螺旋CT三维重建在复杂全髋置换术前的应用

Spiral CT with three-dimensional reconstruction technique in difficult total hip arthoplasty

目的:探讨用螺旋CT三维重建评价复杂的全髋置换术前的临床应用价值。方法:选择2001-02/2003-06解放军总医院骨科收治的髋关节疾患行全髋关节置换术患者85例。髋臼发育不良55例,外伤后畸形愈合18例,其他12例。其中66例既往有患髋手术史。所有患者均进行患髋X射线及螺旋CT薄层容积扫描,术前均采用HispeedNX/I双层螺旋CT机(GE)行螺旋CT三维重建检查,相应数据指导制定手术方案。全髋关节置换术后髋关节功能评价采用Harris评分标准[包括疼痛(0～44分,分值高表示疼痛减轻)、功能、关节活动度及畸形4方面,得分90～100分为优,80～89分为良,70～79分为中,70分以下为差]。结果:纳入患者85例,平均随访15个月,均进入结果分析。①患者髋关节三维CT重建图像:85例检查均取得清晰立体图像,且可消除某一骨性结构,单独观察髋臼、股骨头及其周围毗邻情况,还可消除扫描图像的置入物的金属放射状伪影。②患者髋关节手术前后关节功能:85例患者术前髋关节功能Harris评分平均为46.3分,术后平均为90.4分,术后优良率达95.3%(81/85)。疼痛分数从术前平均17.5分,提高到术后平均42.5分。③患者髋关节手术并发症:随访病例中有1例术后出现足下垂,术后2个月完全恢复。3例在打入扩髓锉时出现股骨颈或股骨距部分裂隙骨折,骨折线均未到达小转子以下,属于VancouverA型骨折,未给予特殊处理,术后3个月允许完全负重,均愈合,随访时无疼痛。2例患者术后有大腿疼痛,但是在四五个月后疼痛消失。结论:螺旋CT三维重建检查为复杂的全髋关节置换手术治疗提供合理的手术方式选择,减少了术中坐骨神经损伤等并发症的发生,提高了手术的安全性,使患者术后下肢功能恢复良好。

AIM： To assess the clinical value of spiral CT with three-dimensional reconstruction teehnique in difficult total hip arthoplasty. METHODS： Eighty-five patients admitted to undergo total hip arthoplasty were selected in the General Hospital of Chinese PLA from February 2001 to June 2003, including 55 eases of Acetabular Dysplasia, 18 of post-trauma malunion and 12 of others. Among them, 66 patients had an operation on affected hip joint. Scanning of X-ray and spiral CT was performed on the affected hip joint in all patients, and three-dimensional reconstruction examination was performed before operation by using Hispeed NX/I double-spiral CT. Then according to the correspondent data, operative scheme was established. Harris scoring was adopted in the evaluation of hip joint function following total hip arthopla.sty, and scoring system included four aspects, pain, function, range of motion, and deformation （scoring range from 0 to 44, 90-100 means good, 80-89 means fair, 70-79 means mid- dle, below 70 means bad）. RESULTS： All the 85 patients had a mean follow-up of 15 months, and were involved in the result analysis. ① Three-dimensional reconstructive CT picture of hip joint： Three-dimensional images were obtained in the 85 cases during the examination, in which, the images of one osseous construction were eliminated for observation of acetabulum, femoral head, etc. ② Joint function of coax before and after operation： The average Harris score was 46.3 before operation and 90.4 after operation with the effective rate of 95.3% （81/85）. And the pain score was increased from 17.5 to 45.2 after operation. ③ Complication： During the follow-up, one case had foot drop and recovered 2 months after operation. Three cases had fissured fracture in neck or spur of femur with fracture line below lesser trochanter which belonged to type Vancouver A without treatment, and recovered ＂after 3 months. Two cases had pain of thigh, which disapL peared 4-5 months later. CONCLUSION： Spiral CT with three-dimensional reconstruction technique provides a optimal operation manner for complex total hip arthop/asty, can decrease the occurrence of complications such as injury of sciatic nerve, improve the operative safety, and ensure a belier recovery of lower limb function.