人工智能术前规划系统辅助人工全髋关节置换术治疗成人Crowe Ⅳ型先天性髋关节发育不良的疗效研究

Artificial intelligence assisted total hip arthroplasty for patients with Crowe type Ⅳ developmental dysplasia of the hip

目的探究人工智能(artificial intelligence,AI)人工全髋关节置换术(total hip arthroplasty,THA)术前规划系统(AIHIP系统)辅助THA治疗成人CroweⅣ型先天性髋关节发育不良(developmental dysplasia of the hip,DDH)的近期疗效。方法回顾分析2019年5月—2020年12月收治的23例符合选择标准的CroweⅣ型DDH患者临床资料。其中男3例,女20例;年龄44~74岁,平均52.65岁。术前双下肢长度差绝对值(15.17±22.17)mm。术前Harris评分为(62.4±7.2)分。采用AIHIP系统进行术前规划,手术均采用常规后外侧入路下THA,13例术中复位困难患者联合行股骨转子下短缩截骨术(subtrochanteric shortening osteotomy,SSOT)。记录患者手术时间、住院时间及不良事件发生情况;术前1 d及术后1周、6个月采用Harris评分评价患肢功能;术后1 d摄骨盆正位X线片评价假体位置;根据术中应用假体型号与术前规划是否一致评价假体匹配程度。结果术后髋臼杯型号与术前规划匹配程度为完全匹配16例、一般匹配4例(+1号1例、–1号3例)、不匹配3例(均为+2号),符合率为86.96%;股骨柄型号匹配程度为完全匹配22例、一般匹配1例(–1号),符合率为100%。1例术中发生股骨假体周围骨折,术中予以钢缆捆绑固定,术后6周下地助行器辅助下行走;其余患者均在术后1 d即下地助行器辅助下行走。手术时间185~315 min,平均239.43 min;住院时间8~20 d,平均9.96 d;脱离助行器时间2~56 d,平均5.09 d。术后患者均获随访6个月。患者切口均Ⅰ期愈合,无感染、脱位、再骨折、下肢深静脉血栓形成等并发症发生;术后1 d及6个月复查X线片示髋臼与股骨假体均固定牢靠且在安全范围;术后1 d双下肢长度差绝对值(11.96±13.48)mm,与术前比较差异无统计学意义(t=0.582,P=0.564)。术后6个月截骨均愈合良好。术后1周及6个月Harris评分分别为(69.5±4.9)分和(79.2±5.7)分,手术前后各时间点间比较差异均有统计学意义(P<0.05)。术后6个月根据Harris评分评价髋关节功能,获良13例、中9例、差1例。结论 AIHIP系统辅助下THA(术中难复位患者联合SSOT)治疗成人CroweⅣ型DDH,术前规划准确率高,术中髋关节易复位,术后患者下地早,早期疗效满意。

Objective To investigate the early effectiveness of artificial intelligence(AI) assisted total hip arthroplasty(THA) system(AIHIP) in the treatment of patients with Crowe type Ⅳ developmental dysplasia of the hip(DDH). Methods The clinical data of 23 patients with Crowe type Ⅳ DDH who met the selection criteria between May2019 and December 2020 were retrospectively analyzed. There were 3 males and 20 females, the age ranged from 44 to 74 years, with an average of 52.65 years. The absolute value of the lower limbs discrepancy before operation was(15.17±22.17) mm. The preoperative Harris score was 62.4±7.2. The AIHIP system was used for preoperative planning,and the operations were all performed via conventional posterolateral approach. Thirteen patients with difficulty in reduction during operation underwent subtrochanteric shortening osteotomy(SSOT). The operation time, hospital stay,and adverse events were recorded;Harris score was used to evaluate the function of the affected limb at 1 day before operation and 1 week and6 months after operation;pelvic anteroposterior X-ray film was taken at 1 day after operation to evaluate the position of the prosthesis. The matching degree of prosthesis was evaluated according to the consistency of intraoperative prosthesis model and preoperative planning. Results The matching degree of acetabular cup model after operation was 16 cases of perfect matching, 4 cases of general matching(1 case of +1, 3 cases of –1), and 3 cases of mismatch(all of them were +2),the coincidence rate was 86.96%. The matching degree of femoral stem model was perfect matching in 22 cases and general matching in 1 case of –1, and the coincidence rate was 100%. One patient had a periprosthesis fracture during operation, and was fixed with a wire cable during operation, and walked with the assistance of walking aid at 6 weeks after operation;the rest of the patients walked with the assistance of walking aid at 1 day after operation. The operation time was 185-315 minutes, with an average of 239.43 minutes;the hospital stay was 8-20 days, with an average of 9.96 days;and the time of disengagement from the walking aid was 2-56 days, with an average of 5.09 days. All patients were followed up 6 months. All incisions healed by first intension, and there was no complication such as infection, dislocation,refracture, and lower extremity deep venous thrombosis;X-ray films at 1 day and 6 months after operation showed that the acetabular and femoral prostheses were firmly fixed and within the safe zone;the absolute value of lower limbs discrepancy at 1 day after operation was(11.96±13.48) mm, which was not significantly decreased compared with that before operation(t=0.582, P=0.564). All osteotomies healed at 6 months after operation. The Harris scores at 1 week and6 months after operation were 69.5±4.9 and 79.2±5.7 respectively, showing significant differences between pre-and postoperation(P<0.05). At 6 months after operation, the hip function was evaluated according to Harris score, and 13 cases were good, 9 cases were fair, and 1 case was poor. Conclusion AIHIP system-assisted THA(difficult to reposition patients combined with SSOT) for adult Crowe type Ⅳ DDH has high preoperative planning accuracy, easy intraoperative reduction, early postoperative landing, and satisfactory short-term effectiveness.