数字化模板联合骨性参数测量辅助髋关节假体型号选择的研究

APPLIC AT ION OF DIGITAL PL ANNING WITH B ONE PA R A METERS IN DETERMINING OPTIMAL SIZE OF PROSTHESIS

目的 探讨采用数字化模板联合骨性参数测量在人工全髋关节置换术（total hip arthroplasty,THA）前选择关节假体的准确性及应用价值。方法 2012年9月-2013年6月,对13例拟定THA治疗患者通过术前测量骨性参数及数字化假体模板,辅助假体型号选择及制定术前计划。男4例,女9例;年龄41～79岁,平均54.08岁。左髋8例,右髋5例。股骨头缺血性坏死8例;股骨颈骨折5例,其中伴股骨头缺血性坏死3例。结果 手术时间140～254 min,平均191.8 min。术中2例输血,6例使用血浆代用品补充血容量。术中假体植入时无股骨或髋臼周围骨折;术后无下肢静脉血栓形成,其中2例下肢动脉斑块形成。患者均获随访,随访时间12～24个月,平均17.3个月。患者疼痛症状均缓解,患肢功能显著改善。股骨头缺血性坏死患者Harris评分从术前（54.0±12.9）分提高至术后3个月（91.1±4.1）分,差异有统计学意义（t=7.259,P=0.000）。术前假体选择型号与实际型号比较,股骨假体获优9例,良3例,差1例,优良率92.31%;髋臼假体获优7例,良5例,差1例,优良率92.31%。结论 THA术前采用数字化模板联合骨性参数测量可准确预估假体型号,提高假体选择准确性。

Objective To investigate the accuracy and value of digital planning with bone parameters in determining the appropriate prosthesis for total hip arthroplasty （THA）. Methods The preoperative radiographs was taken in 13 cases scheduled for THA between September 2012 and June 2013; the bone parameters were measured by digital template, and the prosthesis was selected and preoperative plan was made. There were 4 males and 9 females with an average age of 54.08 years （range, 41-79 years）, including 8 left hips and 5 right hips. The causes were osteonecrosis of the femoral head in 8 cases and femoral neck fracture in 5 cases （3 cases had osteonecrosis of the femoral head）. Results The operation time was 140-254 minutes （mean, 191.8 minutes）. Two cases received blood transfusion, and 6 patients received plasma substitutes transfusion. There was no intraoperative fractures or postoperative thrombosis; atherosclerotic plaque occurred in 2 cases. Thirteen cases were followed up 12-24 months with an average of 17.3 months. The pain was relieved and limb function was improved in all patients. Harris score was significantly improved from preoperative 54.0±12.9 to 91.1±4.1 at 3 months after operation （t=7.259, P=0.000）. Compared with the actual implants, the appropriate sizes of femoral stem was selected in 12 cases （92.31%） （excellent in 9 cases, good in 3 cases, and poor in 1 case）, and the appropriate sizes of acetabular cup was selected in 11 cases （84.62%） （excellent in 7 cases, good in 4 cases, and poor in 2 cases）. Conclusion Digital planning could increase the accuracy in choosing the size of prosthesis for THA.