三维术前规划辅助全髋关节置换术治疗发育性髋关节发育不良继发骨关节炎  

Application of preoperative three-dimensional reconstruction planning in total hip arthroplasty for development dysplasia of the hip secondary to osteoarthritis

作　　者：吴立忠[1] 祝福贵 李章来 詹洋[1] 吴星[1] 翁绳健[1] 张逸凌 李炜明[1] Wu Lizhong;Zhu Fugui;Li Zhanglai;Zhan Yang;Wu Xing;Weng Shengjian;Zhang Yiling;Li Weiming(Department of Joint Surgery,Fuzhou Second Hospital,Fuzhou 350007,China;Harvard Medical School,Boston 02138,USA)

机构地区：[1]福州市第二医院关节外科,福州350007 [2]哈佛大学医学院,波士顿02138

出　　处：《中华骨科杂志》2023年第1期55-61,共7页Chinese Journal of Orthopaedics

基　　金：福建省创伤骨科急救与康复临床医学研究中心(2020Y2014)。

摘　　要：目的分析三维术前规划辅助全髋关节置换治疗发育性髋关节发育不良继发骨关节炎的临床疗效。方法回顾性分析2019年10月至2021年3月接受初次单侧人工全髋关节置换术的80例CroweⅠ~Ⅲ型发育性髋关节发育不良继发骨关节炎的患者资料,男18例、女62例;年龄(55.7±10.4)岁(范围41~72岁)。三维规划组的40例患者采用下肢全长CT扫描数据在三维重建软件上规划假体型号及安装角度并计算下肢长度差和股骨偏距;常规规划组的40例患者采用常规胶片测量法进行术前规划,根据术前的测量数据及术中双下肢比对的方法计算下肢长度差。比较两组术后双下肢长度差及髋关节偏心距、Harris髋关节功能评分、手术时间、术中失血量和并发症的发生率。结果80例患者均顺利完成手术,统一随访至术后3个月。三维规划组的手术时间为(70.9±7.7)min,术后下肢长度差为(2.78±1.31)cm,髋关节偏心距差为(2.43±1.41)cm,术后1周的髋关节功能评分为(75.67±3.35)分;对照组为手术时间为(81.6±13.3)min,术后下肢长度差为(5.35±2.15)cm,髋关节偏心距差为(5.50±2.83)cm,术后1周的髋关节功能评分为(67.35±4.21)分。三维规划组优于常规规划组,差异均有统计学意义(t=-4.91,P<0.001;t=-5.74,P<0.001;t=5.75,P<0.001;t=12.33,P=0.002)。三维规划组术中使用髋臼假体与规划型号相同的比例为95%、股骨柄为90%,而常规规划组髋臼假体与规划型号相同的比例为75%、股骨柄仅为68%,差异有统计学意义(χ^(2)=7.51,P=0.023;χ^(2)=14.92,P=0.005)。80例患者术中无一例出现血管及神经损伤,术后无一例发生脱位及假体周围感染等并发症。结论三维术前规划辅助全髋关节置换治疗CroweⅠ~Ⅲ型发育性髋关节发育不良继发骨关节炎可以提高手术的精准性,有利于恢复下肢长度和髋关节偏心距。Objective To investigate the clinical efficacy of preoperative three-dimensional(3D)reconstruction planning in total hip arthroplasty for development dysplasia of the hip secondary to osteoarthritis.Methods A total of 80 patients with osteoarthritis secondary to Crowe I-III developmental dysplasia of the hip who underwent primary unilateral total hip arthroplasty from October 2019 to March 2021 were retrospectively analyzed,including 18 males and 62 females and the mean age was 55.7±10.4 years(range 41-72 years).Forty patients in the 3D group,the prosthesis type and installation angle were planed on the 3D reconstruction software based on the full-length CT scan data of the lower limbs,and the length difference of the lower limbs and hip offset were calculated.Forty patients in the control group underwent preoperative planning using conventional film measurement,and lower limb length was judged based on the preoperative measurement data and intraoperative comparison of both lower limbs.The difference of postoperative leg length,hip offset,hip function score,operating time,intraoperative blood loss,and incidence of complications were compared between the two groups.Results All 80 patients completed the surgery successfully and the follow-up time was up to 3 months after operation.The 3D group was better than the control group in operation time(70.9±7.7 min vs.81.6±13.3 min,t=-4.91,P<0.001),the difference of postoperative lower limb length(2.78±1.31 cm vs.5.35±2.15 cm,t=-5.74,P<0.001),and hip function score at 1 week after operation(75.67±3.35 vs.67.35±4.21,t=12.33,P=0.002),with statistically significant differences.In the 3D group,95%of acetabular prosthesis and 90%of femoral stem components were consistent with the planned model,while the rate were only 75%and 68%in the control group,and the difference was statistically significant(χ^(2)=7.51,P=0.023;χ^(2)=14.92,P=0.005).There were no intraoperative complications such as vascular and nerve injury,and no postoperative complications such as dislocation or

关 键 词：发育性髋关节发育不良 外科手术 计算机辅助 关节成形术 置换 髋 成像 三维 

分 类 号：R687.4[医药卫生—骨科学]