全髋关节置换术术前模板测量与规划研究进展

Research progress of preoperative templating and planning in total hip arthroplasty

人工髋关节置换术手术量逐年增多,手术技术、假体设计的进步使得髋关节置换术日渐完善,然而术中和术后并发症包括下肢不等长、脱位、骨折、神经损伤、假体松动、感染等仍然是其主要存在的问题。更快的康复,术后患者更好的功能,更短的手术时间以及更长的假体使用寿命仍然是关节外科医师追求的目标。通过良好的术前规划并做到术中有备无患,尽可能恢复髋关节的生物力学包括股骨偏距和下肢长度等是获得良好预后的一个行之有效的办法。术前规划也经历了从基于X光的乳酸胶片模板到数字化二维模板,再到三维术前规划的演变过程。相对于CT检查,X线平片在评估髋关节形态方面有着明显的不足。基于CT的三维评估可以最优化假体位置及大小的选择,并预估手术的困难。术前规划结合术中导航和手术机器人系统,近年来在全髋关节置换手术质量控制方面扮演着越来越重要的角色。

The number of total hip arthroplasty is increasing year by year.With the progress of surgical techniques and prosthesis design,hip arthroplasty is becoming more and more popular.However,intraoperative and postoperative complications,including leg length discrepancy,dislocation,fracture,nerve injury,prosthesis loosening and infection,are still the main problems.Faster rehabilitation,better postoperative function,shorter operation time and longer prosthesis service time are still the current goals.It is an effective method to recover the biomechanics of hip including femoral offset and lower limb length through good preoperative planning and intraoperation implementation.Preoperative planning has experienced the evolution process from X-ray based on acetate film template to digital two-dimensional template,and then to three-dimensional preoperative planning.Compared with CT examination,X-ray film has obvious deficiencies in the evaluation of hip detail morphology.CT based on 3D evaluation can optimize the selection of prosthesis position and size,and predict the difficulty of surgery.Preoperative planning combined with intraoperative navigation and surgical robot system plays an increasingly important role in the quality control of total hip arthroplasty in recent years.