| Background: osteonecrosis of femoral head(ONFH)is one of the common hip diseases in clinic.total hip arthroplasty(THA)is a common surgical procedure for the treatment of ONFH.It can relieve pain symptoms and restore hip joint structure and function in patients with advanced osteonecrosis of the femoral head.The global offset(GO)is composed of femoral offset and acetabular offset,which comprehensively considers the effects of femoral offset and acetabular offset on the recovery of hip joint structure.As an important biomechanical parameter of hip joint,global offset can affect the efficacy and prognosis of total hip arthroplasty.3D printing technology can use preoperative imaging data of patients to restore the morphology and structure of the hip joint,and achieve the clinical goal of native reconstruction of the hip joint.Clinicians can measure the biomechanical parameters of the healthy hip joint on the physical model printed by 3D printing to guide the preoperative recovery of the affected side,realize the selection of preoperative prosthesis size and estimate the degree of osteotomy or acetabulum by preoperative simulation,so that the mechanical parameters of the affected side are close to the restoration of the healthy side.At present,intraoperative repair of global offset is a difficulty in clinical work.We use3 D printing technology to reconstruct the correct global offset during operation and observe its clinical effect.Objective: To investigate the effect of three-dimensional(3D)printing technology on the correct reconstruction of total hip offset and the effectiveness of total hip arthroplasty(THA).Methods: The clinical data and follow-up data of 68 patients with unilateral femoral head aseptic necrosis who underwent primary total hip arthroplasty at Department of Orthopedics,the First Affiliated Hospital of Henan University from January 2019 to December 2021 were selected.The patients who used3 D printing technology to reconstruct the total offset before operation were classified as the 3D printing group,and the patients who did not use 3D printing technology were classified as the control group.Among the 68 patients eligible for this study,there were 46 patients in the 3D printing group and 22 patients in the control group.The preoperative general data of the patients in the 3D printing group and the control group were recorded,including gender,age,body mass index,Harris hip score and bilateral global offset,and the difference between the two groups was statistically significant.The patients were followed up regularly at the 3rd,6th and 12 th month after surgery and the bilateral anteroposterior and lateral radiographs were reviewed.At follow-up,the imaging indexes of GO,femoral offset,and abductor arm were measured and recorded.The correct rate of GO reconstruction after operation and the indexes evaluating hip joint function were recorded and counted.The abductor muscle strength score,VAS score,range of motion and function score of the hip joint,postoperative complications(leg length discrepancy,positive Trendelenburg sign,hip dislocation,etc.),and surgical indicators including operation time,intraoperative blood loss and postoperative drainage volume should be recorded,and the differences of the above indicators between the two groups were compared.The correlation between 3D printing assisted reconstruction of GO,femoral offset and abductor arm,the difference of GO between the replacement side and the healthy side(ΔGO)and the correlation of hip function score were analyzed.Results: Sixty-eight patients were followed up.There was no significant difference in gender,age,body mass index and bilateral global offset between the two groups before operation(P > 0.05).(1)The correct rate of postoperative GO reconstruction: the correct rate of postoperative GO reconstruction in the 3D printing group was significantly higher than that in the control group(P < 0.05).(2)Postoperative hip function indexes: there was no significant difference in abduction muscle strength score,hip VAS score,hip range of motion and hip Harris score between the two groups before operation(P > 0.05).At last follow-up,the abductor muscle strength score,hip range of motion,and hip Harris score of the two groups were significantly higher than those before operation,and the hip VAS score was significantly lower than that before operation(P < 0.05).At the last follow-up,the abduction muscle strength score [(93.1±5.4)points],hip joint range of motion [(207.6±4.7)°] and hip Harris score [(95.8±2.7)points] in the 3D printing group were higher than those in the control group [(85.6±4.8)points,(182)points].8±6.9)°] and Harris score of the hip joint [(86.5±3.2)points](P < 0.05).The VAS score of the 3D printing group(2.8±1.1)was lower than that of the control group(3.0±1.3)(P < 0.05).(3)Postoperative complications: In the 3D printing group,there was 1 case of unequal lower limbs and 1 case of prosthesis dislocation;In the control group,there were 5 cases of unequal leg length and 4cases of Trendelenburg sign(+).The rate of lower limb inequality and Trendelenburg positive rate in the3 D printing group were lower than those in the control group(P=0.019 and P=0.015),but there was no statistical difference in the incidence of prosthesis dislocation between the two groups(P > 0.05).(4)Correlation analysis: The correlation analysis between GO reconstruction assisted by 3D printing and postoperative soft tissue balance showed that the GO and FO(femoral offset)on the replacement side were(78.3±8.5)mm and(42.1±6.3)mm,respectively.There was a positive correlation between GO and FO on the replacement side(r=0.786,P < 0.001).The postoperative GO and abductor arm of the replacement side were(78.3±8.5)mm and(58.7±8.2)mm,respectively,and there was a positive correlation between them(r=0.618,P < 0.001).Pearson correlation analysis was used to analyze the difference of GO(ΔGO)between the replacement side and the healthy side and the Harris score of the hip joint in the 3D printing group at the 6 months after operation and the last follow-up,respectively.The ΔGO was negatively correlated with the Harris score of the hip joint at the 6 months after operation and the last follow-up(r=-0.346,P < 0.001;r=-0.658,P < 0.001).(5)Surgical indicators: the operation time,intraoperative blood loss and postoperative drainage in the3 D printing group were significantly less than those in the control group(P < 0.05).Conclusion: 3D printing technology assisted primary total hip replacement can significantly improve the accuracy of global offset reconstruction,It can also significantly improve the clinical efficacy of patients after surgery. |
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