全髋关节置换术中臼杯三维覆盖率与二维覆盖率关系的应用研究  

Application of the relationship between three-dimensional coverage and two-dimensional coverage of the acetabulum cup in total hip arthroplasty

作　　者：王金子 常文举 张培 陈祖庆 张勇 丁海 Wang Jinzi;Chang Wenju;Zhang Pei;Chen Zuqing;Zhang Yong;Ding Hai(Department of Orthopaedics,the First Affiliated Hospital of Bengbu Medical University,Key Laboratory of Anhui Province for Tissue Transplantation,Bengbu 233000,China)

机构地区：[1]蚌埠医科大学第一附属医院骨科,组织移植安徽省重点实验室,蚌埠233000

出　　处：《中华骨科杂志》2024年第24期1602-1610,共9页Chinese Journal of Orthopaedics

基　　金：安徽省高等学校自然科学基金重点研究项目(KJ2020A0579);安徽省高等学校科学研究项目(2023AH051987);安徽省新时代育人质量工程项目(2022qywsysfkc033)。

摘　　要：目的探讨全髋关节置换术(total hip arthroplasty,THA)中三维真实臼杯覆盖率与二维X线下臼杯覆盖率的关系,并确定可以用于评估臼杯覆盖率的有效参数。方法基于健康成人骨盆CT三维重建数据,3D打印16个骨盆模型,采用常规THA手术操作制备术后髋臼模型。将术后模型以髋臼为中心固定于"C"型臂X线机下进行透视,通过不同角度(15°、30°、45°)旋转"C"型臂X线机,透视获得髋关节正位X线片与髂骨斜位X线片,观察并记录不同透视角度(正位、15°髂骨斜位、30°髂骨斜位、45°髂骨斜位)二维臼杯覆盖率与基于骨盆模型实际测量的三维臼杯覆盖率。由两名观察者分别独立进行X线相关参数(臼杯覆盖率、外展角、前倾角)的评估,统计分析观察者间信度。比较二维与三维臼杯覆盖率的差异。采用多重线性回归分析臼杯前倾角、外展角与臼杯二维、三维覆盖率的相关性。结果正位X线片组、15°斜位片组、30°斜位片组、45°斜位片组臼杯覆盖率分别为87.37%±2.59%、87.01%±2.53%、85.39%±2.57%、83.20%±2.51%,差异有统计学意义(F=6.700,P=0.001)。45°斜位片组与30°斜位片组低于正位片组,45°斜位片组低于30°斜位片组和15°斜位片组,差异均有统计学意义(P<0.05)。外展角和前倾角分别为45.33°±2.22°、14.61°±2.53°。三维臼杯覆盖率为85.66%±2.51%。45°斜位片组明显低于三维覆盖组,差异均有统计学意义(P<0.05);正位片组与三维覆盖组的差异无统计学意义(t=1.893,P=0.062)。多重线性回归分析结果显示,臼杯外展角、前倾角与二维及三维臼杯覆盖率呈负相关,回归方程为:二维臼杯覆盖率=124.627-0.700×外展角-0.379×前倾角,决定系数R^(2)=0.814,P=0.001;三维臼杯覆盖率=120.291-0.603×外展角-0.499×前倾角,R^(2)=0.917,P<0.001。结论不同X线透视角度显示的臼杯覆盖率存在差异,X线正位图像具有高估的风险,特别是外展角的变化可�Objective To investigate the correlation between three-dimensional(3D)true acetabular cup coverage and two-dimensional(2D)X-ray acetabular cup coverage in total hip arthroplasty(THA)and identify effective parameters for evaluating acetabular cup coverage.Methods Sixteen pelvic models were 3D-printed from CT reconstruction data of healthy adult pelvises.Postoperative acetabular models were prepared using standard THA procedures.The postoperative models were centered on the acetabulum and positioned under a C-arm fluoroscope.Fluoroscopy was conducted by rotating the C-arm at different angles(15°,30°,and 45°)to obtain anteroposterior(AP)and iliac oblique X-ray images of the hip joint.The 2D acetabular coverage at different fluoroscopic angles(AP,15°iliac oblique,30°iliac oblique,and 45°iliac oblique)was recorded and compared with the 3D acetabular coverage measured from the pelvic models.Two independent observers assessed related parameters(coverage,abduction angle,anteversion angle)from the 2D X-ray images,and inter-observer reliability was statistically analyzed.Differences between 2D and 3D acetabular coverage were compared,and multiple linear regression analysis was used to assess correlations between acetabular anteversion angle,abduction angle,and both 2D and 3D acetabular coverage.Results The acetabular coverage for the 2D X-ray groups(AP,15°iliac oblique,30°iliac oblique,and 45°iliac oblique)was 87.37%±2.59%,87.01%±2.53%,85.39%±2.57%,and 83.20%±2.51%,respectively,with statistically significant differences(F=6.700,P=0.001).The 45°iliac oblique group had significantly lower coverage than both the 30°iliac oblique group and the AP group,while the 30°iliac oblique group showed significantly lower coverage than the 15°iliac oblique group(all differences,P<0.05).The mean abduction and anteversion angles were 45.33°±2.22°and 14.61°±2.53°,respectively.The 3D acetabular coverage was 85.66%±2.51%.The 45°iliac oblique group had significantly lower coverage than the 3D coverage group(P<0.05),whe

关 键 词：关节成形术 置换 髋 打印 三维 髋臼 假体植入 覆盖率 外展角 前倾角 

分 类 号：R68[医药卫生—骨科学]