个性化髋臼导板在单侧全髋关节成形术中应用的实验研究

Experimental study of custom-made acetabular navigation template in unilateral total hip arthroplasty

目的探讨个性化髋臼导板在单侧全髋关节成形术(THA)中的应用。方法2018年11月至2020年4月中国人民解放军联勤保障部队第920医院骨科选取人尸体髋标本20例(由昆明医科大学人体解剖学教研室提供)进行实验研究。每例标本右侧定义为导板侧,左侧定义为对照侧。经CT扫描后对每例标本髋关节行三维重建,计算并确定导板侧髋关节旋转中心(HJC)及旋转轴线,设计并制作与导板侧髋臼Harris窝表面形态一致的反向导板,辅助THA术中髋臼假体植入。测量术后导板侧髋臼假体与对照侧髋臼的外展角(β)、前倾角(α)、HJC与泪滴的垂直距离(H)和水平距离(W)并进行比较。采用Prism 6.0软件对数据进行统计学分析。结果个性化髋臼导板与髋臼Harris窝贴合紧密且稳定性好。髋臼导板辅助臼杯假体植入后与对照侧髋臼方位对称。导板侧与对照侧β角分别为(49.9±4.1)°和(49.5±4.7)°,α角分别为(17.7±3.1)°和(18.3±3.5)°,H值分别为(21.6±2.8)mm和(21.9±3.4)mm,W值分别为(29.7±3.1)mm和(30.90±3.31)mm,差异均无统计学意义(均P>0.05)。结论应用个性化髋臼导板可做为辅助单侧THA术中髋臼假体准确植入的有效手段。

Objective To study the application of the individualized acetabular navigation template for assisting implant of acetabular prosthesis in unilateral total hip arthroplasty(THA).Methods Twenty cadaver hip specimens(provided by the Department of Anatomy,Kunming Medical University)were selected to research in the 920th Hospital of Joint Logistics Support Force from November 2018 to April 2020.The right side of each specimen was defined as the guide side,and the left as the control side.After CT scan,the 3-D model of the each hip of the specimen was reconstructed.The hip joint center(HJC)and rotation axis of the guide side were calculated.The reverse navigation template with the same surface shape of the acetabular fossa of the guide side was designed and made to assist acetabular prosthesis implantation during THA.The abduction angle(β),anteversion angle(α),vertical distance(H)and horizontal distance(W)between HJC and tear drop were measured and compared.And the Prism 6.0 software was used for statistical analysis of the data.Results The individualized acetabular navigation template perfectly matched the Harris fossa of the acetabulum and reliable stability has been obtained.The prosthesis was placed symmetrically with the contralateral acetabulum.Theβvalue of the cup and the contral side was(49.9±4.1)°and(49.5±4.7)°,respectively.Theαvalue of the cup and the contral side was(17.7±3.1)°and(18.3±3.5)°,respectively.The H value and W value of guild side and control side was(21.6±2.8)mm and(21.9±3.4)mm,(29.7±3.1)mm and(30.90±3.31)mm,respectively.None of the differences were significant(all P>0.05).Conclusion The application of individualized acetabular navigation template can be used as an effective means to assist the accurate implantation of acetabular prosthesis in unilateral THA.