数字化导航模板在Salter截骨术中的临床应用

Clinical application of computer-assisted navigational template for Salter osteotomy

目的利用数字化技术为Salter截骨术设计一种导航模板,并探讨其临床应用效果。方法自2012年4月~2015年6月,收集21例单侧发育性髋关节脱位行Salter截骨术患儿的术前骨盆CT原始数据,应用数字化技术,模拟Salter截骨术,设计并生产辅助截取三角形髂骨植骨块的导航模板,辅助术中截骨。分析双侧髋关节手术前后及末次随访的髋臼指数(AI),采用Mckay临床疗效评定标准和Severin X线评定标准评定手术疗效。结果双侧髋关节手术前后及末次随访的髋臼指数进行重复测量因素的方差分析,不同测量时间之间(F=357.72,P=0.00)、部位之间(F=221.05,P=0.00)存在显著的主效应。时间与部位之间存在显著的交互效应(F=1984.82,P=0.00)。所有时间水平间均存在显著差异(P=0.00)。Pearson相关性分析表明,患侧髋臼指数术后改善的角度与导航模板的角度或三角形髂骨植骨块顶角的角度均成正相关,相关系数分别为(r=0.91,P=0.00)及(r=0.96,P=0.00)。改良Severin影像学分类为优14例、良5例、可2例,优良率90.48%。改良Mckay功能评价为优13例、良7例、可1例,优良率95.24%。结论数字化导航模板可辅助Salter截骨术快速、精确截取三角形髂骨植骨块,提高手术精确度和成功率,缩短手术时间。

Objective To develop and validate a navigational template for Salter osteotomy by digital technology. Methods Between April 2012 and June 2015, 21 children with unilateral developmental dislocation of the hip underwent Salter osteotomy. Preoperative CT scan pelvic images were obtained. Applying digital technology, Salter osteotomy were simulated and navigational templates for assisting in accurately cutting out a triangular bone graft from ilium were designed and manufactured. Then the navigational templates were use in the operations. The acetabular indexes（AI） of both hips were measured before and after surgery and at the latest follow-up. The efficacy wasevaluated according to Mckay clinical effects grading standard and Severin X rays grading standard. Results The AIs of both hips measured before and after surgery and at the last follow-up were analyzed with repeated measures analysis of variance. There is significant main effect in time（F=357.72, P=0.00） and in part （F=221.05, P=0.00）. There is significant interaction effect between time and part（F=1984.82, P=0.00）. There is significant difference between all the time levels（P=0.00）.The Pearson correlation analysis indicates that the reduction of AIs of the disordered hip joints is positively related to the angels of the navigational templates（r=0.91,P=0.00） or to the apex angles of the triangular bone grafts from iliums（r=0.96,P=0.00）. According to Severin X rays grading standard, 14 cases were excellent, 5 cases were good, and 2 cases were poor. The excellent and good rate was 90.48%. According to Mckay clinical effects grading standard, 13 cases were excellent, 7 cases were good, and 1 case was poor. The excellent and goodrate was 95.24%. Conclusion The computer-assisted navigational templates can assist in cutting out triangular bone grafts from ilium more rapidly and more accurately in Salter osteotomy. It can improve the success rate and accuracy of the operations, and shorten the operation time.