骨盆高度法与模板测量法术前测量髋臼杯大小的差别

Comparative study of preoperative planning of acetabular cups for primary total hip arthroplasty between pelvic height planning and conventional templating

目的探讨初次全髋关节置换术前骨盆高度法和传统胶片模板法测量髋臼杯大小的差别。方法 2014-07至2014-12在解放军总医院关节外科连续行初次全髋关节置换术患者200例(288髋),随机分为A组(100例)和B组(100例),术前分别应用传统胶片模板法和骨盆高度法测量髋臼杯大小,并与术中实际选择髋臼大小进行对比,比较其实际吻合度。结果以术中实际所用髋臼杯大小为准,A组尺寸一致或者相差一个型号者57例(47.5%),相差两个型号者49例(40.8%),相差三个型号者14例(11.7%);B组尺寸一致或者相差一个型号者145例(86.3%),相差两个型号者20例(11.9%),相差三个型号者3例(1.80%)。A组与术中实际差值(2.58±0.89)mm、B组较术中实际差值(1.38±1.22)mm,两组差值行独立样本t检验(P=0.0000),差异具有统计学意义。结论 B组实际吻合度明显高于A组,可以作为一种初次全髋置换术前测量髋臼大小的方法。

Objective To evaluate the value of pelvic height planning and conventional templating for measurement of the acetabular cup size before primary total hip arthroplasty. Methods A comparative randomised study was conducted in Joint Department of PLA General Hospital between July 2014 and December 2014,involving 200 consecutive patients（ 288hips） who underwent primary THA. These patients were randomly and equally divided into Group A（ conventional templating） and Group B（ pelvic height planning）. The size of cetabular cups were measured preoperatively with conventional templating and pelvic height planning respectively,and compared with the exact size of cups used intraoperatively. Results According to the exact size of acetabular cups,the cup size was close or within ± one size in 57（ 47. 5%） cases,within ± two sizes in 49（ 40. 8%）,and within ± three sizes in 14（ 11. 7%）in Group A. The cup size was close or within ± one size in 145（ 86. 3%）,within ± two sizes in 20（ 11. 9%）,and within ± three sizes in 3（ 1. 8%） in Group B. The difference between the preoperative size and actual cup was（ 2. 58 ± 0. 89） mm in group A and（ 1. 38 ± 1. 22） mm in Group B. There was a statistically significant difference between the two groups using independent samples t-test（ P = 0. 000）. Conclusions The actual goodness of fit of pelvic height planning is significantly higher than that of conventional templating,which can be used as a method to measure the cup size before primary total hip arthroplasty.