骨水泥型全髋关节置换术术前规划的准确性。三维计算机规划与传统模板法的随机比较。
Accuracy of the preoperative planning for cementless total hip arthroplasty. A randomised comparison between three-dimensional computerised planning and conventional templating.
机构信息
Department of Orthopaedic Surgery and Traumatology, la Pitié-Salpétrière Hospital, 47-83 boulevard de l'Hôpital, 154, rue de Picpus, 75012 Paris, France.
出版信息
Orthop Traumatol Surg Res. 2012 Apr;98(2):151-8. doi: 10.1016/j.otsr.2011.09.023. Epub 2012 Feb 29.
INTRODUCTION
A high accuracy was recently reported for the three-dimensional (3D) computerised planning of total hip arthroplasty (THA), comparing well with navigation regarding leg length and femoral offset. However, there is no randomised study comparing 3D preoperative planning with conventional 2D templating in terms of accuracy and clinical relevance.
HYPOTHESIS
The 3D preoperative planning has a higher accuracy than the conventional 2D preoperative templating regarding the implants size and their positioning.
PATIENTS AND METHODS
A prospective comparative randomised study was carried out from 2008 to 2009, including two groups of 30 patients who underwent THA for primary osteoarthritis. One surgeon performed all the surgical procedures using a minimally invasive direct anterior approach. In one group, the planning was made on calibrated X-rays using 2D templates. In the other group, a CT-scan based 3D computerised planning was performed with dedicated software. The reconstructed hip final anatomy was compared postoperatively to the preoperative planning and the accuracy was expressed as the mean difference (±SD) between the planned positioning and the final positioning of the implants.
RESULTS
The prediction rate for the stem and the cup sizes were respectively of 100% and 96% in the 3D group versus 43% for both components in the 2D group. When combining both components, the prediction rate was 96% in the 3D group versus 16% in the 2D group. In the 3D group, a high accuracy was achieved for the planning of the leg length (-1.8±3.6 mm ranging from -8 to+4mm) and the femoral offset (-0.07±2.7 mm ranging from -5 to+4mm) versus 1.37±6.4mm ranging from -9 to 13 mm and 0.33±5.7 mm (-16 to 11 mm) in the 2D templating group (P<0.0001).
DISCUSSION
The 3D planning gives a higher accuracy than conventional 2D templating in forecasting the size of cup and the stem. This contributes to the prediction for leg length and offset that is more reliable with the 3D technique. This study suggests that 3D planning CT-scan data is an attractive alternative to navigation to restore these parameters. The high accuracy achieved by a low-experience surgeon suggests that 3D planning may help shorten the learning curve when using the minimally invasive direct anterior approach.
LEVEL OF EVIDENCE
Level III low-powered prospective randomized trial.
简介
最近有研究报道称，三维（3D）计算机辅助全髋关节置换术（THA）规划具有很高的准确性，在下肢长度和股骨偏心距方面与导航技术相当。然而，目前还没有随机研究比较 3D 术前规划与传统 2D 模板在准确性和临床相关性方面的差异。
假设
3D 术前规划在预测假体大小和位置方面比传统的 2D 术前模板更准确。
患者和方法
这是一项前瞻性随机对照研究，于 2008 年至 2009 年进行，共纳入 30 例原发性骨关节炎患者，均接受 THA 治疗。一位外科医生使用微创直接前入路完成所有手术。一组患者使用校准 X 线片和 2D 模板进行规划，另一组则使用 CT 扫描和专用软件进行 3D 计算机辅助规划。术后比较重建髋关节的最终解剖结构与术前规划，并以假体的实际定位与计划定位之间的平均差值（±标准差）表示准确性。
结果
3D 组预测股骨柄和髋臼杯的准确率分别为 100%和 96%，而 2D 组两者的准确率均为 43%。当结合两种方法时，3D 组的预测准确率为 96%，而 2D 组仅为 16%。3D 组在下肢长度（-1.8±3.6mm，范围为-8 至+4mm）和股骨偏心距（-0.07±2.7mm，范围为-5 至+4mm）的规划方面取得了较高的准确性，而 2D 模板组的准确性分别为 1.37±6.4mm（范围为-9 至 13mm）和 0.33±5.7mm（范围为-16 至 11mm）（P<0.0001）。
讨论
3D 规划在预测髋臼杯和股骨柄的大小方面比传统的 2D 模板更准确。这有助于更可靠地预测下肢长度和偏心距，而 3D 技术在这方面具有优势。本研究表明，3D 规划 CT 扫描数据是导航技术的一种有吸引力的替代方法，可以恢复这些参数。即使由经验相对较少的外科医生进行操作，也能达到较高的准确性，这表明 3D 规划可能有助于缩短使用微创直接前入路时的学习曲线。
证据等级
III 级低效能前瞻性随机试验。
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