个性化数字模拟辅助髋臼假体精准植入在CroweⅠ和Ⅱ型髋关节发育不良中的应用

Application of personalized digital analog assisted acetabular prosthesis precise implantation in Crowe type Ⅰ and Ⅱ hip dysplasia

目的:探讨采用个性化数字模拟辅助髋臼假体精准植入在髋关节发育不良应用的疗效。方法:自2017年2月至2019年7月收治的11例(12髋)髋关节发育不良行全髋关节置换术患者,男4例(5髋),女7例(7髋),年龄27~61 (46.64±12.93)岁;Crowe分型Ⅰ型8髋,Ⅱ型4髋。将术前CT薄层扫描导入Mimics 10.01软件,通过术前模拟选择合适髋臼假体尺寸及安放角度,并了解髋臼骨量缺损情况,决定术中是否需要结构植骨,测量患者术前后的双下肢长度、髋臼假体前倾角、外展角、髋臼旋转中心高度、髋关节中心水平距离,观察术后脱位、植骨愈合情况及臼杯松动情况,并采用髋关节Harris评分评价关节功能。结果:所有患者获得随访,时间18~30(23.45±3.70)个月,术后未发生假体脱位、松动、植骨均愈合。1例因术中坐骨神经牵拉出现支配区域麻木,给予营养神经药物治疗于术后1个月恢复。双下肢长度差由术前(31.73±5.98) mm下降至术后3个月的(4.73±1.90) mm(t=15.268,P<0.01)。术后臼杯髋臼前倾角(17.45±3.62)°、外展角(40.10±2.30)°。所有病例外展角及前倾角均位于Lewinnek安全范围内,术后髋关节旋转中心高度(20.64±2.58) mm,术后髋关节水平内移距离(33.46±3.61) mm。Harris评分由术前(45.36±2.34)分提高至术后3个月(91.27±2.37)分(P<0.05)。结论:髋关节发育不良患者通过术前个性化数字模拟重建髋臼,可以更好的了解髋臼缺损情况,有助于评估髋臼假体的大小、安放角度及是否需要结构植骨,可获得满意的临床疗效。

Objective:To explore the effect of personalized digital analog assisted acetabular prosthesis precise implantation in hip dysplasia.Methods:From February 2017 to July 2019,11 patients(12 hips) with hip dysplasia underwent total hip arthroplasty,including 4 males(5 hips) and 7 females(7 hips),aged from 27 to 61 years old,with an average of(46.64±12.93)years old;Crowe classification:8 hips in type Ⅰ and 4 hips in type Ⅱ.The preoperative thin-layer CT scan was imported into Mimics 10.01 software.The appropriate size and placement angle of acetabular prosthesis were selected through preoperative simulation,and the acetabular bone defect was understood to determine whether structural bone grafting was needed during the operation.The length of both lower limbs,the anteversion angle of acetabular prosthesis,the abduction angle,the height of acetabular rotation center and the horizontal distance of hip joint center before and after the operation were measured,and the postoperative dislocation,bone graft healing and acetabular cup loosening were observed.The hip Harris score was used to evaluate the joint function.Results:All patients were followed up for 18 to 30 months with an average of(23.45±3.70) months.There was no prosthesis dislocation,loosening and bone graft healing after operation.One case had numbness in the innervation area due to the traction of sciatic nerve during operation,and was treated with neurotrophic drugs and recovered one month after operation:The length difference of both lower limbs decreased from(31.73±5.98) mm before operation to(4.73±1.90) mm3 months after operation(t=15.268.P<0.01).The anteversion angle of acetabular cup and acetabulum was(17.45±3.62)°and abduction angle was(40.10±2.30)° after operation.In all cases,the abduction angle and anteversion angle were within the safe range of Lewinek.The height of hip rotation center was(20.64±2.58) mm and the horizontal inward displacement of hip was(33.46±3.61) mm.Harris score increased from(45.36±2.34) before operation to(91.27±2.37) 3 months after operation(P<0.05).Conclusion:Through preoperative personalized digital analog reconstruction of acetabulum in patients with hip dysplasia,we can better understand the acetabular defect,help to evaluate the size and placement angle of acetabular prosthesis and whether structural bone grafting is needed,and obtain satisfactory clinical curative effect.