基于三维数据的术前计划指导全髋关节置换术髋臼假体植入的准确性分析

Analysis of accuracy for acetabular component in total hip arthroplasty using preoperative planning based on three-dimensional data

背景:精确的术前计划是全髋关节置换术(total hip arthroplasty,THA)获得成功的重要基础。目的:对基于三维数据的术前计划指导THA髋臼假体植入的准确性进行分析。方法:纳入20例拟行THA的患者。所有患者均行髋部CT薄层扫描。术前以Mimics 17.0软件对所有髋部CT扫描数据进行处理,生成髋部三维模型;利用Rhinoceros 4.0软件生成180°半球型三维CAD髋臼杯模型,在三维模型上进行模拟髋臼假体安放,预测臼杯大小、臼杯外展角、旋转中心位置,预测结果与术后实际结果进行比较。结果:应用三维软件进行术前计划,85%(17/20)的臼杯预测型号与实际型号一致,15%(3/20)相差一个型号。术前预测的臼杯外展角39.40°±4.18°、髋臼旋转中心位置的水平距离(82.89±5.17)mm和垂直距离(47.38±6.95)mm,与术后实际外展角39.77°±4.76°、水平距离(82.14±5.80)mm和垂直距离(48.32±8.40)mm比较无统计学差异(P>0.05)。结论:基于三维数据的THA术前计划,能提高臼杯型号选择和植入位置的准确性。

Background： Accurate preoperative planning is the important basis of a successful total hip arthroplasty（THA）.Objective： To investigate the accuracy of pre operative planning based on three dimensional（3 D） data for acetabular component in THA. Methods： A total of 20 patients who were scheduled for primary THA between October 2016 and May 2017 were enrolled in this prospective study. The CT thin slice scan data of all patients were imported into Mimics 17.0 software to establish 3 D models, 3 D CAD 180° hemisphere acetabular cup model was also established by Rhinoceros 4.0 software,and then placed the acetabular component on the 3 D model to predict the acetabular component size, acetabular component abduction angle and hip rotation center position. The results were compared with post operative results. Results： 85%（17/20） components were predicted exactly and 15%（3/20） components were predicted with one size difference using 3 D planning. There was no significant difference（P〉0.05） between the 3 D planned acetabular component abduction angle（39.40°±4.18°）, hip rotation center distance（horizontal distance： [82.89±5.17] mm; vertical distance： [47.38±6.95] mm）, and those found post operatively（acetabular component abduction angle： [39.77°±4.76°]; horizontal distance： [82.14±5.80] mm; vertical distance： [48.32±8.40] mm）. Conclusions： Pre operative planning based on three dimensional data is an accurate and reliable method for predicting acetabular component sizes and placement in THA.