基于CT测量的旋顶角、旋顶距在全髋关节置换术前股骨假体个体化选择中的应用

Application value of"central trochanter angle"and"center to trochanter distance"on individual selection of femoral prosthesis in total hip arthroplasty based on CT measurement

目的探讨基于CT测量的旋顶角、旋顶距与股骨颈干角(FNSA)、股骨偏心距(FO)之间的关系,以及旋顶角、旋顶距在全髋关节置换术(THA)术前不同FNSA股骨假体选择中的应用价值。方法横断面研究。纳入2022年7—12月烟台市烟台山医院关节外科收治的单侧髋关节或单侧膝关节病变患者255例,年龄22~86(65.1±9.0)岁,其中男85例、女170例,≤65岁114例、>65岁141例。患者术前均行全骨盆、双侧股骨全长CT扫描,将扫描后CT原始数据导入Mimics 19.0软件,重建健侧股骨三维模型,应用3-matic Research 11.0软件在健侧股骨三维模型上定位股骨头旋转中心,测量股骨头直径(FHD)、股骨颈长度(FNL)、FNSA、FO、股骨颈前倾角(FNAA)、旋顶距、旋顶角等参数。采用人工智能辅助THA三维规划系统AIJOINT V1.0.0.0软件,依据CT三维测量数据对患者进行术前规划、设计,个性化选择不同颈干角人工股骨柄并模拟手术。观察指标:(1)在健侧股骨三维模型中,观察FHD、FNL、FNSA、FO、FNAA、旋顶角和旋顶距在不同性别和年龄间的差异,以及FNSA、FO、旋顶距、旋顶角之间的相关性。(2)患者按术前规划、模拟手术选择的股骨柄类型分为135°Corail组和125°Corail组,比较2组间性别、年龄、身高、体质量、体质量指数(BMI)等基线资料,以及FHD、FNL、FNSA、FO、FNAA、旋顶角和旋顶距之间的差异。(3)采用受试者操作特征(ROC)曲线分析旋顶角、旋顶距对THA股骨假体类型的选择效能。结果(1)255侧成人健侧股骨三维模型测量结果显示,FHD为(46.15±3.38)mm,FNL为(47.37±4.54)mm,FNSA为123.21°±5.61°,FO为(39.37±4.76)mm,FNAA为10.52°±7.46°,旋顶角为14.19°±5.29°,旋顶距为(11.69±4.54)mm。女性FHD、FNL、FO、旋顶角和旋顶距均小于男性,FNSA、FNAA均大于男性,差异均有统计学意义(P值均<0.05)。>65岁者FO、旋顶角和旋顶距均大于≤65岁者,差异均有统计学意义(P值均<0.05),而FHD、FNL、FNSA、FNAA不同年龄分层比较,差异均无统计学意义(P值均>0.05)。Pearson相关分析显示,旋顶角与旋顶距之间存在极强的正相关(r=0.968,P<0.001),旋顶距与FO之间存在中度正相关(r=0.531,P<0.01),旋顶角与FO之间存在弱正相关(r=0.391,P<0.001);而FNSA与FO、旋顶角、旋顶距之间存在强负相关(r=−0.674、−0.695、−0.767,P值均<0.001)。(2)依据术前规划、模拟手术匹配股骨柄类型分组,135°Corail组115例,125°Corail组140例。2组间比较,患者年龄、FNSA、FO、旋顶角、旋顶距差异均有统计学意义(P值均<0.001)。(3)旋顶角、旋顶距对THA股骨假体类型选择的ROC曲线显示,旋顶角、旋顶距的约登指数分别为0.896、0.816,最佳临界值分别为12.60°、10.54 mm,灵敏度分别为100%、92.9%,特异度分别为89.6%、88.7%,AUC分别为0.984、0.972。旋顶角、旋顶距对THA股骨假体类型选择的效能较高,根据最佳临界值,旋顶角>12.60°或旋顶距>10.54 mm,选择125°Corail股骨柄,反之则选择135°Corail股骨柄。结论旋顶角、旋顶距与FNSA、FO存在相关性,对不同FNSA股骨假体类型选择的效能均较高,可作为THA术前股骨假体个性化选择的参数。

Objective This study aimed to explore the relationship between central trochanter angle(CTA),center to trochanter distance(CTD),femoral neck stem angle(FNSA),and femoral offset(FO)measured by CT,and the role of CTA and CTD in the selection of femoral prosthesis with different neck shaft angles in total hip arthroplasty(THA).Methods A cross-sectional study was conducted.A total of 255 patients with unilateral hip or knee joint lesions admitted to the Joint and Bone Surgery Department of Yantaishan Hospital from July 2022,to December 2022,were included,including 85 males and 170 females,aged 22-86(65.1±9.0)years.The patients were divided into≤65-year-old group(114 cases)and>65-year-old group(141 cases)on the basis of their age.All patients underwent total pelvic and bilateral femur full-length CT scans before THA.The scanned CT Dicom data were imported into Mimics software(version 19.0)to reconstruct a three-dimensional(3D)model of the healthy side femur.3-Matic Research software(version 11.0)was used to measure parameters,such as femoral head rotation center,femoral head diameter(FHD),femoral neck length(FNL),FNSA,FO,femoral neck anteversion angle(FNAA),CTD,and CTA,on the 3D model.The artificial intelligence-assisted THA 3D planning system AIJOINT software(version 1.0.0.0)was used to plan and design preoperative procedures for the 255 patients on the basis of CT data.Personalized selection of femoral stems with different neck shaft angles and simulated operation was performed.The observation indicators included the following:(1)In the 3D model of healthy femur,the differences in FHD,FNL,FNSA,FO,FNAA,CTA,and CTD among different genders and ages and the correlation among FNSA,FO,CTA,and CTD were observed.(2)In accordance with the preoperative planning and simulated surgical selection of patients,the type of femoral prosthesis was divided into 135°Corail group and 125°Corail group.Baseline data,such as gender,age,height,body mass,and body mass index,were compared between the two groups.Moreover,differences in FHD,FNL,FNSA,FO,FNAA,CTA,and CTD were compared.(3)Receiver operating characteristic(ROC)curves were used to analyze the predictive performance of CTA and CTD on the selection of THA femoral prosthesis types.Results(1)The results of CT measurement of 255 healthy sides of adult femurs showed that FHD was(46.15±3.38)mm,FNL was(47.37±4.54)mm,FNSA was 123.21°±5.61°,FO was(39.37±4.76)mm,FNAA was 10.52°±7.46°,CTA was 14.19°±5.29°,and CTD was(11.69±4.54)mm.Comparison of anatomical measurement parameters between different genders showed that the FHD,FNL,FO,CTA,and CTD in females were smaller than those in males,whereas the FNSA and FNAA were larger,with statistically significant differences(all P values<0.05).The FO,CTA,and CTD of the>65-year-old group were higher than those of the≤65-year-old group,and the differences were statistically significant(all P values<0.05).Meanwhile,the differences in FHD,FNL,FNSA,and FNAA were not statistically significant(all P values>0.05).Pearson's correlation analysis showed a strong positive correlation between CTA and CTD(r=0.968,P<0.001).A moderate positive correlation was found between CTD and FO(r=0.531,P<0.001).A weak positive correlation was observed between CTA and FO(r=0.391,P<0.001).FNSA had a strong negative correlation with FO,CTA,and CTD(r=−0.674,−0.695,−0.767,all P values<0.001).(2)In accordance with preoperative planning and simulated surgery matching,115 and 140 cases were categorized into the 135°and 125°Corail groups,respectively.Statistically significant differences were noted in patient age,FNSA,FO,CTA,and CTD between the two groups(all P values<0.001).(3)The ROC curves of the selection of femoral prosthesis types for THA showed that the Youden indices of CTA and CTD were 0.896 and 0.816,respectively.The cutoff points were 12.60°and 10.54 mm,with sensitivities of 100%and 92.9%,specificities of 89.6%and 88.7%,and AUC scores of 0.984 and 0.972,respectively.The efficiency of selecting the type of THA femoral prosthesis was relatively high for CTA and CTD.In accordance with the optimal critical value,if the CTA was greater than 12.60°or the CTD was greater than 10.54 mm,a 125°Corail femoral stem was selected;otherwise,a 135°Corail femoral stem was selected.Conclusion CTA and CTD are correlated with FNSA and FO.CTA and CTD are important measurement parameters for predicting the selection of femoral stem prosthesis with different neck shaft angles for patients undergoing THA.