数字导航技术在成人Crowe Ⅳ型髋关节发育不良手术治疗中的应用研究

Application of digital navigation system in treatment of adult DDH surgery

目的 创立一种数字化髋臼成型导航路径,研究数字化导航技术在髋关节发育不良（DDH）全髋关节置换术中的应用价值。方法 10例成人CroweⅣ型单侧DDH,随机分为导航组和非导航组,导航组采用计算机辅助设计（CAD）、逆向工程软件通过计算机辅助设计及数字化快速成型技术,术中行计算机辅助设计导航模板完成全髋关节置换术,非导航组用常规技术行全髋关节置换。结果 导航组实际术中操作与在计算机图像模拟操作及在计算机快速成型患髋模型操作过程非常相近,导航组和非导航在手术时间（t=-5.284,P=0.024）、术中出血量（t=-1.732,P=0.034）、臼杯外展角偏移幅度（t=-3.734,P=0.024）方面比较差异有统计学意义（P〈0.05）。10例均获得平均9.5（3-17）个月随访,非导航组有1例术中置入假体过程中导致股骨干劈裂,行半皮质钢板固定,导航组手术治疗准确程度较非导航组高,术后复查DR片,假体位置满意。结论 数字化导航技术可以进一步提高手术精度,增加置入假体的精确度。提高成年期髋关节发育不良重建手术的成功率,且能缩短手术时间。与传统治疗方法相比较,数字导航技术具有准确度高、定位时间短的优点。

Objective To create a digital acetabulum molding navigation path and investigate application value of digital navigation technology in total hip replacement for developmental dysplasia of the hip. Methods Ten adult patients with DDH（Crowe Ⅳ） were divided into computer navigation group and non-computer navigation group. In the computer navigation group of 5 cases, CAD, reverse engineering software, computer-aided design and 3D print were used for DDH acetabulum molding preoperative and intraoperative localization and simulation of operation on the computer workstation. The surgery path planning, 3D printing solid model preoperative drills, computer-aided design navigation template assisted in total hip arthroplasty. In the non-computer navigation group, the conventional techniques were used in total hip replacement. Results In navigation group actual operation and computer simulation of operation image and 3D rapid prototyping of joint model were very similar. Between navigation and non-navigation group there were significant differences in surgery time（t =-5.284, P =0.024）, blood loss（t =-1.732, P =0.034） abduction angle offset amplitude（t =-3.734, P =0.024）. Ten cases were followed up for average 9.5（3-17）months. The femoral fracture occurred in one case of non-navigation group when the prosthesis was implanted, and was fixed with plate in surgery. Navigation group had high accuracy with satisfactory prosthesis position.Conclusion In unilateral congenital hip dysplasia acetabular location, total hip arthroplasty with computer-aided design navigation template can accurately reconstruct the affected hip rotation center, and effectively improve the accuracy of the prosthesis placement with advantages of higher accuracy and quicker positioning.