摘要
[目的]介绍术前计算机模拟手术结合3D打印个性化导板引导下Tonnis骨盆三联截骨术治疗儿童DDH的手术技术与初步结果。[方法] 2019年1月~2019年10月,对12例(12髋) DDH患儿采用此技术治疗。术前行CT扫描,获得骨盆股骨三维重建模型,进行标准化参数测量及模拟手术。个性化设计髂骨截骨导板和髋臼旋转导板并实物3D打印。术中操作首先使用截骨导板引导髂骨截骨,再使用旋转导板引导髋臼旋转,螺钉固定完成手术。[结果] 12例患儿均顺利手术,无严重并发症。随访13~18个月,至末次随访时,所有患儿均未出现髋关节活动受限、股骨头再脱位、股骨髋臼撞击综合征等并发症。患侧髋关节Harris功能评分由术前的(85.08±5.30)分显著增加至末次随访时的(93.92±1.68)分(P<0.05)。影像方面,12例患儿术前患侧与健侧CEA-CP、CEA-SP、AASA、PASA的差异均有统计学意义(P<0.05),而术后患侧与健侧CEA-CP、CEA-SP、AASA、AAVA差异均无统计学意义(P>0.05),PASA较术前改善。[结论]此计算机辅助技术显著提升了骨盆截骨治疗DDH的精准性,改善了临床效果。
[Objective] To introduce the surgical technique and preliminary clinical outcomes of computer-assisted Tonnis triple pelvic osteotomy for developmental dysplasia of the hip in children. [Methods] From January 2019 to October 2019, a total of 12 patients received surgical treatment with this technique. Before operation, CT scanning data obtained from the patients were individually processed to create pelvic 3D models. As standardized measurements of the acetabulum, and mimic Tonnis triple osteotomy were conducted on the models, a personalized guider for iliac osteotomy and an individualized guider for acetabular rotation were designed and made to the real state by 3D printer. During the clinical operation, the iliac osteotomy was performed by using the osteotomy guider, whereas acetabular rotation was finished with the rotation guider. [Results] All the 12 children had Tonnis triple osteotomy performed smoothly without serious complications, and followed up for 13 to 18 months. To the latest follow-up, no hip ankylosis, re-dislocation and femoroacetabular impingement happened in anyone of them. The Harris score significantly increased from(85.08±5.30) before operation to(93.92±1.68) at the latest follow up(P<0.05). With regard to radiographic assessment, significant differences were found between the affected side or the intact side in term of center-edge angle in the coronal plane(CEA-CP), center-edge angle in the sagittal plane(CEA-SP), anterior acetabular section angle(AASA) before operation(P<0.05), while which became not statistically different between the affected side and the intact side postoperatively(P>0.05). [Conclusion] This computer-assisted technique does enhance the accuracy and efficiency of Tonnis triple pelvic osteotomy for DDH in children.
作者
官哲轩
严亚波
黄鲁豫
徐会法
刘峙辰
王新力
李超
GUAN Zhe-xuan;YAN Ya-bo;HUANG Lu-yu;XU Hui-fa;LIU Zhi-chen;WANG Xin-li;LI Chao(Department of Orthopedics,Xijing Hospital,Aire Force Medical University,Xi’an 710032,China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2021年第7期649-652,共4页
Orthopedic Journal of China
基金
陕西省自然科学基础研究项目(编号:2017JC2-04)。