[术前数字化规划在发育性髋关节发育不良髋臼重建中的作用]
[Effect of preoperative digital planning in acetabular reconstruction in development dysplasia of the hip].
作者信息
Zhao Xiaoyi, Kang Yan, Wu Peihui, Zhang Ziji, Zhang Zhiqi, Fu Ming, Liao Weiming
出版信息
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2013 Dec;27(12):1419-23.
OBJECTIVE
To evaluate the effect of preoperative digital planning in acetabular reconstruction of total hip arthroplasty (THA) for development dysplasia of the hip (DDH).
METHODS
A prospective study was performed on 42 patients with DDH undergoing primary THA between January 2009 and December 2011. The patients were divided into 2 groups according to whether preoperative digital planning was made or not; before operation, conventional imaging method was used in 23 cases (group A), and TraumaCad software was used for preoperative digital planning in 19 cases (group B). There was no significant difference in gender, age, body mass index, DDH classification, and preoperative Harris score between 2 groups (P > 0.05). The operation time, amount of bleeding, and postoperative complication were observed. After 7 days of operation, X-ray films were done to measure the vertical location, horizontal location, radiographic anteversion angle, radiographic inclination angle, and prosthesis size by TraumaCad software. The qualified rate of cup placement was compared between 2 groups. Coincidence rate of cup size between preoperative predicted by the digital planning and actually implanted in group B also was calculated.
RESULTS
The operation time and the amount of bleeding were (119.25 +/- 47.16) minutes and (410.00 +/- 200.39) mL in group A and were (155.31 +/- 84.03) minutes and (387.50 +/- 251.99) mL in group B respectively, showing no significant difference between 2 groups (P > 0.05). Incision infection and prosthetic anterior dislocation occurred in 1 case of group A respectively, prosthetic posterior dislocation in 1 case of group B. The patients were followed up 1 year and 1 month to 4 years and 1 month (mean, 2 years and 8 months ) in group A, and 1 year and 3 months to 4 years (mean, 2 years and 7 months) in group B. At last follow-up, the Harris scores were 91.09 +/- 5.35 in group A and 91.72 +/- 3.48 in group B, which were significantly increased when compared with preoperative scores (P < 0.05), but no significant difference was found between 2 groups (t=0.41, P=0.69). The qualified rate of cup placement of group B (78.95%, 15/19) was significantly higher than that of group A (43.48%, 10/23) (chi2=5.43, P=0.02); the coincidence rate of the cup size between preoperative predicted by the digital planning and actually implanted was 68.42% (13/19).
CONCLUSION
Preoperative digital planning can further optimize the acetabular reconstruction in THA for DDH.
目的
评估术前数字化规划在发育性髋关节发育不良（DDH）全髋关节置换术（THA）髋臼重建中的效果。
方法
对2009年1月至2011年12月期间行初次THA的42例DDH患者进行前瞻性研究。根据是否进行术前数字化规划将患者分为2组；术前，23例采用传统成像方法（A组），19例采用TraumaCad软件进行术前数字化规划（B组）。两组在性别、年龄、体重指数、DDH分级及术前Harris评分方面差异无统计学意义（P>0.05）。观察手术时间、出血量及术后并发症。术后7天拍摄X线片，采用TraumaCad软件测量髋臼假体的垂直位置、水平位置、影像学前倾角、影像学倾斜角及假体尺寸。比较两组髋臼杯置入合格率。计算B组术前数字化规划预测与实际植入的髋臼杯尺寸符合率。
结果
A组手术时间和出血量分别为（119.25±47.16）分钟和（410.00±200.39）ml，B组分别为（155.31±84.03）分钟和（387.50±251.99）ml，两组差异无统计学意义（P>0.05）。A组分别有1例发生切口感染和假体前脱位，B组有1例发生假体后脱位。A组随访时间为1年1个月至4年1个月（平均2年8个月），B组为1年3个月至4年（平均2年7个月）。末次随访时，A组Harris评分为91.09±5.35，B组为91.72±3.48，与术前评分相比均显著提高（P<0.05），但两组间差异无统计学意义（t=0.41，P=0.69）。B组髋臼杯置入合格率（78.95%，15/19）显著高于A组（43.48%，10/23）（χ2=5.43，P=0.02）；术前数字化规划预测与实际植入的髋臼杯尺寸符合率为68.42%（13/19）。
结论
术前数字化规划可进一步优化DDH患者THA中的髋臼重建。
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