基于三维CT的模拟手术重建高位脱位髋关节全髋置换髋臼

Simulated surgeries of acetabular reconstruction for high -dislocated hips

目的探讨通过模拟手术，准确重建髋臼。方法收集28例高位脱位来我院行全髋父节置换的患者资料，共32髋。通过MIMICS软件对患者的CT扫描数据进行三维重建，进行模拟手术重建髋臼臼杯。记录臼杯位于满意位置时旋转中心的坐标，计算不同前倾角时臼杯的骨性覆盖率。结果为了获得更好的髋臼方位，在重建髋臼臼杯时需要向内挫磨（4．18±2．59）mm，向后（4．61±2．59）mm，向上（2．58±2．08）mm。臼杯前倾角为5。时覆盖率为（84±7）％；前倾角为15。时覆盖率为（88±4）％；25。时为（92±7）％；35。时为（93±8）％。每一个臼杯均可以获得大于70％的覆盖率。髋臼的骨性覆盖率随臼杯的前倾增加而增加。结论我们发现高位脱位臼杯重建时可以适当内移、后移并轻微上移旋转中心。根据患者的个体情况进行精确的术前设计，术中准确地实施，所有的臼杯均可以获得满意的位置、方向和覆盖率。

Objective To investigate how to precisely reconstruct the acetabular cup in high de- velupmental dishocated hips. Methods Twenty - eight patients with 32 high developmental dislocated hips were admitted into our hospital for total hip arthroptasties （ THAs ）. After 3 - dimensional construction of CT scans, simulated acetabular reconstruction was done by the Mimics software. Three - dimensional cov- erage of the cup at different anteversion was calculated. Results To get better cup position, we needed to ream the acetabulmn （4. 18 ± 2.59） mm medially, （4.61 ± 2.59） mm posteriorly, and （2.58 ± 2.08 ） mm superiorly in average. Every cup could get more than 70% coverage. Bony coverage of the cup increased with anteversion. Conclusion Every high dislocated hip can get enough coverage by putting the cup medially, posteriorly and a bit superiorly. Larger anteversion of the cup is suggested for high develop- mental dishwated hips.