Wang Chenggong, Xiao Han, Yang Weiwei, Wang Long, Hu Yihe, Liu Hua, Zhong Da
Department of Orthopedics, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, 410008, Hunan, China.
Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China.
J Orthop Surg Res. 2019 Jan 14;14(1):19. doi: 10.1186/s13018-018-1029-1.
It is challenging to create an ideal artificial acetabulum during total hip arthroplasty (THA) in adult DDH. Our team developed a new patient-specific instrument (PSI) that uses the superolateral rim of the acetabulum as a positioning mark to assist in the production of an artificial acetabulum in adult Crowe II/III DDH patients. The purpose of this retrospective study is to verify whether this new PSI can be used to implement the preoperative plan accurately and quickly to create an ideal artificial acetabulum during THA in adult Crowe II/III DDH patients.
We selected suitable adult Crowe II/III DDH patients from the registration system for artificial joint surgery at our hospital during April 2016 to March 2018 who underwent THA assisted by a PSI using the superolateral rim of the acetabulum as a positioning mark. We retrospectively analyzed data, including preoperative and postoperative anteversion, inclination, postoperative bilateral rotator center discrepancy (BRCD), surgery time, and the incidence of neurovascular injury. All patients underwent follow-up, and their Harris hip score (HHS) and X-ray data were recorded. Then, we performed statistical analyses on the data described above.
A total of 20 hip surgeries from 17 patients were included in our study. All patients underwent a successful operation assisted by the PSI. The mean anteversion of the cup in our preoperative plan was 15.1° (range, 10.0° to 20.0°), while the mean postoperative anteversion of the cup was 15.3° (range, 7.0° to 28.6°). The mean inclination of the cup in our preoperative plan was 44.7° (range, 40.0° to 50.0°), while the mean postoperative inclination of the cup was 45.6° (range, 35.0° to 57.6°). Paired-samples t test revealed no significant differences in anteversion and inclination between pre- and postoperation times (P > 0.05). The mean BRCD was 3.38 ± 3.0 mm (range, 0.5 to 11.0 mm). The average operation time was 105.1 ± 15.4 min, and no patients had neurovascular injury complications. All patients' acetabular components appeared clinically and radiologically stable after surgery. The mean HHS values were significantly improved at 12 weeks (P < 0.05) and 24 weeks (P < 0.05) postoperatively compared to the preoperative mean scores.
The new PSI is accurate and practical to create an ideal artificial acetabulum during THA in adult Crowe II/III DDH patients.
在成人发育性髋关节发育不良（DDH）患者的全髋关节置换术（THA）中，创建理想的人工髋臼具有挑战性。我们的团队开发了一种新的个性化器械（PSI），该器械以髋臼的上外侧边缘作为定位标记，以协助为成人Crowe II/III型DDH患者制作人工髋臼。这项回顾性研究的目的是验证这种新的PSI是否可用于在成人Crowe II/III型DDH患者的THA期间准确、快速地实施术前计划，以创建理想的人工髋臼。
我们从2016年4月至2018年3月我院人工关节手术登记系统中选择合适的成人Crowe II/III型DDH患者，这些患者接受了以髋臼上外侧边缘作为定位标记的PSI辅助的THA。我们回顾性分析了数据，包括术前和术后的前倾角、倾斜角、术后双侧旋转中心差异（BRCD）、手术时间以及神经血管损伤的发生率。所有患者均接受随访，并记录其Harris髋关节评分（HHS）和X线数据。然后，我们对上述数据进行了统计分析。
我们的研究共纳入了17例患者的20例髋关节手术。所有患者均在PSI辅助下成功完成手术。我们术前计划中髋臼杯的平均前倾角为15.1°（范围为10.0°至20.0°），而术后髋臼杯的平均前倾角为15.3°（范围为7.0°至28.6°）。我们术前计划中髋臼杯的平均倾斜角为44.7°（范围为40.0°至50.0°），而术后髋臼杯的平均倾斜角为45.6°（范围为35.0°至57.6°）。配对样本t检验显示术前和术后前倾角和倾斜角无显著差异（P>0.05）。平均BRCD为3.38±3.0mm（范围为0.5至11.0mm）。平均手术时间为105.1±15.4分钟，无患者发生神经血管损伤并发症。所有患者术后髋臼组件在临床和影像学上均表现稳定。与术前平均评分相比，术后12周（P<0.05）和24周（P<0.05）时平均HHS值显著改善。
新的PSI在成人Crowe II/III型DDH患者的THA期间创建理想的人工髋臼准确且实用。
