数字化术前计划在发育性髋关节发育不良患者髋臼重建中的作用

EFFECT OF PREOPERATIVE DIGITAL PLANNING IN ACETABULAR RECONSTRUCTION IN DEVELOPMENT DYSPLASIA OF THE HIP

目的评价数字化术前计划对人工全髋关节置换（totalhiparthroplasty，THA）治疗发育性髋关节发育不良（developmentdysplasiaofthehip，DDH）中髋臼重建的作用。方法将2009年1月一2011年12月收治并符合选择标准的42例DDH患者纳入研究，根据术前计划方法不同随机分为两组，其中23例（A组）行常规术前影像学分析，19例（B组）采用TraumaCad软件进行术前计划。两组患者性别、年龄、体重指数、DDH分型及术前Harris评分比较，差异均无统计学意义（P〉0．05），具有可比性。记录两组手术时间、术中出血量以及相关并发症发生情况；于术后7d复查骨盆标准前后位x线片，采用TraumaCad软件测量髋臼假体水平距离、垂直距离、影像学前倾角、影像学外倾角和假体大小，比较两组髋臼假体放置合格率，以及B组术前预测和实际放置假体大小符合率。结果A、B组手术时间分别为（119．25±47．16）、（155．31±84．03）min，术中出血量分别为（410．00±200．39）、（387．50士251．99）mL，两组比较差异均无统计学意义（P〉0．05）。术后3例发生并发症，其中A组切口感染1例，假体前脱位1例；B组假体后脱位1例。患者均获随访，A组随访时间1年1个月～4年1个月，平均2年8个月；B组1年3个月～4年，平均2年7个月。末次随访时，A组Harris评分为（91．09士5．35）分，B组为（91．72士3．48）分，均较术前显著提高（P〈0．05）；但两组间比较差异无统计学意义（t=-0．41，P=0．69）。TraumaCad软件测量示，B组髋臼假体放置合格率为78．95％（15／19），明显高于A组的43．48％（10／23）（Z2=5．43，P=0．02）。B组髋臼假体术前预测大小与实际放置符合率为68．42％（13／19）。结论THA治疗DDH时数字化术前计划能进一步优化髋臼重建。

Objective To evaluate the effect of preoperative digital planning in acetabular reconstruction of total hip arthroplasty （THA） for development dysplasia of the hip （DDH）. Methods A prospective study was performed on 42 patients with DDH undergoing primary THA between January 2009 and December 2011. The patients were divided into 2 groups according to whether preoperative digital planning was made or not; before operation, conventional imaging method was used in 23 cases （group A）, and TraumaCad software was used for preoperative digital planning in 19 cases （group B）. There was no significant difference in gender, age, body mass index, DDH classification, and preoperative Harris score between 2 groups （P 〉 0.05）. The operation time, amount of bleeding, and postoperative complication were observed. After 7 days of operation, X-ray films were done to measure the vertical location, horizontal location, radiographic anteversion angle, radiographic inclination angle, and prosthesis size by TraumaCad software. The qualified rate of cup placement was compared between 2 groups. Coincidence rate of cup size between preoperative predicted by the digital planning and actually implanted in group B also was calculated. Results The operation time and the amount of bleeding were （119.25±47.16） minutes and （410.00±200.39） mL in group A and were （155.31 ±84.03） minutes and （387.50±251.99） mL in group B respectively, showing no significant difference between 2 groups （P 〉 0.05）. Incision infection and prosthetic anterior dislocation occurred in 1 case of group A respectively, prosthetic posterior dislocation in 1 case of group B. The patients were followed up 1 year and 1 month to 4 years and 1 month （mean, 2 years and 8 months ） in group A, and 1 year and 3 months to 4 years （mean, 2 years and 7 months） in group B. At last follow-up, the Harris scores were 91.09±5.35 in group A and 91.72±3.48 in group B, which were significantly increased when compared with preoperative scores （P 〈 0.05）, but no significant difference was found between 2 groups （t=-0.41, P=0.69）. The qualified rate of cup placement of group B （78.95%, 15/19） was significantly higher than that of group A （43.48%, 10/23） （Z2=5.43, P=0.02）; the coincidence rate of the cup size between preoperative predicted by the digital planning and actually implanted was 68.42% （13/19） Conclusion Preoperative digital planning can further optimize the acetabular reconstruction in THA for DDH.