AI-HIP系统在全髋关节置换中的假体型号及联合偏心距和截骨的作用研究

AI-HIP system for prosthesis size,global femoral offset and osteotomy in total hip arthroplasty

目的:探讨AI-HIP辅助手术规划系统在初次单侧全髋关节置换术(total hip arthroplasty,THA)中的规划效果及其临床结果。方法:回顾性分析2022年3月至2022年11月连续性应用AI-HIP系统行初次单侧THA的36例患者的临床资料,男16例,女20例,年龄43~81(62.2±10.9)岁,将其纳入AI-HIP组;根据配对原则选择同期采用传统模板方法规划的患者36例,男16例,女20例,年龄40~80(60.9±12.1)岁,作为对照组。比较两组假体的准确率,以及术前规划和术后实际联合偏心距差值、下肢长度差值、距小转子上缘截骨高度和顶肩距以评价规划效果,采用Harris评分和疼痛视觉模拟评分(visual analogue scale,VAS)评价其临床疗效。结果:两组均获得随访,时间12~18(14.5±2.1)个月。AI-HIP组规划髋臼杯和股骨柄假体型号的完全准确率、近似准确率分别为72.2%、100%和58.3%、88.9%,均优于对照组的44.4%、83.3%和33.3%、66.7%(P<0.05);规划股骨头假体型号差异无统计学意义(P>0.05)。AI-HIP组术后实际联合偏心距差值、联合偏心距差值(实际-规划)分别为1.0(0.2,2.4)mm、1.1(-2.1,3.2)mm,优于对照组的3.0(1.4,4.9)mm、3.5(-1.6,6.5)mm(P<0.05)。两组间术后实际距小转子上缘截骨高度比较,差异无统计学意义(P>0.05)。AI-HIP组术后实际下肢长度差值、下肢长度差值(实际-规划)、距小转子上缘截骨高度(实际-规划)、术后实际顶肩距、顶肩距差值(实际-规划)分别为1.5(0.2,2.8)、1.1(-0.3,2.2)、2.1(-2.3,4.1)、(15.3±4.1)、-2.2(-4.8,0.3)mm,优于对照组的2.6(1.3,4.1)、2.5(0.3,3.8)、5.8(-2.4,7.7)、(13.0±4.3)、-5.7(-9.4,-2.2)mm(P<0.05)。末次随访,两组Harris评分中功能、疼痛、功能、畸形、总分及VAS比较,差异均无统计学意义(P>0.05);而AI-HIP组Harris评分中活动度评分(4.8±0.6)分,高于对照组(4.4±0.8)分(P<0.05)。结论:AI-HIP辅助手术规划系统较传统模板规划,在初次单侧THA中对髋臼杯和股骨柄假体型号的预测、恢复联合偏心距、规划下肢长度、截骨高度和顶肩距方面具有良好的准确性,临床效果满意。

Objective To explore planning effect of AI-HIP assisted surgical planning system in primary unilateral total hip arthroplasty(THA)and its influence on clinical outcomes.Methods A retrospective analysis was conducted on clinical data of 36 patients who underwent their first unilateral THA from March 2022 to November 2022 and continuously used AI-HIP system(AI-HIP group),including 16 males and 20 females,aged from 43 to 81 years old with an average of(62.2±10.9)years old.According to the matching principle,36 patients who were planned by the traditional template method at the same period were selected as the control group,including 16 males and 20 females,aged from 40 to 80 years old with an average of(60.9±12.1)years old.The accuracy between two groups of prostheses were compared,as well as the combined eccentricity difference between preoperative planning and postoperative practice,lower limb length difference,osteotomy height from the upper edge of the lesser trochanter and top shoulder distance to evaluate planning effect.Harris score and visual analogue scale(VAS)were used to evaluate clinical efficacy.Results Both groups were followed up for 12 to 18 months with an average of(14.5±2.1)months.The complete accuracy and approximate accuracy of acetabular cup and femoral stalk prosthesis in AI-HIP group were 72.2%,100%,58.3%,88.9%,respectively,which were better than 44.4%,83.3%,33.3%,66.7%in control group(P<0.05).There was no statistical significance in planning of femoral head prosthesis size(P>0.05).The actual combined eccentricity difference and combined eccentricity difference(practical-planning)in AI-HIP group were 1.0(0.2,2.4)mm and 1.1(-2.1,3.2)mm,respectively;which were better than 3.0(1.4,4.9)mm and 3.5(-1.6,6.5)mm in control group(P<0.05).There was no significant difference between two groups in actual osteotomy height of the upper margin of the lesser trochanter(P>0.05).In AI-HIP group,the actual difference of lower extremity length after surgery,the difference of lower extremity length(practical-planning),osteotomy height from the upper margin of lesser trochanter(practical-planning),actual topshoulder distance after surgery,and topshoulder distance(practical-planning)were 1.5(0.2,2.8),1.1(-0.3,2.2),2.1(-2.3,4.1),(15.3±4.1),2.2(-4.8,0.3)mm,respectively;which were better than control group of 2.6(1.3,4.1),2.5(0.3,3.8),5.8(-2.4,7.7),(13.0±4.3),-5.7(-9.4,-2.2)mm(P<0.05).At final follow-up,there were no significant differences in Harris scores of pain,function,deformity,total scores and VAS between two groups(P>0.05).The range of motion score was 4.8±0.6 in AI-HIP group,which was higher than that in control group(4.4±0.8)(P<0.05).Conclusion Compared with traditional template planning,AI-HIP assisted surgical planning system has good accuracy in predicting the prosthetic size of the acetabular cup and femoral stalk,restoring joint eccentricity,planning lower limb length,osteotomy height and top shoulder distance on the first unilateral THA,and the clinical follow-up effect is satisfactory.