Department of Orthopedics, Orthopedic Research Institute, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China; Department of Orthopedic Surgery, Peking Union Medical College Hospital, Beijing, China; Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
J Arthroplasty. 2023 Aug;38(8):1551-1558. doi: 10.1016/j.arth.2023.01.067. Epub 2023 Feb 9.
This study aimed to investigate the relationship between acetabular width, three-dimensional (3D) simulation, and surgical results in total hip arthroplasty patients who have developmental dysplasia of the hip (DDH).
This retrospective study included 216 DDH cases. Inner and outer acetabular width (OAW) was measured at the plane passing through the center of acetabular fossa. 3D simulation and 2D standard templating were performed. The actual cup size and the use of augments during surgery were recorded. Association among the indices and their distribution in different types of DDH were analyzed.
A difference of 13 to 14 millimeters (mm) was found between the inner acetabular width and actual cup size used in type II, III, and IV cases, while the difference was 0.2 to 3.6 mm for OAW. The accuracy of 2D templating and 3D simulation in predicting cup size was comparable in Crowe type I (86.5 versus 76%, P = .075), type II (72.7 versus 51.5%, P = .127), and type III (93.3 versus 66.7%, P = .169). The 3D simulation was significantly more accurate in Crowe type IV (89.1% versus 60.9%, P = .001). Augments and bone grafts were significantly more commonly used in type II (25%) than in the other types (0 to 6.5%).
OAW more accurately predicted actual cup size than inner acetabular width. The supero-lateral acetabular bone defects in type II cases require additional attention. Compared with 2D templating, 3D simulation is more accurate in predicting actual cup size in dysplastic hips with severe deformity and may be recommended in these selected cases, especially for Crowe IV patients.
本研究旨在探讨髋臼宽度、三维（3D）模拟与髋关节发育不良（DDH）患者全髋关节置换术的手术结果之间的关系。
本回顾性研究纳入了 216 例 DDH 患者。在经过髋臼窝中心的平面上测量髋臼内、外宽度（OAW）。进行 3D 模拟和 2D 标准模板匹配。记录实际杯的大小和术中使用的增强物。分析这些指标之间的关联及其在不同类型 DDH 中的分布。
在 II、III 和 IV 型病例中，髋臼内宽度与实际使用的杯尺寸相差 13 至 14 毫米（mm），而 OAW 相差 0.2 至 3.6 mm。在 Crowe Ⅰ型（86.5%对 76%，P=0.075）、Ⅱ型（72.7%对 51.5%，P=0.127）和Ⅲ型（93.3%对 66.7%，P=0.169）中，2D 模板匹配和 3D 模拟在预测杯尺寸方面的准确性相当。在 Crowe Ⅳ型（89.1%对 60.9%，P=0.001）中，3D 模拟明显更准确。在 II 型（25%）中，增强物和骨移植比其他类型（0 至 6.5%）更常用。
OAW 比髋臼内宽度更能准确预测实际杯的大小。在 II 型病例中，髋臼上外侧骨缺损需要额外注意。与 2D 模板匹配相比，3D 模拟在预测严重畸形发育不良髋关节的实际杯尺寸方面更准确，在这些选定的病例中可能更推荐使用，特别是对于 Crowe IV 型患者。
