Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah.
J Arthroplasty. 2023 Jul;38(7S):S16-S22.e1. doi: 10.1016/j.arth.2023.03.052. Epub 2023 Mar 25.
Radiographic assessment of acetabular fragment positioning during periacetabular osteotomy (PAO) has been linked to hip survivorship. Intraoperative plain radiographs are time and resource intensive, while fluoroscopy can introduce image distortion affecting measurement accuracy. Our purpose was to determine whether intraoperative fluoroscopy-based measurements with a distortion correcting fluoroscopic tool improved PAO measurement targets.
We retrospectively reviewed 570 PAOs; 136 PAOs utilized a distortion correcting fluoroscopic tool, and 434 PAOs performed with routine fluoroscopy, prior to this technology. Lateral center-edge angle (LCEA), acetabular index (AI), posterior wall sign (PWS), and anterior center-edge angle (ACEA) were measured on preoperative standing radiographs, intraoperative fluoroscopic images, and postoperative standing radiographs. Defined target zones of correction were AI: 0-10, ACEA: 25-40, LCEA: 25-40, PWS: negative. Postoperative correction in zones and patient-reported outcomes were compared using chi-square tests and paired t-tests, respectively.
The average difference between postcorrection fluoroscopic measurements and 6-week postoperative radiographs was 0.21° for LCEA, 0.01° for ACEA, and -0.07° for AI (all P < .01). The PWS agreement was 92%. The percentages of hips meeting target goals overall improved with the new fluoroscopic tool: 74%-92% for LCEA (P < .01), 72%-85% for ACEA (P < .01), and 69 versus 74% for AI (P = .25), though there was no improvement in PWS (85 versus 85%, P = .92). All patient-reported outcomes except PROMIS Mental Health were significantly improved at most recent follow-up.
Our study demonstrated improved PAO measurements and target goals with the use of a distortion correcting quantitative fluoroscopic real-time measuring device. This value-additive tool gives reliable quantitative measurements of correction without interfering with surgical workflow.
髋臼周围截骨术（PAO）中髋臼骨折块位置的影像学评估与髋关节生存率相关。术中的普通 X 线片既费时又费资源，而透视可能会导致图像失真，影响测量的准确性。我们的目的是确定在 PAO 术中使用一种具有失真校正功能的透视工具是否可以改善测量目标。
我们回顾性分析了 570 例 PAO 患者的资料；其中 136 例行透视工具校正的髋臼周围截骨术，434 例行常规透视。术前站立位 X 线片、术中透视图像和术后站立位 X 线片上测量了外侧中心边缘角（LCEA）、髋臼指数（AI）、后壁征（PWS）和前中心边缘角（ACEA）。使用卡方检验比较定义的校正目标区和术后患者报告的结果，分别采用配对 t 检验比较术后校正区和术后患者报告的结果。
术后透视校正测量值与 6 周后 X 线片的平均差值为 LCEA 0.21°，ACEA 0.01°，AI -0.07°（均 P <.01）。PWS 的一致性为 92%。总体上，使用新的透视工具后，符合目标的髋关节百分比有所提高：LCEA 为 74%-92%（P <.01），ACEA 为 72%-85%（P <.01），AI 为 69%与 74%（P=.25），但 PWS 无改善（85%与 85%，P=.92）。除 PROMIS 心理健康外，所有患者报告的结局在最近的随访中均有显著改善。
我们的研究表明，使用失真校正的定量透视实时测量设备可改善 PAO 测量和目标。这种增值工具可在不干扰手术流程的情况下，提供可靠的定量校正测量。
