CT三维重建球形拟合技术在Cam型髋臼股骨撞击症术前规划中的应用

Preoperative planning of Cam-type femoroacetabular impingement using spherical fitting technique in CT three-dimensional reconstruction

目的探讨应用CT三维重建球形拟合技术对Cam型髋臼股骨撞击症(femoral acetabular impingement,FAI)切除范围进行术前规划的可行性和效果。方法纳入2020年7月至2022年6月于南方医科大学第三附属医院运动医学科接受关节镜下股骨头颈成形术的Cam型FAI患者46例,男20例、女26例,年龄(38.4±15.2)岁(范围24~53岁),术前通过CT三维重建球形拟合技术进行切除范围规划(球形拟合组);纳入2018年7月至2020年6月接受关节镜下股骨头颈成形术的Cam型FAI患者42例,男17例、女25例,年龄(43.6±18.4)岁(范围24~61岁),术前通过CT三维重建观察法进行切除范围规划(观察法组)。通过对比两组患者术后α角、股骨头颈偏心率及术后3、6、9、12个月的改良Harris评分(modified Harris hip score,mHHS)和疼痛视觉模拟评分(visual analogue score,VAS)的差异,评估采用球形拟合技术进行术前规划对股骨头颈成形术患者预后的影响。结果球形拟合组和观察法组随访时间分别为(11.8±0.6)、(11.3±0.8)个月。两组术前α角、股骨头颈偏心率、mHHS和VAS的差异均无统计学意义(P>0.05);两组术后3、6、9、12个月的mHHS逐渐升高,VAS逐渐降低,术后mHHS、VAS均优于术前,差异均有统计学意义(P<0.05)。球形拟合组术后9个月mHHS为(83.2±14.8)分,较观察法组的(70.5±11.2)分高,差异有统计学意义(t=4.471,P=0.007);球形拟合组术后12个月mHHS为(85.7±13.3)分,高于观察法组的(73.2±2.5)分,差异有统计学意义(t=4.596,P=0.008)。两组术后α角、股骨头颈偏心率,术后3、6个月的mHHS及术后3、6、9、12个月VAS的差异无统计学意义(P>0.05)。结论CT三维重建球形拟合技术能够辅助术前规划Cam畸形切除范围,有利于关节镜下股骨头颈成形术的顺利进行;该技术辅助下的股骨头颈成形可获得满意的早期疗效。

Objective To explore the feasibility and effect of applying spherical fitting technology in CT three-dimensional reconstruction in preoperative planning of the resection range of Cam-type femoral acetabular impingement(FAI).Methods 46 Cam-type FAI patients who underwent arthroscopic femoroplasty in the Department of Sports Medicine in the Third Affiliated Hospital of Southern Medical University from July 2020 to June 2022 were enrolled in the spherical fitting group,including 26 females and 20 males,with an average age of 38.4±15.2 years(range of 24-53 years).The preoperative planning was performed using spherical fitting technology in CT three-dimensional reconstruction.Another 42 Cam-type FAI patients who underwent arthroscopic femoroplasty from July 2018 to June 2020 were enrolled in the observation group,including 25 females and 17 males,with an average age of 43.6±18.4 years(range 24-61 years).The preoperative planning was performed using CT three-dimensional reconstruction observation method.This study evaluated the impact of femoroplasty planned by spherical fitting technique on patients'prognosis though comparing the differences of postoperativeαangle,femoral head-neck offset ratio,modified Harris hip score(mHHS),and visual analog score(VAS)at 3,6,9,and 12 months between two groups.Results The average follow-up time was 11.8±0.6 months in spherical fitting group and 11.3±0.8 months in observation group.There was no significant difference regardingαangle,femoral head-neck offset ratio,mHHS,and VAS between two groups preoperatively(P>0.05).The mHHS in two groups increased gradually,while VAS decreased sequentially at 3,6,9,and 12 months postoperatively.The postoperative mHHS and VAS were significantly better than those before surgery(P<0.05).The mHHS was 83.2±14.8 vs.70.5±11.2 in spherical fitting group and observation group at the followup of 9 months with significant difference(t=4.471,P=0.007).It was 85.7±13.3 vs.73.2±12.5 at the followup of 12 months with significant difference(t=4.596,P=0.008).No significant difference was found inαangle,femoral head-neck offset ratio or mHHS at 3 and 6 months postoperatively(P>0.05),and no significant difference was found in VAS at 3,6,9,and 12 months postoperatively between two groups.Conclusion The spherical fitting technology in CT three-dimensional reconstruction could assist surgeons with planning of the resection range of Cam deformity preoperatively,and achieve a smooth progress of arthroscopic femoroplasty intraoperatively;after short term follow-up,we found that patients who underwent femoroplasty using this technology achieved satisfactory outcomes.