Crowe IV型髋关节发育不良中真髋臼的形态学及骨缺损映射分析
Morphological and bone defect mapping analysis of true acetabulum in Crowe type IV hip dysplasia.
作者信息
Yang Yuhui, Chen Duanyong, Zhang Bichun, Li Qingtian, Hu Linyong, Ma Yuanchen, Zheng Qiujian
机构信息
Department of Orthopedics, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China.
The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
出版信息
J Orthop Surg Res. 2024 Dec 30;19(1):888. doi: 10.1186/s13018-024-05389-1.
BACKGROUND
The primary aim of this study was to quantitatively analysis the acetabular morphological feature and 2D/3D coverage of the Crowe IV DDH hip, dividing into subgroups by the false acetabulum. The secondary aim was to propose a 3D bone mapping to determine acetabular bone defect analysis from the perspective of the implanted simulation.
METHODS
A total of 53 Crowe IV hips (27 hips without the false acetabulum in IVa group and 26 hips in IVb group) and 40 normal hips met the inclusion criteria and were retrospectively evaluated. Firstly, the anatomical size and volume of the acetabulum were measured quantitatively. Secondly, through the simulated implantation, morphological assessments of the true acetabulum included Cup-CE, Cup-Sharp, acetabular anteversion angle, and thickness of the medial wall. Last, Acetabular sector angles (ASAs) and the component coverage ratio were measured to provide coverage indices. Further, 3D bone mapping visualization was applied to determine the uncovered component portion distribution.
RESULTS
The anatomic shape and volume of the acetabular triangle were significantly smaller in Crowe IV hips. At the level of the acetabular component center, IVb acetabula were found to be more anteverted and abductive, with smaller Cup-CE and larger Cup-Sharp angles. The coverage sector angles in Crowe IVa hips were larger in the anterosuperior and superior direction, while smaller in the posterosuperior and posterior direction, with no subgroup difference in total component coverage. Both 3D bone mapping and correlation analysis reveal that posterosuperior and posterior bone stock is highly associated with the component coverage.
CONCLUSION
With the presence of the false acetabulum, there existed acetabular anteversion and segmental coverage distinctions between subgroups. During the acetabular reconstruction, management of posterosuperior and posterior bone stock was important for ideal component coverage.
背景
本研究的主要目的是定量分析Crowe IV型发育性髋关节发育不良（DDH）髋关节的髋臼形态特征及二维/三维覆盖率，并根据假髋臼进行亚组划分。次要目的是提出一种三维骨图谱，从植入模拟的角度确定髋臼骨缺损分析。
方法
共有53例Crowe IV型髋关节（IVa组27例无假髋臼髋关节，IVb组26例）和40例正常髋关节符合纳入标准并进行回顾性评估。首先，定量测量髋臼的解剖大小和体积。其次，通过模拟植入，对真髋臼进行形态学评估，包括髋臼杯中心边缘角（Cup-CE）、髋臼杯锐利角（Cup-Sharp）、髋臼前倾角和内侧壁厚度。最后，测量髋臼扇形角（ASA）和假体覆盖率以提供覆盖指数。此外，应用三维骨图谱可视化来确定未覆盖假体部分的分布。
结果
Crowe IV型髋关节髋臼三角形的解剖形状和体积明显较小。在髋臼假体中心水平，发现IVb组髋臼更前倾和外展，Cup-CE角较小，Cup-Sharp角较大。Crowe IVa组髋关节的覆盖扇形角在前后上方向较大，而在后上和后方向较小，假体总覆盖率无亚组差异。三维骨图谱和相关性分析均显示，后上和后部骨量与假体覆盖高度相关。
结论
由于存在假髋臼，各亚组之间存在髋臼前倾和节段性覆盖差异。在髋臼重建过程中，处理后上和后部骨量对于实现理想的假体覆盖很重要。
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