| Objective To explore the clinical significance and application value of 3D printed model in adult Crowe Ⅳ developmental dysplasia of the hip combined with S-ROM group prosthesis for total hip arthroplasty.Methods In this study,We enrolled patients diagnosed with Crowe Ⅳ developmental dysplasia of the hip underwent total hip arthroplasty in People’s Hospital of Ningxia Hui Autonomous Region between January 2017 and June 2020.Patients were divided into two groups: 3D model group(n = 10,12 hips)and routine operation group(n = 14,14hips).All patients were treated with combined prosthesis(S-ROM,Beijing-Aikang).According to the need of intraoperative reduction,subtrochanteric transverse osteotomy was used for total hip arthroplasty.The complexity and expected usefulness of 3D printing model and CT three-dimensional reconstruction of hip surgery,the consistency between preoperative planning and intraoperative plan,operation time,intraoperative blood loss,Harris score of preoperative and postoperative follow-up,position and offset distance of prosthesis rotation center relative to acetabular anatomical rotation center,and postoperative complications were observed.Results There was no significant difference in general data between 3D model group and routine operation group.The 3D printing model was used to simulate the operation before operation and plan the operation plan.The operation time in the 3D model group was(150.00±17.65)min less than that in the conventional operation group(160.79±20.90)min,P<0.05.The intraoperative blood loss in the 3D model group was(975.00±142.33)ml less than that in the conventional operation group(1092.86±449.725)ml,but there was no statistical difference between the two groups(P>0.05).The Spearman’s correlation coefficient evaluation of the complexity of hip joint lesions and the expected usefulness score by four senior attending doctors in joint surgery showed that the complexity of hip lesions was positively correlated with the expected clinical usefulness(ρ = 0.63,P=0.033),indicating that with the increase of the complexity of joint lesions,3D printing model is more useful for clinical guidance.The average score of clarity of CT 3D reconstruction and print model was tested by Wilcoxon-U test,which suggested that the print model of the same patient had higher clarity than CT 3D reconstruction model(P < 0.001).In the 3D model group,the consistency of the preoperative simulation planning of the operation plan and determining the acetabular test model with the actual intraoperative scheme was 100%.In the routine group,the preoperative planning of the surgical plan and the rough estimation of the prosthesis type were different from the actual intraoperative scheme.The position and offset distance of the hip prosthesis rotation center relative to the anatomical rotation center were measured on the positive hip X-ray film of the two groups.The results showed that the offset distance was less than 1cm,and there was no significant difference between the two groups(P > 0.05).The results showed that the reconstruction of acetabular side was basically located in the center of anatomical rotation in both groups.The Harris score of the 3D model group recovered from 41.98 ±2.95 before operation to 71.14 ±3.89 at the last follow-up,while the Harris score of the patients in the routine operation group recovered from 43.72 ±4.50 before operation to 72.13 ±2.91 at the last follow-up after operation.There was significant difference in Harris scores between the two groups before and after operation(P< 0.001).The patients of the two groups recovered well in short-term follow-up,and there was no difference in postoperative complications.Conclusion In adult Crowe type Ⅳ DDH patients,the use of 3D printing model for reasonable preoperative planning of surgical plan can reduce the operative time and further achieve precise treatment.3D printing model combined with S-ROM prosthesis in the treatment of adult Crowe Ⅳ DDH recovered well,and satisfactory clinical and imaging results could be obtained. |
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