术中透视与术后CT测量泰勒空间支架安装参数的精准度比较研究  

Comparison of intraoperative fluoroscopy and postoperative CT measurement of mounting parameters for Taylor Spatial Frame

作　　者：石博文[1] 王晓亮 张克刚[1] 陈旭[1] 李卫哲[1] 郭峰[1] 刘亚斌[1] 舒衡生[1] Shi Bowen;Wang Xiaoliang;Zhang Kegang;Chen Xu;Li Weizhe;Guo Feng;Liu Yabin;Shu Hengsheng(Department of Orthopaedic Traumatology,Tianjin Hospital,Tianjin 300211,China;Department of Radiology,Tianjin Hospital,Tianjin 300211,China)

机构地区：[1]天津市天津医院创伤骨科,300211 [2]天津市天津医院放射科,300211

出　　处：《中华骨科杂志》2020年第5期285-293,共9页Chinese Journal of Orthopaedics

摘　　要：目的比较术中透视与术后CT测量泰勒空间支架(Taylor Spatial Frame,TSF)安装参数的精准度和术后疗效。方法回顾性分析2006年6月至2017年12月,采用TSF治疗膝关节周围畸形患者资料,根据测量安装参数不同方法分为透视组(通过术中透视测量获得安装参数)和CT组(通过术后CT测量获得安装参数)。其中透视组33例(35侧),男23例(23侧),女10例(12侧);年龄(36.4±11.6)岁;22例(24侧)行单纯胫骨高位截骨矫形,5例(5侧)行股骨远端截骨矫形,6例(6侧)同时行股骨远端和胫骨高位截骨矫形。CT组30例(30侧),男19例,女11例;年龄(36.9±13.8)岁;22例行单纯胫骨高位截骨矫形,5例行股骨远端截骨矫形,3例同时行股骨远端和胫骨高位截骨矫形。采用t检验比较两组的手术时间、外固定时间、电子处方数量及畸形矫正时间、机械轴偏移距离(mechanical axis deviation,MAD)、胫骨近端内侧角(medial proximal tibia angle,MPTA)、机械轴股骨远端外侧角(mechanicallateral distal femoral angle,mLDFA)、膝关节活动范围(range of motion,ROM)及纽约特种外科医院(hospital for special surgery,HSS)膝关节功能评分。结果63例患者均获得随访,随访时间21.9个月(范围,12~60个月)。透视组和CT组手术时间分别为(100.9±9.1)min和(79.2±10.8)min,电子处方数量为(1.4±0.6)个和(1.2±0.4)个,畸形矫正时间为(19.4±3.6)d和(16.0±4.4)d,以上各指标两组比较差异均有统计学意义(t=8.803,2.042,3.440;均P<0.05)。透视组和CT组外固定时间分别为(4.8±0.9)个月和(4.6±0.9)个月,MAD为(4.3±2.1)mm和(4.0±1.9)mm,MPTA为88.5°±1.9°和87.8°±1.7°,mLDFA为89.2°和88.6°,膝关节ROM为122.4°±3.9°和122.7°±3.4°,HSS评分为(90.0±3.6)分和(91.1±2.9)分,以上各指标两组比较差异均无统计学意义(均P>0.05)。透视组22侧肢体通过一个电子处方获得畸形矫正,13侧肢体通过两个或两个以上电子处方获得畸形矫正,CT组25侧肢体通过1个电子处方获得Objective To investigate the accuracy and postoperative efficacy of fluoroscopy and CT in measuring the mounting parameters of Taylor Spatial Frame.Methods Data of patients with peripheral knee deformities who were treated by Taylor Spatial Frame from June 2006 to December 2017 were retrospectively analyzed.According to different measurement methods of mounting parameters,they were divided into fluoroscopy group(mounting parameters were obtained by intraoperative fluoroscopy)and CT group(mounting parameters were obtained by postoperative CT).There were 33 patients(35 segments)in the fluoroscopy group,23 males(23 segments)and 10 females(12 segments),with an average age of 36.4±11.6 years old.In CT group,there were 30 patients,19 males and 11 females,with an average age of 36.9±13.8 years.There were 22 cases(24 segments)of high tibial osteotomy,5 cases(5 segments)of distal femur osteotomy,and 6 cases(6 segments)of both distal femur and high tibial osteotomy.Operation time,external fixation time,the number of electronic prescription and deformity correction time,mechanical axis deviation(MAD),medial proximal tibia angle(MPTA),mechanical lateral distal femoral angle(mLDFA),range of motion(ROM)andhospital for special surgery(HSS)knee functional scores were compared between the two groups.Results All the 63 patients were followed up for 21.9 months(range,12-60 months).In fluoroscopy group,operating time was 100.9±9.1 min,electronic prescription number 1.4±0.6,and deformity correction time was 19.4±3.6 days.In CT group,operating time was 79.2±10.8 min,electronic prescription number 1.2±0.4,and deformity correction time was 16.0±4.4 days.The difference of the above indexes between the two groups was statistically significant(t=8.803,2.042,3.440,all P<0.05).In the fluoroscopy group,the external fixation time was 4.8±0.9 months;MAD was 4.3±2.1 mm;MPTA was 88.5°±1.9°;mLDFA was knee 89.2°;ROM was 122.4°±3.9°and HSS score was 90.0±3.6.In CT group,the external fixation time was 4.6±0.9 months;MAD was 4.0±1.

关 键 词：膝关节 肌肉骨骼畸形 X线透视检查 体层摄影术 螺旋计算机 外固定器 

分 类 号：R687[医药卫生—骨科学]