| Objective:To evaluate the effectiveness of light-curing 3D printing technology in design and guide total hip arthroplasty surgery in adult with DDH.To design preoperative scheme,guide the position and angle of the cup prosthesis and enhance recovery after surgery,and it was beneficial to the teaching and training of young doctors,shorten the growth cycle.Methods:Between January 2014 and October 2017,the First Affiliated Hospital of Kunming Medical University,33 patients with severe DDH underwent THA.Inclusion criteria:(1)18 years old<age<75 years old,Crowe type ? and ? DDH patients;(2)willing to cooperate with total hip replacement surgery,willing to cooperate with this study and provide relevant information.Exclusion criteria:(1)The patients witch diagnosed as developmental dysplasia of the hip in adults,were no need for surgical treatment,and patients with Crowe type ? and ?;(2)hypertension,coronary heart disease,diabetes,emphysema,chronic renal insufficiency,viral hepatitis,and hypothyroidism and so on;(3)hips with other disease,such as polio,rheumatoid arthritis,acetabular fracture,etc;(4)The patients did not support this study,were unwilling to accept the investigation and provide the relevant information.There were 9 males and 27 females,with an average age of 45.06± 10.75 years,were divided into experimental group and control group.They were categorized according to wthere the 3D printing technology was applied.The general condition of the patients were recorded before operation in all two groups.And in the experimental group,patients underwent spiral CT scanning to make the hip 3D models.Design modle of acetabular cup by Imageware 12.0.According to the hip 3D model,the size of prosthesis and operation scheme were estimated before the operation,and the surgery simulation was performed.The control group performed routine procedure.The actual situation of hip joint,the size of prosthesis,time of operation and blood lose and so on were recorded.A standard X ray was used to measure the HJC of the hip joint,the size of the prosthesis,the anteversion angle and the abduction angle of the acetabular cup before and after the operation.The operation time,blood lose,volume of drainage and length of stay after the operation were evaluated.In the effect of the operation,the hip joint activity,VAS score,Harris score,SF-36 scale and satisfaction with treatment were evaluated.According to the relevant evaluation indicators,we compared the difference between the experimental group and the control group,and evaluated the value of 3D printing in the treatment of DDH by THA.Keep an account of satisfaction with treatment.Meanwhile,related literatures were retrieved for systematic evaluation of Meta analysis.Results:The general situation of the subjects before operation was analyzed.The patients lies in the 40?50 age group,the BMI was in the normal range about 60.61%,the type of Crowe ? type accounted for the total of 2/3,and the patients over 50 years old had more complications.The differences in the datas of the two groups were compared,P>0.05,the difference was not statistically significant.Sharp angle of the all cases were measured by X-ray and CT before operation,the measurement of X ray was 45.06± 2.74 degrees,and the CT was 44.14 ± 3.17 degrees.The difference between the two methods was statistically significant,which explain that CT was more accurate.Indeed,the 3D model was based on CT datas and the measured values were the same,so the 3D model is more accurate too.According to the imaging evaluation,the preoperative and postoperative HJC gap in the experimental group,the vertical distance was 10.89 + 3.14mm,the horizontal distance was 6.67 ± 2.28mm;the vertical distance of the control group was 14.33 +4.33mm,and the horizontal distance was 8.61 ± 2.24mm.The difference between the two groups was statistically significant.The abduction angle of the cup was 45 degrees as standard,the abduction angle gap of the cup before and after operation,the experimental group 1.6 ± 1.14 degrees,the control group 4.33 ± 1.91 degrees,the difference between the two groups was statistically analyzed,P<0.05,the difference was statistically significant.The anteversion angle of the cup was 15 degrees as standard,the abduction angle gap of the cup before and after operation,the experimental group 2.84 ± 1.63 degrees,the control group 3.99 ± 1.75 degrees,the difference between the two groups was statistically analyzed,P<0.05,the difference was statistically significant.The actual hip condition of the experimental group was basically consistent with that of the preoperative 3D printing model.The type of prosthesis used in the operation was completely consistent with the preoperative prediction.From the operation condition,the actual situation of the hip joint in the 18 cases of the experimental group was basically the same as that of the 3D printing model.In the experimental group,the size of prosthesis used in the operation was exactly the same as the preoperation prediction;12 cases of the cup prosthesis and 11 cases of the femoral prosthesis were matched in the control group.The difference between the two groups was statistically was statistically significant,which indicated that the matching degree of prosthesis is more higher in the experimental group.The operation time of the experimental group was 100.12±11.27min,blood lose was 365.56±54.45ml,volume of drainage was 98.76±18.15ml,In the control group,operation time was 117.12± 14.17min,blood lose was 394.89±47.13ml and volume of drainage was 115.94±20.39ml.The datas of experimental group were all less than the control group,the difference between the two groups was statistically analyzed,P<0.05,the difference was statistically significant.From the operative effect,the Harris score,VAS score,hip joint activity,the gap of limbs length and SF-36 were significantly before and after the operation,and the difference was not statistically significant between the two groups.There was no significant difference in the length of stay and treatment satisfaction between the two groups,P>0.05,the difference was not statistically significant.The results of clinical control experiment showed that the accuracy of operation in experimental group was higher than that in control group,such as the vertical distance and horizontal distance of HJC,the abduction angle of the cup and the matching degree of the prosthesis.The time of operation,blood lose and volume of drainage were less,and the difference was statistically significant.In Meta analysis,269 articles were collected in the literature retrieval databases,and 72 articles were repeating.Excluding 181 articles that were inconsistent with the purpose,obj ect and intervention of the study.The remaining 16 articles were read full text,excluding 10 articles(5 articles without comparison or only case analysis);2 articles operation methods was different;3 articles had research design but no result evaluation.).Finally,only 6 articles were included,all of them were case control studies.After systematic evaluation of Meta analysis,it showed that the experimental group was better than the control group in the operation time and the abduction angle gap of cup,and the results of Meta analysis were stable.It showed that the application of 3D printing technique in the treatment of adult DDH with total hip replacement was effective.The medical application of 3D printing technology is gradually mature,the sample size and evaluation index was being perfected,and the research was being further deepened to get a more comprehensive and instructive result.All cases were follow-up(3?34 months).The hip function was improved significantly after the operation with good activity.In the control group,1 case had femoral nerve palsy,but it got right after 1 month.No complications such as joint infection,prosthesis loosening,prosthesis dislocation,sciatic nerve injury occurred during the follow-up period in the other cases.Conclusion:Application of light-curing 3D printing technology in the design and guide prosthesis implantation of total hip arthroplasty surgery in adult with DDH,it can improve the accuracy and security of operation,shorten the time of operation about 30min,the blood loss about 30ml and the volume of drainage about 17ml,reduce the incidence of complications,and improve the hip function and the quality of life obviously.It was beneficial to the teaching and training of young doctors,shorten the growth cycle. |
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