Cao Zheng, Yang Wei, Yang Minzhi, Kong Xiangpeng, Wang Yi, Guo Renwen, Chen Jiying, Chai Wei
Medical School of Nankai University, Tianjing, 300071, P.R.China;Department of Orthopedics, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, P.R.China.
Department of Orthopedics, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2019 Nov 15;33(11):1374-1378. doi: 10.7507/1002-1892.201903108.
To investigate the accuracy of preoperative digital-template planning in total hip arthroplasty (THA) via direct anterior approach (DAA) and its effect on the short-term effectiveness.
The clinical data of 77 patients (109 hips) with osteonecrosis of femoral head who underwent THA via DAA between January 2016 and May 2018 was retrospectively analyzed. According to the type of template, patients were divided into digital-template group (group A, 40 patients, 56 hips) and conventional-template group (group B, 37 patients, 53 hips). There was no significant difference in age, gender, body mass index, the stages of osteonecrosis of femoral head, and preoperative Harris hip score (HHS) ( >0.05). The operation time, intraoperative blood loss, frequencies of intraoperative fluoroscopy, and complications were recorded. Otherwise, the consistency rate of preoperative planning and practical prosthesis size was analyzed. Position of acetabular prosthesis and femoral prosthesis alignment were measured on anteroposterior X-ray film of the pelvis at 3 months after operation. HHS was used to evaluate clinical function.
The consistency rate of preoperative planning and practical acetabular prosthesis size was significantly higher in group A (80.4%, 45/56) than that in group B (62.3%, 33/53), showing significant difference ( =4.38, =0.04). But there was no significant difference in the consistency rate of preoperative planning and practical femoral prosthesis size between group A (83.9%, 47/56) and group B (79.2%, 42/53）( =0.40, =0.53). The prosthesis abductions were (40.7±6.4)° in group A and (38.8±7.3)° in group B; the femoral prosthesis alignment deviations were (0.1±1.8)° in group A and (0.3±1.7)° in group B. There was no significant difference in the prosthesis abduction and femoral prosthesis alignment deviation between 2 groups ( >0.05). No prosthesis sinking or loosening occurred during follow-up. The operation time and frequencies of intraoperative fluoroscopy were less in group A than those in group B ( <0.05). But there was no significant difference in intraoperative blood loss between 2 groups ( =1.92, =0.06). The complication occurred in 1 hip of group A and 6 hips of group B, with no significant difference ( =0.06). All patients were followed up 6-22 months (mean 13.8 months) in group A and 6-24 months (mean, 14.6 months) in group B. At last follow-up, the HHS scores were 91.8±3.1 in group A and 92.6±4.2 in group B, and the difference was not significant ( =1.14, =0.26).
Preoperative digital-template planning in THA via DAA is accurate, which can reduce the operation time and frequencies of intraoperative fluoroscopy without enhancing the risk of complication.
探讨全髋关节置换术（THA）直接前路（DAA）术前数字模板规划的准确性及其对短期疗效的影响。
回顾性分析2016年1月至2018年5月间77例（109髋）股骨头坏死患者行DAA THA的临床资料。根据模板类型，将患者分为数字模板组（A组，40例患者，56髋）和传统模板组（B组，37例患者，53髋）。两组患者在年龄、性别、体重指数、股骨头坏死分期及术前Harris髋关节评分（HHS）方面差异均无统计学意义（P>0.05）。记录手术时间、术中出血量、术中透视次数及并发症情况。此外，分析术前规划与实际假体尺寸的符合率。术后3个月在骨盆前后位X线片上测量髋臼假体位置及股骨假体对线情况。采用HHS评估临床功能。
A组术前规划与实际髋臼假体尺寸的符合率（80.4%，45/56）显著高于B组（62.3%，33/53），差异有统计学意义（χ²=4.38，P=0.04）。但A组（83.9%，47/56）与B组（79.2%，42/53）术前规划与实际股骨假体尺寸的符合率差异无统计学意义（χ²=0.40，P=0.53）。A组假体外展角度为（40.7±6.4）°，B组为（38.8±7.3）°；A组股骨假体对线偏差为（0.1±1.8）°，B组为（0.3±1.7）°。两组假体外展角度及股骨假体对线偏差差异均无统计学意义（P>0.05）。随访期间未发生假体下沉或松动。A组手术时间及术中透视次数少于B组（P<0.05）。但两组术中出血量差异无统计学意义（t=1.92，P=0.06）。A组有1髋发生并发症，B组有6髋发生并发症，差异无统计学意义（P=0.06）。A组所有患者随访6-22个月（平均13.8个月），B组随访6-24个月（平均14.6个月）。末次随访时，A组HHS评分为91.8±3.1，B组为92.6±4.2，差异无统计学意义（t=1.14，P=0.26）。
DAA THA术前数字模板规划准确，可减少手术时间及术中透视次数，且不增加并发症风险。
