螺旋CT参数测量指导全髋关节置换术的可行性研究

Accuracy of three-dimensional CT scan parameters for guiding total hip arthroplasty

目的探讨螺旋CT相关参数测量在预防全髋关节置换术（THA）患者肢体不等长、术后脱位的指导作用。方法收治86例初次行单侧THA患者，按随机数字表法分成两组：研究组45例通过螺旋CT三维重建技术测量健侧髋臼前倾角、外展角、股骨颈截骨处与股骨头旋转中心距离、大转子尖与股骨头旋转中心距离，以此规划患侧THA；对照组41例不进行参数测量。对比手术前后疗效，验证螺旋CT三维重建术前相关参数测量在预防THA患者肢体不等长及术后脱位等的指导作用。结果86例患者均获随访，研究组随访时间（11．2±6．2）个月，对照组随访时间（11．6±6．2）个月。关节功能随访情况：研究组术后3个月Hafts评分（87．2±5．4）分；对照组术后3个月Harris评分（80．9±7．9）分（P〈0．05）。研究组术后肢体不等长（0．4±0．2）cm；对照组为（1．1±0．4）cm（P〈0．05）。两组术后3个月内脱位各1例。结论术前CT三维重建参数测量在THA术中具有一定的指导意义。

Objective To investigate the clinical significance of preoperative three-dimensional CT scan parameters to restore postoperative limb length and reduce postoperative dislocation in patients with total hip arthroplasty （THA）. Methods Clinical data of two groups involving 86 cases that had primary unilateral THA were included. In study group 45 cases were operated on with the measurement of contralateral acetabular anteversion, acetabular abduction angle, distance from femoral neck osteotomy to the center of rotation of the femoral head and distance from femoral trochanter tip to the center of rotation based on three-dimensional CT scan. Another 41 cases under conventional surgery which not used these parameters served as control. Surgical efficacy was compared to verify the role of CT scan parameters in restoring postoperative limb length and reducing postoperative dislocation. Results Period of follow-up was （ 1 1. 2 ± 6.2） months in study group and （ 11.6 ± 6.2） months in control group. Harris hip score in study group was （ 87.2 ± 5.4 ） points versus （ 80.9 ± 7.9 ） points in control group three months after operation （P 〈 0.05 ）. Limb length discrepancy in study group was （0.4 ± 0.2 ） cm versus （ 1.1 ± 0.4） cm in control group （ P 〈 0. 05 ）. Each group had one dislocation three months after operation. Conclusion The parameter measurement with three-dimensional CT scan has some guiding significance in THA.