Inoue Daisuke, Kabata Tamon, Kimura Hiroaki, Tsuchiya Hiroyuki
Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan.
Department of Orthopaedic Surgery, Kanazawa Red Cross Hospital, Kanazawa, Japan.
Eur J Orthop Surg Traumatol. 2019 Jan;29(1):65-71. doi: 10.1007/s00590-018-2279-7. Epub 2018 Aug 21.
The purpose of this study was to conduct a prospective clinical trial to investigate the accuracy of an MRI-based patient-specific acetabular instrument guide during THA.
We conducted a prospective consecutive review of 14 hips in 14 patients who underwent primary THA with a posterolateral approach between September 2016 and February 2018. All preoperative planning and postoperative evaluations were completed on CT-based templating software. A pelvic MRI was taken to create a patient-specific surgical instrument guide. In order to assess the effect of increased experience on accuracy, we divided the cases into two groups according to when surgery was performed and investigated the absolute error in the acetabular component angle between preoperative planning and the postoperative state for each of the groups.
We did not experience postoperative complications such as implant early dislocation in any of the cases. The absolute errors of acetabular implant angle using the patient-specific instrument guide were 3.7° ± 2.2° inclination and 4.5° ± 3.9° anteversion. The absolute error of the initial group was 4.7° ± 2.1° inclination and 6.1° ± 4.0° anteversion; for the later group, it was 2.8° ± 1.8° inclination and 3.2° ± 2.9° anteversion. There was a significant difference in the absolute error of acetabular implant placement between the initial group and the later group.
We believe this study shows that MRI-based patient-specific instrumentation may be a useful alternative to surgical tracking during THA once the slight learning curve has been overcome.
本研究的目的是进行一项前瞻性临床试验，以调查在全髋关节置换术（THA）期间基于MRI的患者特异性髋臼器械导向器的准确性。
我们对2016年9月至2018年2月期间采用后外侧入路接受初次THA的14例患者的14个髋关节进行了前瞻性连续回顾。所有术前规划和术后评估均在基于CT的模板软件上完成。进行骨盆MRI以创建患者特异性手术器械导向器。为了评估经验增加对准确性的影响，我们根据手术时间将病例分为两组，并调查每组术前规划与术后状态之间髋臼组件角度的绝对误差。
我们在任何病例中均未遇到术后并发症，如植入物早期脱位。使用患者特异性器械导向器时髋臼植入角度的绝对误差为倾斜3.7°±2.2°，前倾角4.5°±3.9°。初始组的绝对误差为倾斜4.7°±2.1°，前倾角6.1°±4.0°；后期组为倾斜2.8°±1.8°，前倾角3.2°±2.9°。初始组和后期组之间髋臼植入物放置的绝对误差存在显著差异。
我们认为本研究表明，一旦克服了轻微的学习曲线，基于MRI的患者特异性器械在THA期间可能是手术跟踪的一种有用替代方法。
