可视化智能辅助髋臼镜像重建技术治疗CroweⅡ、Ⅲ型发育性髋关节发育不良  

Visual treatment solution-assisted acetabular mirror reconstruction for patients with Crowe typeⅡ-Ⅲdevelopmental dysplasia of the hip

作　　者：柴伟[1,2] 张博涵 孔祥朋 张洪 周勇刚[1,2] 蒋青 Chai Wei;Zhang Bohan;Kong Xiangpeng;Zhang Hong;Zhou Yonggang;Jiang Qing(Senior Department of Orthopaedics,Forth Medical Center of Chinese PLA General Hospital,Beijing 100048,China;National Clinical Research Center for Orthopaedics,Sports Medicine and Rehabilitation,Beijing 100853,China;Division of Sports Medicine and Adult Reconstructive Surgery,Department of Orthopedic Surgery,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]解放军总医院第四医学中心骨科医学部,北京100048 [2]国家骨科与运动康复临床医学研究中心,北京100853 [3]南京大学医学院附属鼓楼医院骨科、运动医学与成人重建外科,南京210008

出　　处：《中华骨科杂志》2024年第6期345-353,共9页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金区域联合重点项目(U22A20355)。

摘　　要：目的探讨镜像重建理念在可视化智能辅助系统(visual treatment solution,VTS)辅助全髋关节置换术(total hip arthroplasty,THA)治疗CroweⅡ、Ⅲ型发育性髋关节发育不良(developmental dysplasia of the hip,DDH)中应用的可行性和疗效。方法回顾性分析2022年6月至2023年8月于解放军总医院第四医学中心骨科医学部接受初次THA的单侧CroweⅡ、Ⅲ型DDH患者67例。按旋转中心重建位置不同进行术前规划及手术,依照对侧正常关节旋转中心重建(镜像组)37例,男8例、女29例,年龄为(40.9±13.1)岁;选取骨量丰富区域直接高位重建(高位组)30例,男7例、女23例,年龄为(38.3±11.1)岁。比较两组术后12个月时患侧与健侧髋关节旋转中心高度、大转子高度及股骨偏距,比较两组手术前后组间的Harris髋关节评分(Harris hip score,HHS)和西安大略和麦克马斯特大学(the Western Ontario and McMaster University,WOMAC)骨关节炎指数评分。结果所有患者均顺利完成手术,镜像组手术时间、术中出血量、随访时间分别为(113.9±22.9)min、(287.8±181.6)ml、(12.8±1.8)个月,高位组分别为(118.0±26.2)min、(293.3±125.8)ml、(13.7±2.3)个月,组间差异均无统计学意义(P>0.05)。镜像组术后12个月患侧旋转中心高度、大转子高度及股骨偏距分别为(16.1±3.8)、(17.7±5.2)、(34.4±5.1)mm,与健侧的差异均无统计学意义(P>0.05);HHS和WOMAC骨关节炎指数评分分别为(84.3±6.3)、(9.4±2.5)分,较术前的(32.3±5.3)、(76.9±5.4)分改善,差异有统计学意义(t=-34.222,P<0.001;t=64.486,P<0.001);高位组患侧旋转中心高度、大转子高度及股骨偏距分别为(27.9±3.7)、(25.4±7.9)、(35.4±6.2)mm,较健侧增加,差异有统计学意义(t=-15.706,P<0.001;t=-6.494,P<0.001;t=-2.555,P=0.016);HHS和WOMAC骨关节炎指数评分分别为(79.5±4.9)、(13.9±3.3)分,较术前的(30.9±4.8)、(78.7±5.3)分改善,差异有统计学意义(t=-37.339,P<0.001;t=64.375,P<0.001)。镜像组与高位组ObjectiveTo analyze the feasibility and clinical efficacy of mirror reconstruction in total hip arthroplasty(THA)assisted by visual treatment solution(VTS)for patients with Crowe type II-III developmental dysplasia of the hip(DDH).MethodsIncluded in this study were 67 patients(67 hips)with unilateral Crowe type II-III DDH undergoing primary THA from June 2022 to August 2023.According to the reconstruction position of the rotation center,the patients were divided into mirror group and high group.There were 37 patients(37 hips)in the mirror group,reconstructed by referring to the rotation center of contralateral normal hip,with 8 males and 27 females,aged 40.9±16.7 years old and 30 patients(30 hips)in the high group,reconstructed by the"high hip center"strategy,with 7 males and 23 females,aged 38.3±11.1 years old.The radiographic results between the affected hip and the normal hip in 12 months postoperatively and the clinical results before and after the operation were compared.ResultsAll the operations for patients with Crowe type II-III DDH were completed successfully.The operation time,intraoperative blood loss and the follow-up time in the mirror group were 113.9±22.9 min,287.8±181.6 ml and 12.8±1.8 months,respectively,while those in the high group were 118.0±26.2 min,293.3±125.8 ml and 13.7±2.3 months respectively without significant difference between the two groups.In 12 months postoperatively the rotation center height,greater trochanter height and femoral offset of 37 hips in the mirror group were 16.1±3.8 mm,17.7±5.2 mm and 34.4±5.1 mm,respectively,which were not significantly different from those of the normal side,while the HHS and WOMAC osteoarthritis index were significantly improved compared to those before operation from 32.3±5.3 and 76.9±5.4 points to 84.3±6.3 and 9.4±2.5 points(t=-34.222,P<0.001;t=64.486,P<0.001).In the high group,the rotational center height,greater trochanter height and femoral offset of 30 hips were 27.9±3.7 mm,25.4±7.9 mm and 35.4±6.2 mm,respectively,which we

关 键 词：发育性髋关节发育不良 关节成形术 置换 髋 手术导航系统 镜像重建 

分 类 号：R687.4[医药卫生—骨科学]