Parchi Paolo Domenico, Ferrari Vincenzo, Piolanti Nicola, Andreani Lorenzo, Condino Sara, Evangelisti Gisberto, Lisanti Michele
1st Orthopaedic Department University of Pisa, Pisa, Italy.
EndoCAS Center for Computer Assisted Surgery University of Pisa, Pisa, Italy.
Surg Technol Int. 2013 Sep;23:228-34.
Each year approximately 1 million total hip replacements (THR) are performed worldwide. A percentage of failure due to surgical approach and imprecise implant placement still exists. These result in several serious complications. We propose an approach to plan, to simulate, and to assist prosthesis implantation for difficult cases of THR based on 3-D virtual models, generated by segmenting patients' CT images, 3-D solid models, obtained by rapid prototyping (RP), and virtual procedure simulation. We carried out 8 THR with the aid of 3-D reconstruction and RP. After each procedure a questionnaire was submitted to the surgeon to assess the perceived added value of the technology. In all cases, the surgeon evaluated the 3-D model as useful in order to perform the planning. The clinical results showed a mean increase in the Harris Hip Score of about 42.5 points. The mean time of prototyping was 7.3 hours, (min 3.5 hours, max 9.3 hours). The mean surgery time was 65 minutes (min 50 minutes, max 88 minutes). Our study suggests that meticulous preoperative planning is necessary in front of a great aberration of the joint and in absence of normal anatomical landmarks, CT scan is mandatory, and 3-D reconstruction with solid model is useful.
全球每年大约进行100万例全髋关节置换术（THR）。由于手术入路和植入物放置不精确导致的失败仍占一定比例。这些会引发多种严重并发症。我们提出一种基于3D虚拟模型的方法，用于计划、模拟和辅助复杂THR病例的假体植入，该模型由分割患者的CT图像生成，通过快速成型（RP）获得3D实体模型，并进行虚拟手术模拟。我们借助3D重建和RP进行了8例THR手术。每次手术后，向外科医生发放一份问卷，以评估该技术的感知附加值。在所有病例中，外科医生都认为3D模型对手术规划很有用。临床结果显示，Harris髋关节评分平均提高约42.5分。原型制作的平均时间为7.3小时（最短3.5小时，最长9.3小时）。平均手术时间为65分钟（最短50分钟，最长88分钟）。我们的研究表明，对于关节严重畸形且缺乏正常解剖标志的情况，细致的术前规划是必要的，必须进行CT扫描，3D实体模型重建很有用。
