三维影像处理技术在成人髋关节发育不良联合前倾角匹配中的应用研究

3D-CT used to determine an optimal combined anteversion angle of femoral neck-acetabulum in total hip arthroplasty for adult hip developmental dysplasia

【摘要】目的探讨三维影像处理（3D—CT）技术在成人髋关节发育不良（DDH）全髋关节置换术（THA）中对于股骨颈一髋臼联合前倾角匹配的指导作用。方法回顾性分析2011年3月至2014年3月通过3D—CT技术进行THA的21例（21髋）DDH患者资料，男5例，女16例（；年龄30～78岁，平均55．3岁。DDH按Crowe分型：Ⅱ型6例，Ⅲ型11例，Ⅳ型4例。所有患者术前行薄层CT扫描并将二维原始数据导入M3D可视数字化软件进行三维重建，通过3D—CT技术进行术前预演制定最合适的股骨颈一髋臼联合前倾角调整方案，拟定最佳的联合前倾角度进行THA。术后通过3D—CT技术评估臼杯的骨性覆盖情况、测量臼杯的前倾角度及联合前倾角度，验证术后联合前倾角度与术前拟定角度的吻合情况，并采用Harris评分标准评定疗效。结果21例患者术后获3～36个月（平均12．8个月）随访。末次随访时采用Harris评分评定疗效：优17例，良4例。术前Harris评分[（46．2±5．3）分]与末次随访时[（86．3±4．3）分]比较差异有统计学意义（P〈0．05）。所有患者髋臼杯的覆盖率均大于70％，术后髋臼杯前倾角度与术前拟定角度吻合率达95％，股骨颈一髋臼联合前倾角度在安全范围内，所有患者均未出现脱位。结论3D—CT技术可以通过术前预演制定最佳的股骨颈一髋臼联合前倾角调整方案，对成人DDH患者THA股骨颈一髋臼联合前倾角的调整具有较高的指导价值，按拟定的方案进行手术臼杯可获得最好的骨性包容、最大的初始稳定性，同时可获得最佳的头臼匹配度，降低术后假体脱位率，提高假体生存率。

Objective To investigate how 3D-CT was used to determine an optimal combined an- teversion angle of femoral neck-acetabulum in total hip arthro （THA） for adult developmental dysplasia of the hip（DDH）. Methods 3D-CT was used in 21 adult patients（21 hips） with DDH who had been treated by THA from March 2011 to March 2014. They were 5 men and 16 women, 30 to 78 years of age （average, 55.3 years）. By the Crowe classification, there were 6 cases of type 11, 11 cases of type HI, and 4 cases of type IV. After all the patients underwent thin slice CT scanning, their primary 2-dimentional data were imported into M3D visual digitization software for 3-dimentional reconstruction. The 3D-CT images were used before each THA to find an optimal combined anteversion angle of femoral neck-acetabulum for the surgery. After surgery, the 3D-CT images were used to evaluate bony coverage of the acetabulum cup and the agreement between the combined anteversion angle of femoral neck-acetabulum determined preoperatively and the postoperative one. Harris scores were used to evaluate the efficacy of THA. Results The 21 patients were followed up for an average of 12.8 months （range, from 3 to 36 months） . The Harris scores at the last follow-up revealed 17 excellent cases and 4 good ones. The preoperative Harris scores （46. 2± 5.3） increased significantly to 86.3 ±4. 3 at the last follow-up （ P 〈 0. 05）. All the patients obtained bony coverage of the acetabulum cup of more than 70%. The agreement between the combined anteversion angle of femoral neck-acetabulum de- termined preoperatively and the postoperative one reached 95%. All the postoperative combined anteversion angles of femoral neck-acetabulum were in a safe range. No anterior dislocation was observed. Conclusions In a preoperative rehearsal of THA, 3D-CT reconstruction can be used to find an optimal combined anteversion angle of femoral neck-acetabulum which may lead to the best bony coverage, the most initial stability, the best match between the femoral head and the acetabulum, reduced prosthesis dislocation and in- creased prosthesis survival.