Three-dimensional printed navigation template assisted core decompression and bone grafting for treatment of ARCO stage II non-traumatic femoral head necrosis / 中国组织工程研究

ABSTRACT

BACKGROUND: Core decompression and bone grafting is the main postoperative method in the treatment of ARCO stage II non-invasive necrosis of the femoral head, but there are risks of inaccurate location, incomplete or excessive removal of necrotic bone. OBJECTIVE: To observe the accuracy and safety of three-dimensional(3 D) printed navigation template assisted core decompression and bone grafting in the treatment of ARCO stage II non-traumatic femoral head necrosis. METHODS: Eighty patients(96 hips) of ARCO stage II non-traumatic femoral head necrosis were enrolled from January to November 2017 in Honghui Hospital Affiliated to Xi’an Jiaotong University. The patients were randomly divided into two groups. In the 3 D group, 40 cases(48 hips) received 3 D printed navigation template assisted core decompression and bone grafting. In the control group, 40 cases(48 hips) received core decompression and bone grafting(no navigation template). All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. The operation time, intraoperative fluoroscopy, and intraoperative blood loss were recorded, and X-ray examination results at 3, 6, 12, and 24 months after operation were observed. The femoral head survival rate, hip Harris score, and pain visual analogue scale score were evaluated. The efficacy was compared. RESULTS AND CONCLUSION:(1) Compared with the control group, the operation time was shortened from(132.57±14.86) minutes to(82.63±10.31) minutes; the number of intraoperative fluoroscopy was reduced from(16.80±2.15) times to(4.93±1.36) times; blood loss was reduced from(143.23±17.98) mL to(75.64± 16.23) mL in the 3 D group. Operation time, number of fluoroscopy, and blood loss were superior in the 3 D group than in the control group(P < 0.05).(2) The 24-month follow-up of imaging showed that only 2 cases of the femoral head collapsed in the 3 D group, but the hip joint function was acceptable. There was no artificial hip arthroplasty and the femoral head survival rate was 96%. In the control group, femoral head collapsed in 9 cases. Four of them had total hip arthroplasty due to limited hip joint activity, and the femoral head survival rate was 81%. The survival rate of the femoral head in the 3 D group was higher than that in the control group(P=0.024).(3) Compared with the control group, Harris score and visual analogue scale score were improved in the 3 D group(P < 0.05).(4) Applying 3 D printed navigation template to core decompression and bone grafting for ARCO stage II non-traumatic femoral head necrosis can reduce the operation time, intraoperative fluoroscopy and blood loss, and improve the accuracy and safety of intraoperative positioning.