Mishra Abhishek, Verma Tarun, Agarwal Gaurang, Sharma Amit, Maini Lalit
1Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India.
Plot no. 60, Vivek Nagar Colony, Nasirpur, Varanasi, Uttar Pradesh India.
Indian J Orthop. 2020 Mar 17;54(2):174-180. doi: 10.1007/s43465-020-00061-2. eCollection 2020 Apr.
Acetabular cup placement is an important modifiable factor determining complication rates like aseptic loosening and hip dislocation related to faulty cup placement, which by standard method is largely dependent upon eyeballing and surgeon's judgment. We evaluated a self-designed, low-cost, patient-specific acetabular jig to guide cup placement in total hip arthroplasty in comparison to conventional technique.
It was a prospective randomized control study. Thirty-six patients were categorized into group-A & group-B. In group-A, virtually designed acetabular jig was 3 Dimensional (3D) printed and used intra-operatively to guide cup placement. In group-B, the standard method of cup placement was used. Acetabular cup placement was evaluated on post-operative x-rays and compared between two groups.
In group-A, angle of anteversion were significantly in centre of range of safe zone as compared to group B in which hip is maximally stable with more precision in creating hip centre as compared to group-B without any significant( = 0.325) increase in surgical time or blood loss.
Computed tomography (CT) scan based virtual pre-operative templating and cup placement guided by virtually designed, patient-specific acetabular jig is a low-cost tool with a short learning curve which can be designed and made available easily. It is a useful tool in decreasing chances of malpositioning of cup and recreates hip centre close to anatomical one especially in cases where anatomy has been distorted such as bony ankylosis and developmental dysplasia of hip.
髋臼杯的放置是一个重要的可调节因素，它决定了诸如无菌性松动和因髋臼杯放置不当导致的髋关节脱位等并发症的发生率。按照标准方法，髋臼杯的放置很大程度上依赖于目测和外科医生的判断。我们评估了一种自行设计的、低成本的、针对患者的髋臼夹具，用于在全髋关节置换术中指导髋臼杯的放置，并与传统技术进行比较。
这是一项前瞻性随机对照研究。36例患者被分为A组和B组。在A组中，通过计算机辅助设计的髋臼夹具进行三维（3D）打印，并在术中用于指导髋臼杯的放置。在B组中，采用髋臼杯放置的标准方法。通过术后X线评估髋臼杯的放置情况，并在两组之间进行比较。
与B组相比，A组的前倾角显著处于安全区范围的中心，在创建髋关节中心时更加精确，髋关节稳定性更高，且手术时间和失血量均无显著增加（P = 0.325）。
基于计算机断层扫描（CT）扫描的虚拟术前模板设计以及由针对患者的、计算机辅助设计的髋臼夹具指导的髋臼杯放置，是一种低成本工具，学习曲线短，易于设计和获取。它是一种有用的工具，可减少髋臼杯放置不当的几率，并使髋关节中心更接近解剖学位置，尤其是在解剖结构已扭曲的情况下，如骨性强直和发育性髋关节发育不良。
