Caffrey Jason P, Jeffords Megan E, Farnsworth Christine L, Bomar James D, Upasani Vidyadhar V
Department of Orthopedic Surgery University of California.
Rady Children's Hospital, San Diego, CA.
J Pediatr Orthop. 2019 Mar;39(3):e159-e164. doi: 10.1097/BPO.0000000000001271.
BACKGROUND: Children with developmental dysplasia of the hip may require a pelvic osteotomy to treat acetabular dysplasia. Three osteotomies are commonly performed in these patients (Pemberton, Dega, and San Diego), though comparative studies of each are limited. The purpose of this study was to compare changes in acetabular morphology (acetabular version, volume, and octant coverage angles) created by these 3 osteotomies using matched patient-specific 3D-printed pelvic models. METHODS: Fourteen patients with developmental dysplasia of the hip and preoperative computed tomography (CT) imaging were retrospectively included. For each patient CT, bone and cartilage tissues were independently segmented, and 3 identical pelvises were 3D-printed using a dual material printer. Bone was printed with rigid material and cartilage with flexible material to simulate the flexibility of the triradiate cartilage and pubic symphysis. Pemberton, Dega, and San Diego acetabular osteotomies were performed on the triplicate set of 3D prints. Acetabular version, volume, and octant coverage angles (posterior, superior-posterior, superior, superior-anterior, and anterior) were determined before and after each mock surgery by morphologic assessment using preoperative and postoperative CT images. RESULTS: San Diego osteotomy yielded a small increase (+3.34±1.71 degrees) in version, compared with decreases with Pemberton (-5.47±1.54 degrees) and Dega (-8.57±1.21 degrees, P<0.05). Acetabular volume decreased similarly for Pemberton (-13.36%±2.88%), Dega (-19.21%±2.73%), and San Diego (-19.29%±2.44%; P=0.215) osteotomies. San Diego osteotomy tended to have a larger postoperative increase in the posterior regions, and the Dega and Pemberton osteotomies tended to have larger postoperative increases in the anterior coverage regions. CONCLUSIONS: Quantifiable differences were identified in acetabular octant coverage angles and version between the 3 pelvic osteotomies. San Diego osteotomy increased acetabular coverage posteriorly resulting in acetabular anteversion, whereas Pemberton and Dega had greater superior-anterior coverage resulting in relative acetabular retroversion. This study is the first known to utilize 3D-printed models for comparison of surgical approaches in pediatric pelvic osteotomies.
背景:发育性髋关节发育不良的儿童可能需要进行骨盆截骨术来治疗髋臼发育不良。这些患者通常会进行三种截骨术(彭伯顿截骨术、德加截骨术和圣地亚哥截骨术),不过对每种截骨术的比较研究有限。本研究的目的是使用匹配的患者特异性3D打印骨盆模型,比较这三种截骨术所造成的髋臼形态变化(髋臼旋转角、容积和象限覆盖角)。 方法:回顾性纳入14例发育性髋关节发育不良且术前行计算机断层扫描(CT)成像的患者。对于每位患者的CT扫描,分别对骨组织和软骨组织进行分割,并使用双材料打印机3D打印出3个相同的骨盆模型。用刚性材料打印骨骼,用柔性材料打印软骨,以模拟髋臼三角软骨和耻骨联合的柔韧性。在这三组3D打印模型上分别进行彭伯顿截骨术、德加截骨术和圣地亚哥髋臼截骨术。通过术前和术后CT图像的形态学评估,在每次模拟手术后测定髋臼旋转角、容积和象限覆盖角(后方、后上、上方、前上和前方)。 结果:与彭伯顿截骨术(-5.47±1.54度)和德加截骨术(-8.57±1.21度,P<0.05)造成的旋转角减小相比,圣地亚哥截骨术使旋转角有小幅增加(+3.34±1.71度)。彭伯顿截骨术(-13.36%±2.88%)、德加截骨术(-19.21%±2.73%)和圣地亚哥截骨术(-19.29%±2.44%;P=0.215)使髋臼容积的减小情况相似。圣地亚哥截骨术后后方区域的增加趋势更大,而德加截骨术和彭伯顿截骨术后前覆盖区域的增加趋势更大。 结论:在三种骨盆截骨术之间,髋臼象限覆盖角和旋转角存在可量化的差异。圣地亚哥截骨术增加了髋臼后方的覆盖,导致髋臼前倾,而彭伯顿截骨术和德加截骨术增加了髋臼前上的覆盖,导致相对髋臼后倾。本研究是已知的第一项利用3D打印模型比较儿童骨盆截骨术手术方法的研究。
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