数字化模板与传统胶片模板术前测量在髋假体精确性选择上的比较研究

Comparsion of fidelity in preoperative planning of total hip replacement between digital templating and hard-copy templating

目的探讨数字化模板与传统胶片模板测量在髋关节置换术中的精确性差别及数字化术前模板测量的应用价值。方法分别应用数字化模板与传统胶片模板对2005年1月至2006年6月间行非骨水泥型人工髋关节假体置换的患者进行数字化术前计划。其中男23例,女17例,年龄(50.1±12.9)岁。比较计划与手术实际间假体尺寸、置放位置、偏心距及下肢长度的吻合程度。结果两种方法在假体型号(包括臼杯、股骨柄、颈长)选择方面与术中实际尺寸吻合度存在差异(P<0.05),数字化模板测量与术中实际吻合度更高。对偏心距的设定,与术中实际一致者,数字化模板测量达14例(占70%),优于传统测量(8例,占40%)。应用配对t检验对术前计划及术中实际的截骨高度进行统计学分析,显示传统模板设定值较术中实际相差(0.61±0.21)cm,差异具有统计学意义(P<0.05),数字化模板者相差(0.01±0.15)cm,吻合度高。结论数字化术前模板测量可提高术中假体选择的精确性,并能更好地完成截骨高度的术前制定,从而恢复患肢的长度及偏心距。

Objective To compare the fidelity of digital and traditional preoperative planning with hard-copy templating for total hip replacement, and investigate the liability of digital planning in increasing the accuracy of intra-operative choice of component. Methods The preoperative radiographs of 40 cases who preformed THR from January 2005 to June 2006 were divided into two groups randomly. Preoperative planning was performed with digital templating and traditional one respectively. The present study included male and female patients with the average age of （50. 1 ± 12. 9 ） years. The differences of sizes of implants, osteotomy line, leg length and offset were compared between the preoperative planning and intra-operative actual ones. Results The coincidences for choice of prosthesis size between the planning using digital one and actual one were better than those between the planning using traditional one and actual one（P 〈 0. 05）. 70% of the cases planned with digital template got the same offset as the actual one, compared with 40% of those planned with traditional template. Significant difference of osteotomy line was found between preoperative plan performed with traditional template and actual one （ P 〈 0. 05 ）, but not found for those with digital template. Conclusions Digital planning could increase the fidelity in choosing component sizes. Meanwhile, the exact coincidence of osteotomy line and offset between digital panning and intra-operative actual one illuminated that it was a useful guide which could help the operator to correct leg length discrepancy and offset.