人工智能术前规划系统在人工全髋关节置换术治疗成人发育性髋关节发育不良中的应用研究

Application of artificial intelligence preoperative planning system in total hip arthroplasty for adult developmental dysplasia of the hip

目的 通过与传统X线片模板测量方法比较,探讨在成人发育性髋关节发育不良(developmental dysplasia of the hip,DDH)患者人工全髋关节置换术(total hip arthroplasty,THA)前采用人工智能术前规划系统(AI-HIP系统)预测假体型号以及指导假体安放位置的准确性。方法 将2020年8月—2022年8月拟行初次THA的DDH患者作为研究对象,其中28例(28髋)患者符合选择标准纳入研究。其中,男10例,女18例;年龄34~77岁,平均59.3岁。左侧12例,右侧16例。DDH分型:CroweⅠ型10例,Ⅱ型8例,Ⅲ型5例,Ⅳ型5例。股骨头坏死国际骨循环协会(ARCO)分期:Ⅲ期13例,Ⅳ期15例;病程2.5~23.0年,平均8.6年。下肢长度差值(limb length discrepancy,LLD)为11.0(8.0,17.5)mm。术前所有患者基于AI-HIP系统和X线片模板测量预测假体型号,与术中实际应用假体型号进行比较,以评价AI-HIP系统预测假体型号的准确性;比较AIHIP系统术前规划和术后实际髋臼外展角、髋臼前倾角、股骨颈截骨位置、尖肩距、LLD,评价AI-HIP系统对假体安放位置的评估能力。结果 基于AI-HIP系统术前预测的髋臼假体型号与术中实际使用假体型号吻合23例(82.1%)、股骨假体型号吻合24例(85.7%),高于基于X线片模板测量预测结果 [16例(57.1%)、17例(60.7%)],差异均有统计学意义(P<0.05)。AI-HIP系统术前预测髋臼外展角、髋臼前倾角、股骨颈截骨位置、尖肩距与术后测量结果比较,差异均无统计学意义(P>0.05)。THA术后LLD较术前减小(P<0.05),但与AI-HIP系统术前规划置换术后LLD比较,差异无统计学意义(P>0.05)。结论 与传统X线片模板测量方法相比,AI-HIP系统在术前预测假体型号方面具有较高准确性和可重复性,能指导成人DDH患者THA术中假体放置。

Objective By comparing with the traditional X-ray template measurement method, to explore the accuracy of artificial intelligence preoperative planning system(AI-HIP) to predict the type of prosthesis and guide the placement of prosthesis before total hip arthroplasty(THA) in adult patients with developmental dysplasia of the hip(DDH). Methods Patients with DDH scheduled for initial THA between August 2020 and August 2022 were enrolled as study object, of which 28 cases(28 hips) met the selection criteria were enrolled in the study. Among them, there were 10males and 18 females, aged from 34 to 77 years, with an average of 59.3 years. There were 12 cases of the left DDH and 16cases of the right DDH. According to DDH classification, there were 10 cases of Crowe type Ⅰ, 8 cases of type Ⅱ, 5 cases of type Ⅲ, and 5 cases of type Ⅳ. According to Association Research Circulation Osseous(ARCO) staging of osteonecrosis of the femoral head, 13 cases were in stage Ⅲ and 15 cases in stage Ⅳ. The disease duration was 2.5-23.0years(mean, 8.6 years). The limb length discrepancy(LLD) was 11.0(8.0, 17.5) mm. Before operation, the prosthesis types of all patients were predicted by AI-HIP system and X-ray template measurement method, respectively. And the preoperative results were compared with the actual prosthesis type during operation in order to estimate the accuracy of the AI-HIP system. Then, the differences in the acetabular abduction angle, acetabular anteversion angle, femoral neck osteotomy position, tip-shoulder distance, and LLD were compared between preoperative planned measurements by AI-HIP system and actual measurement results after operation, in order to investigate the ability of AI-HIP system to evaluate the placement position of prosthesis. Results The types of acetabular and femoral prostheses predicted based on AI-HIP system before operation were consistent with the actual prostheses in 23 cases(82.1%) and 24 cases(85.7%), respectively.The types of acetabular and femoral prostheses predicted based on X-ray template measurement before operation were consistent with the actual prostheses in 16 cases(57.1%) and 17 cases(60.7%), respectively. There were significant differences between AI-HIP system and X-ray template measurement(P<0.05). There was no significant difference in acetabular abduction angle, acetabular anteversion angle, femoral neck osteotomy position, and tip-shoulder distance between AI-HIP system and actual measurement after operation(P>0.05). LLD after operation was significantly lower than that before operation(P<0.05). There was no significant difference between the LLD predicted based on AI-HIP system and the actual measurement after operation(P>0.05). Conclusion Compared with the traditional X-ray template measurement method, the preoperative planning of AI-HIP system has better accuracy and repeatability in predicting the prosthesis type. It has a certain reference for the prosthesis placement of adult DDH.