中国组织工程研究 ›› 2018, Vol. 22 ›› Issue (19): 3044-3048.doi: 10.3969/j.issn.2095-4344.0191

• 数字化骨科 digital orthopedics • 上一篇    下一篇

3D打印抗生素骨水泥占位器在年老体弱患者髋关节置换后感染中的应用

李远辉,曾勉东,尹德龙,胡汉生,余升华,王 钊   

  1. 广州医科大学附属第三医院骨科,广东省广州市 510150
  • 出版日期:2018-07-08 发布日期:2018-07-08
  • 通讯作者: 曾勉东,广州医科大学附属第三医院骨科,广东省广州市 150510
  • 作者简介:李远辉,男,1982年生,广东省五华县人,汉族,2010年广州医科大学毕业,硕士,主治医师,主要从事创伤、关节方面的临床研究。
  • 基金资助:

    广东省医学科学技术研究基金项目(B2016026)

Application of three-dimensional printed antibiotic bone cement spacer in infected hip after hip arthroplasty for senile and infirm patients  

Li Yuan-hui, Zeng Mian-dong, Yin De-long, Hu Han-sheng, Yu Sheng-hua, Wang Zhao   

  1. Department of Orthopedics, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, Guangdong Province, China
  • Online:2018-07-08 Published:2018-07-08
  • Contact: Zeng Mian-dong, Department of Orthopedics, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, Guangdong Province, China
  • About author:Li Yuan-hui, Master, Attending physician, Department of Orthopedics, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, Guangdong Province, China
  • Supported by:

    the Medical Science and Technology Research Fund Project of Guangdong Province, No. B2016026

摘要:

文章快速阅读:
 

文题释义:
3D打印:又称“快速成型技术”或者“快速原型技术”,在三维数字模型的基础上采用逐层制造方式将材料堆积起来的新型“增材制造”技术。由于材料学的不断发展,3D打印的材料一开始主要是各种不同形式的塑料、硅胶、金属、陶瓷等固体材料,逐渐发展到液体、凝胶、甚至生物细胞等混合材料。
抗生素骨水泥占位器:抗生素骨水泥可以在感染部位长期有效释放抗生素,这是全身应用抗生素药物所不能达到的,同时可以避免由全身使用抗生素带来的全身多器官的毒副作用。在关节感染后翻修中由Insall于1983年首先描述取出假体、使用抗生素骨水泥占位器控制感染。这一治疗方法已经成为治疗关节假体周围感染的金标准。
 
摘要
背景:髋关节置换后感染对于年老体弱患者是灾难性的并发症,对于这类患者如何有效控制感染,保留一定的髋关节功能是一个难题。
目的:探讨3D打印抗生素骨水泥股骨头占位器作为年老体弱患者髋关节置换后感染终极治疗的方法及疗效。
方法:2014年1月至2016年12月采用3D打印抗生素骨水泥占位器作为终极治疗手段治疗4例年老体弱髋关节置换后感染患者,术后通过随访观察伤口愈合情况、髋部X射线检查、感染指标、髋关节功能Harris评分及髋部疼痛目测类比评分。
结果与结论:①患者均获得随访,随访时间8-35个月;4例患者均于术后2周伤口愈合,无残留窦道;4例患者末次随访均无翻修,其中1例患者由于尿毒症诱发多器官功能衰竭于术后9个月死亡;②4例年老体弱患者经3D打印抗生素骨水泥股骨头占位器治疗后,感染得到有效控制,并保留了一定的髋关节功能;③目测类比疼痛评分由术前(8.0±1.5)分降到术后末次随访(2.0±1.4)分(P < 0.05),Harris评分由术前(41.6±4.2)分提高到末次随访的(75.8±6.3)分(P < 0.05);④提示对于年老体弱患者,采用3D打印抗生素骨水泥股骨头占位器能有效控制髋关节置换后感染,且保留一定的髋关节功能,亦可作为终极治疗方法。

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程
ORCID: 0000-0003-2122-6001(曾勉东)

关键词: 3D打印, 髋关节置换, 感染, 伤口愈合, 占位器

Abstract:

BACKGROUND: Infection after hip arthroplasty was a catastrophic complication for the senile and infirm patients. It was difficult for such patients to effectively control infection and retain certain hip function.

OBJECTIVE: To investigate the method and effect of three-dimensional (3D) printed antibiotic bone cement spacer as the terminal treatment of infection after hip arthroplasty for the senile and infirm patients.
METHODS: Between January 2014 and December 2016, the 3D printed antibiotic bone cement spacer of femoral head was used as the terminal treatment for four senile and infirm patients with artificial joint infection after hip arthroplasty. The wound healing, hip X-ray examination, infection indicators, Harris score, Visual Analogue Scale score were assessed postoperatively.
RESULTS AND CONCLUSION: (1) All patients were followed up for 8-35 months. In the four cases, wound healing without residual fistula was seen at postoperative 2 weeks. No revisions were performed at the last follow-up in four patients. Among them, one patient died of uremia-induced multiple organ failure at postoperative 9 months. (2) The infections were effectively controlled and the functions of hip were mostly retained after treatments by the 3D printed antibiotic bone cement spacer of femoral head. (3) Visual Analogue Scale score decreased from preoperatively (8.0±1.5) points to the last follow-up (2.0±1.4) points (P < 0.05). Harris score increased from preoperatively (41.6±4.2) points to the last follow-up (75.8±6.3) points (P < 0.05). (4) These findings conclude that 3D printed antibiotic bone cement spacer of femoral head can be used for effectively controlling hip infection and retaining most function of hip, for the senile and infirm patients with joint infection after hip arthroplasty. It can also be used as the ultimate treatment.

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程

Key words: Arthroplasty, Replacement, Hip, Infection, Wound Healing, Tissue Engineering

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