MedSport, Section of Sports Medicine and Shoulder Surgery, University of Michigan, Ann Arbor, Michigan 48106, USA.
Arthroscopy. 2012 Feb;28(2):204-10. doi: 10.1016/j.arthro.2011.11.005.
The purpose of this study was to evaluate the utility of computer-assisted 3-dimensional modeling in diagnosing and treating symptomatic hip impingement.
Eight patients with symptomatic, focal cam and/or pincer impingement lesions underwent high-resolution computed tomography scans and computer-assisted, 3-dimensional modeling of the involved hip. Cam location, alpha angle, neck-shaft angle, femoral version, and acetabular version at the 12-o'clock through 3-o'clock positions were measured. The model was subsequently dynamized to define the preoperative range of motion and location of impingement with hip flexion, internal rotation, and internal rotation at 90° of hip flexion. Virtual cam and pincer osteoplasty was performed to establish normal head-neck offset and head sphericity and to eliminate focal rim impingement lesions. Range of motion and location of impingement were reassessed after resection in the defined area of impingement.
The cam lesion was located between the 12-o'clock and 4-o'clock positions in all cases. The mean alpha angle was 66.4° (range, 53° to 80°). Mean femoral version was 14.6° (range, 5° to 23°). Mean preoperative hip flexion was 109.7° (range, 87.5° to 125.5°), and mean internal rotation at 90° of hip flexion was 16.2° (range, 1.7° to 25.5°). The location of impingement was unique in each case and not predictable based on radiographic measures alone. Virtual osteoplasty in the defined regions of impingement resulted in significant improvements in both hip flexion and internal rotation (P < .05).
Computed tomography-based computer modeling can localize regions of anticipated mechanical impingement in symptomatic patients with hip pain. Computer-assisted navigation may be a valuable surgical tool to more accurately and reliably eliminate offending impingement lesions.
Level IV, diagnostic study.
本研究旨在评估计算机辅助三维建模在诊断和治疗症状性髋关节撞击症中的应用价值。
8 例有症状的局限性凸轮和/或钳夹撞击病变患者接受了高分辨率 CT 扫描和计算机辅助髋关节三维建模。测量凸轮位置、α角、颈干角、股骨前倾角和 12 点至 3 点位置的髋臼前倾角。对模型进行动力学分析，以确定髋关节屈曲、内旋和 90°髋关节内旋时术前活动范围和撞击位置。进行虚拟凸轮和钳夹骨成形术，以建立正常的头-颈偏移和头-球体，并消除局灶性边缘撞击病变。在确定的撞击区域切除后，重新评估活动范围和撞击位置。
所有病例的凸轮病变均位于 12 点至 4 点之间。平均α角为 66.4°（范围 53°至 80°）。平均股骨前倾角为 14.6°（范围 5°至 23°）。术前髋关节屈曲平均为 109.7°（范围 87.5°至 125.5°），髋关节屈曲 90°时内旋平均为 16.2°（范围 1.7°至 25.5°）。撞击的位置在每个病例中都是独特的，不能仅根据影像学测量来预测。在确定的撞击区域进行虚拟骨成形术可显著改善髋关节屈曲和内旋（P<.05）。
基于 CT 的计算机建模可定位有髋关节疼痛症状的患者中预期机械撞击的区域。计算机辅助导航可能是一种有价值的手术工具，可更准确和可靠地消除致病的撞击病变。
IV 级，诊断研究。
