术中画线法与三维重建术前模拟测量股骨截骨旋转角度对比的体外实验

Comparison of preoperative three-dimensional reconstruction simulation and intraoperative drawing of femoral osteotomy to measure rotation angle in vitro

背景:临床上治疗发育性髋关节发育不良股骨颈前倾角增大者常通过股骨上端旋转截骨来实现,而如何术中精准控制旋转角度及位移是手术成功的关键。目的:对比三维重建术前模拟与术中画线法两种股骨截骨旋转角度测量方法在矫正股骨颈前倾角中的价值。方法:取正常成人股骨标本进行体外旋转截骨,画线组通过公式计算股骨上端向前及向后各旋转2,4,6,8 mm所得的前倾角(共8组),然后在股骨标本上完成旋转截骨操作,CT扫描测量术后实际所得前倾角;术前模拟组对完整股骨标本行三维重建,对上述计算所得前倾角,通过Solidworks进行术前模拟股骨截骨旋转至特定角度,测量股骨截骨端表面位移(弧长),然后根据弧长在股骨标本上进行旋转截骨,CT扫描测量术后实际所得前倾角。将两组术后实际所得股骨颈前倾角与计算所得股骨颈前倾角进行对比分析。结果与结论:(1)画线组术后实际测量的前倾角为(8.4±26.2)°,术前计算所得前倾角为(10.3±26.5)°,两者比较差异有显著性意义(P <0.05);(2)术前模拟组术后实际测量的前倾角为(10.4±26.6)°,与术前计算所得前倾角(10.3±26.5)°比较差异无显著性意义(P> 0.05);(3)结果表明,三维重建术前模拟与术中画线法指导股骨旋转截骨均能有效纠正过大股骨前倾角,三维重建术前模拟较术中画线法的误差更小,三维重建术前模拟可以使股骨旋转截骨更加精准化、个性化、智能化。

BACKGROUND:Clinical treatment of the increased anteversion angle of the femoral neck in developmental dysplasia of the hip is often achieved by rotating osteotomy at the upper end of the femur,and how to accurately control the rotation angle and dis placement during the ope ration is the key to the success of the operation.OBJECTIVE:To compare the value of two femoral osteotomy rotation angle measurement methods in the correction of the anteversion angle of the femoral neck by three-dimensional reconstruction simulation before operation and intraoperative line drawing.METHODS:Normal adult femur specimens were taken for external rotation osteotomy.In the line drawing group,formulas were used to calculate the anterior inclination angle of the upper end of the femur by 2,4,6,and 8 mm(total 8 groups).The rotation osteotomy operation was completed.CT scan was used to measure the actual postoperative anteversion angle.In the preoperative simulation group,three-dimensional reconstruction of the intact femoral specimen was performed,and the calculated anteversion angle was performed by Solidworks to simulate the femoral osteotomy rotation to a specific angle before surgery.The surface displacement(arc length)of the femoral osteotomy end was measured,and then a rotary osteotomy was performed on the femoral specimen according to the arc length.The actual anteversion angle obtained after the CT scan was measured.The actual postoperative femoral neck anteversion angle and the calculated femoral neck anteversion angle were compared and analyzed in both groups.RESULTS AND CONCLUSION:(1)The actual measured anteversion angle after the line drawing group was(8.4126.2)°,and the calc ulated preoperative anteversion angle was(10.3±26.5)0;there was a significant difference between the two(P<0.05).(2)The actual measured anteversion angle in the preoperative simulation group was(10.4±26.6)°,which was not significantly different from the calc ulated preoperative anteversion angle(10.3±26.5)°(P>0.05).(3)The results showed that three-dimensional reconstruction pre-simulation and intraoperative line-drawing method to guide femoral rotation osteotomy can effectively correct the excessive femoral anteversion angle.The preoperative simulation of three-dimensional reconstruction has smaller errors than the intraope rative line-drawing method.The preope rative simulation of three-dimensional reconstruction can make the femoral rotation osteotomy more precise,personalized and intelligent.