3DCT技术在成人髋臼发育不良全髋关节置换术中的应用

Application of three-dimensional computed tomography in total hip arthroplasty of adult developmental dysplasia of hip

目的探讨CT三维重建(3DCT)技术在成人髋臼发育不良人工全髋关节置换术(THA)中的应用价值。方法选择单侧髋臼发育不良Crowe分型为Ⅲ、Ⅳ型的患者25例进行THA,其中男性5例5髋,女性20例20髋;年龄21～63岁,平均年龄47.9岁。所有患者术前行骨盆正位数字X射线摄影(DR)及3DCT,依据髋臼三维重建数据指导手术,术后行骨盆正位DR,并对比手术前、后患侧与健侧股骨头中心距理想旋转中心的水平距离和垂直距离来评价患侧髋关节旋转中心的恢复程度。结果CT显示髋臼前后径变小,髋臼后壁增厚,髋臼深径较浅。以上测量指标与正常侧比较,差异均有统计学意义(P<0.05)。术中测量髋臼前后径为(32.98±1.02)mm,髋臼深径为(14.21±0.56)mm,与术前影像测量值比较,差异无统计学意义(P>0.05)。术前股骨头中心距理想旋转中心的水平距离为16～38 mm,平均水平距离为20.15 mm。术后股骨头中心距理想旋转中心水平距离为-2.0～9.3 mm,平均水平距离为2.95 mm,理想旋转中心外侧为正值,手术前后比较差异有显著统计学意义(t=6.74,P<0.01)。术前股骨头中心距理想旋转中心的垂直距离为18～42 mm,平均垂直距离23.58 mm。术后股骨头中心距理想旋转中心的垂直距离为-6.0～13.4 mm,平均垂直距离为3.25 mm,理想旋转中心上方为正值,手术前后比较差异有显著统计学意义(t=4.53,P<0.01)。结论成人髋臼发育不良行THA,3DCT技术可以量化指导如何选择合适的髋臼假体、髋臼骨移植重建部位、髋臼假体安放角度等;对于恢复头臼假体同心复位,恢复髋关节解剖结构,重建关节功能具有重要作用。

Objective To investigate the role of three-dimensional computed tomography （3DCT） reconstruction in total hip arthroplasty（THA） of adult developmental dysplasia of hip（DDH）. Methods A total of 25 patients with congenital DDH of Crowe Ⅲ and Crowe Ⅳ were enrolled, male 5, female 20, aged 21 - 63 years old, mean age 47.9 years old. All of patients underwent pre-operative digital radiography （DR） and 3DCT reconstruction, and measured some parameters to obtain relevant data, then performed THA accorded guideline of the data. All the patients underwent pelvic DR after operation, the horizontal distance and vertical distance from femoral head center to ideal rotation center between contralateral and ipsilateral at pre-operation and post- operation were compared, and recovery level of rotation center in ipsitateral hip were evaluated. Results The CT showed that anteroposterior diameter of acetabulum became smaller, posterior thickness of acetabulum became thicker and depth of acetabulum was shallower, and there were statistically significant differences in morphological parameters of femur and acetabulum between 2 groups（P 〈 0.05）. The intraoperative measurements showed that the anteroposterior diameter of acetabulum was （32.98 ±1.02） mm and the depth of acetabulum was （14.21 ±0.56） mm, and there was no statistically significant difference between pre-operative measurements and post-operative measurements（P 〉 0.05）. The mean horizontal distance in pre-operation was 20.15 mm （16 - 38 mm）, and mean horizontal distance in post-operation was 2.95 mm （- 2.0 - 9.3 mm）. The lateral side of idea center of rotation was positive numeric, and the difference between pre-operation and post-operation were statistically significant （t = 6.74, P 〈 0.01）. The mean vertical distance in pre-operation was 23.58 mm （18 - 42 ram）, and mean vertical distance in post-operation was 3.25 mm（- 6.0 - 13.4 mm）. The upper side of idea center of rotation as positive numeric, and the difference between pre-operation and post-operation were statistically significant（t = 4.53, P 〈 0.01）. Conclusion It is demonstrated that 3DCT reconstruction could provide preferred design for DDH patients with THA, including the customization of acetabular prosthetic, the position of acetabular bone graft and reconstruction, and acetabular component placement angle. The 3DCT plays an important role in recovery of concentric reduction, restoration of anatomical structure and hip joint function.