June 2019 and were followed up.There were 4 males and 12 females,CroweⅢ type 9 cases,CroweⅣ type 7 cases,age 34-64,the average age(50.19+8.92)years,and were followed up for 6～30 months,the average(16.25+7.70)months.All patients underwent total hip arthroplasty assisted by 3D printed individual guide plate and 3D models.The surgery was performed by the same surgeon.By collecting and recording the clinical and imaging data of the patients,the operative time,intraoperative blood loss,length of lower limbs,gait,femoral eccentricity,postoperative complications,VAS score,Harris score,abduction Angle of acetabular prosthesis and anteversion Angle were included in this study.VAS score,Harris score of patients before and after 1 month and the last follow-up,and length difference of lower limbs and femoral eccentricity of the patients were statistically analyzed,to observe gait,incidence of postoperative complications,excellent and good rate of hip joint and other indicators.The operation time,intraoperative blood loss,postoperative hospital stay and VAS score,Harris score,angle of deviation of abduction angle and anteversion angle of acetabular prosthesis,femoral eccentricity,limb shortening and other parameters are expressed in mean ± standard deviation.The VAS score,Harris score,the length difference of lower limbs and the eccentricity of femur were measured by t-test,The difference was statistically significant(P<0.05).Results:All patients were successfully completed,the average operation time was(171.88+19.19)min,the average intraoperative blood loss was(468.75+68.18)ml,The average deviation between the abduction angle and anteversion angle of acetabulum prosthesis and the best prosthesis placement angle was measured by Positive pelvic X-ray,The average deviation of abduction angle and anteversion angle of acetabular prosthesis was(1.94±1.14)° and(2.25±1.28)° respectively.The mean postoperative hospital stay was(14.62±0.78)days.The type of hip prosthesis used in 16 patients was the same as that planned before operation.The Harris score of hip function of the patients was(45.38±8.20)points before surgery,(77.2±7.73)points one month after surgery,compared with preoperation,the differences were statistically significantand(t=13.284,P<0.05),(88.56±3.92)points at the last follow-up,the differences were statistically significant compared with the Harris score before surgery(t=24.104,P<0.05).The average VAS score was(5.31±1.21)before surgery,(2.06±0.43)one month after surgery,compared with preoperation,the differences were statistically significantand(t=-9.043,P<0.05),and(1.31±0.58)during the last follow-up,with statistically significant differences(t=-10.627,P<0.05).The mean limb shortening before surgery was(4.44±1.29)cm,at the last follow-up,the average shortening of the affected limb and the opposite side was(0.71±0.59)cm,which was statistically significant(t=-16.553,P<0.05).The average preoperative femoral eccentricity was(39.29±6.76)mm,and the average preoperative femoral eccentricity was(43.71±4.43)mm at the last follow-up,and the difference was statistically significant(t=5.359,P<0.05).Posterior dislocation of joint prosthesis occurred in 1 patient.None of the patients had any complications,such as infection,fracture nonunion,prosthesis loosening,deep vein thrombosis,pulmonary embolism and nerve injury.6 patients with subtrochanteric osteotomy and 4 patients with structural bone grafting had good healing.The Harris score of hip joint function was excellent(>90)in 5 cases,good(80-89)in 10 cases,and average(70-79)in 1 case,with an excellent and good rate of 93.75%.At the last follow-up,4 patients had mild claudication,all of whom walked without assistance.Conclusion:The use of 3D printing assisted total hip arthroplasty for Crowe typeⅢ/ⅣDDH can improve the accuracy of prosthesis implant placement,precision up to the present medical concept,and reduce the operation time and intraoperative bleeding,simplify operation and reducing postoperative complications,most patients had good recovery of hip joint function.In particular,it can reduce the learning curve and difficulty of young surgeons and greatly improve the success rate of surgery.The number of cases in this study is small and lack of control group,the follow-up time is short,and the accuracy of data results is low,which still needs to be improved.Above all,3D printing assisted treatment of total hip arthroplasty for Crowe typeⅢ/Ⅳ DDH is still a recommended method.