人工智能术前规划系统辅助人工全髋关节置换术后翻修手术的疗效研究  

Effectiveness analysis of revision surgery after total hip arthroplasty assisted by artificial intelligence preoperative planning system

作　　者：朱家庆 孙家豪 刘金柱 马博闻 张驰宇 张超 夏天卫 沈计荣 ZHU Jiaqing;SUN Jiahao;LIU Jinzhu;MA Bowen;ZHANG Chiyu;ZHANG Chao;XIA Tianwei;SHEN Jirong(Department of Orthopaedics,Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing Jiangsu,210029,P.R.China;Department of Orthopaedics,Changzhou Hospital of Traditional Chinese Medicine,Changzhou Jiangsu,213004,P.R.China)

机构地区：[1]南京中医药大学附属医院骨伤科,南京210029 [2]常州市中医医院骨伤科,江苏常州213004

出　　处：《中国修复重建外科杂志》2024年第4期455-460,共6页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探究人工智能术前规划系统(AIHIP系统)辅助髋关节翻修手术的早期疗效。方法回顾分析2019年6月—2023年3月收治且符合选择标准的22例(23髋)髋关节翻修患者临床资料。其中男12例,女10例;年龄44~90岁,平均69.7岁。初次翻修19髋,2次翻修3髋,3次翻修1髋。翻修原因:假体松动12髋,髋臼杯松动4髋,骨溶解3髋,髋臼脱位2髋,术后感染1髋,假体磨损1髋。Paprosky髋臼骨缺损分期:ⅡA期6髋,ⅡB期9髋,ⅡC期4髋,ⅢA期3髋,ⅢB期1髋。记录患者更换假体型号、手术时间、住院时间、下地情况等,以及术后感染、骨折、假体松动等不良事件发生情况。术前、术后1周及6个月采用Harris评分评价患肢功能,比较术前及术后6个月髋关节活动度。结果患者手术时间85~510 min,平均241.8 min;住院时间7~35 d,平均15.2 d;脱离助行器时间2~108 d,平均42.2 d。22例患者均获随访,随访时间8~53个月,平均21.7个月。除1例患者术后出现大腿血肿、1髋发生髋关节脱位外,余患者均无假体松动、感染等不良事件发生。术后髋臼杯型号匹配程度为完全匹配22髋,不匹配1髋(+2号),匹配率95.65%;股骨柄型号匹配程度为完全匹配22例髋、一般匹配1髋(–1号),匹配率100%。术后1周及6个月Harris评分分别为(55.3±9.8)分和(89.6±7.2)分,较术前(33.0±8.6)分显著改善(P<0.05),术后6个月较1周时进一步改善(P<0.05);术后6个月根据Harris评分评价患者髋关节功能,获良21髋、中2髋,可满足日常生活需求。术后6个月髋关节活动度为(111.09±10.11)°,与术前(79.13±18.50)°比较差异有统计学意义(t=−7.269,P<0.001)。结论AIHIP系统辅助治疗THA术后翻修患者,可提升翻修手术的精准性,降低手术难度,患者术后恢复效果好,早期疗效满意。Objective To explore the short-term effectiveness of hip revision surgery guided by artificial intelligence preoperative planning(AIHIP)system.Methods The clinical data of 22 patients(23 hips)who were admitted between June 2019 and March 2023 and met the selection criteria were retrospectively analyzed.There were 12 males and 10 females with an average age of 69.7 years(range,44-90 years).There were 19 hips in the first revision,3 hips in the second revision,and 1 hip in the third revision.The causes of revision included 12 hips with prosthesis loosening,4 hips with acetabular cup loosening,3 hips with osteolysis,2 hips with acetabular dislocation,1 hip with postoperative infection,and 1 hip with prosthesis wear.There were 6 hips in stageⅡA,9 hips in stageⅡB,4 hips in stageⅡC,3 hips in stageⅢA,and 1 hip in stageⅢB according to Paprosky staging of acetabular bone defect.The replacement of prosthesis type,operation time,hospitalization stay,ground active condition,and postoperative infection,fracture,prosthesis loosening,and other adverse events were recorded.The function of the affected limb was evaluated by Harris score before operation,at 1 week and 6 months after operation,and the range of motion of the hip joint was compared before operation and at 6 months after operation.Results The operation time was 85-510 minutes,with an average of 241.8 minutes;the hospitalization stay was 7-35 days,with an average of 15.2 days;the time of disassociation from the walker was 2-108 days,with an average of 42.2 days.All the 22 patients were followed up 8-53 months(mean,21.7 months).No adverse events such as prosthesis loosening or infection occurred in the rest of the patients,except for postoperative hematoma of the thigh in 1 patient and dislocation of the hip in 1 hip.The matching degree of acetabular cup was completely matched in 22 hips and mismatched in 1 hip(+2),the matching rate was 95.65%.The matching degree of femoral stem was completely matched in 22 hips and generally matched in 1 hip(−1),and the mat

关 键 词：人工智能 术前规划 人工全髋关节置换术 翻修手术 

分 类 号：R687.4[医药卫生—骨科学]