目的比较分析无症状人群与发育性髋关节发育不良(developmental dysplasia of the hip,DDH)人群的髋臼三维朝向,为髋部疾病的鉴别诊断、手术规划、植入器械设计及术后评估等提供数据参考。方法回顾性收集符合选择标准的无症状人群骨盆CT...目的比较分析无症状人群与发育性髋关节发育不良(developmental dysplasia of the hip,DDH)人群的髋臼三维朝向,为髋部疾病的鉴别诊断、手术规划、植入器械设计及术后评估等提供数据参考。方法回顾性收集符合选择标准的无症状人群骨盆CT 84例(无症状组)和DDH患者骨盆CT 47例(DDH组)。两组人群性别构成及年龄(包括男女亚组年龄)比较差异均无统计学意义(P>0.05)。使用半自动测量软件MaxTHA测量3种定义下的前倾角和外展角,包括手术学外展角(operative inclination,OI)、影像学外展角(radiographic inclination,RI)、解剖学外展角(anatomic inclination,AI)、手术学前倾角(operative anteversion,OA)、影像学前倾角(radiographic anteversion,RA)和解剖学前倾角(anatomic anteversion,AA),并进行两人群间、不同Crowe分型亚组间、各性别亚组间及左右侧间的比较。结果无症状组与DDH组健、患侧间比较显示,无症状组与DDH组健侧的髋臼朝向各角度参数差异均无统计学意义(P>0.05);DDH组患侧的OI、RI、AI显著大于健侧和无症状组,AA显著小于健侧和无症状组,差异有统计学意义(P<0.05)。正常髋臼与DDH组不同Crowe分型组间比较显示,CroweⅠ型组与正常组髋臼朝向各角度参数比较差异均无统计学意义(P>0.05);CroweⅡ、Ⅲ、Ⅳ型组OI、RI、AI显著大于正常组,CroweⅢ型组的OI、Ⅳ型组的RI和AI显著大于Ⅰ型组,Ⅳ型组的AI显著大于Ⅱ型组(P<0.05);CroweⅢ型组OA、RA、AA显著小于除Ⅰ型组外的各组(P<0.05)。无症状组女性的OA、RA、AA以及DDH组女性的OA、AI显著大于对应组男性,差异有统计学意义(P<0.05)。无症状组男性右侧髋臼的OI、RI、AI、OA以及女性右侧髋臼的RI、AI均显著大于左侧,差异有统计学意义(P<0.05)。结论髋臼朝向在无症状人群和DDH人群间存在人群差异,在不同Crowe分型亚组间存在组间差异,在各人群亚组内存在性别间差异,在无症状人群中存在双侧差异。展开更多
Reconstruction of severe bone defects in revision total knee arthroplasty(TKA)remains a challenge for orthopaedists.The progression of medical imaging and additive manufacturing technology has enabled the rapid manufa...Reconstruction of severe bone defects in revision total knee arthroplasty(TKA)remains a challenge for orthopaedists.The progression of medical imaging and additive manufacturing technology has enabled the rapid manufacture of custom-made implants,and 3D-printed augments with interconnected pore structures have become an alternative approach for the reconstruction of bone defects in revision TKA,especially in patients with complex bone defects.The size and location of the bone defect were determined by thin-layer computed tomography(CT;layer thickness is 1 mm)after reduction of artifacts.The 3D reconstruction models of the host bone were obtained based on thin-layer CT imaging.The custom-made augmentation was designed according to the 3D reconstruction bone model.The augmentation had an interconnected porous structure on the bone-implant interface to achieve biological fixation.After the design was complete,the 3D model of augment was exported in STL format,and augments were fabricated with Ti6Al4V powder using electron beam melting.Thin-layer CT and 3D reconstruction bone models are accurate methods for evaluating periprosthetic bone loss after artifact reduction.The 3D-printed augments perfectly match the bone defects during surgery.3D-printed augmentation is an effective approach for the reconstruction of bone defects in revision TKA.Thus,surgeons and engineers should carefully evaluate the bone defect during augment design to avoid a mismatch between the augment and host bone.展开更多
基金the 3D Snowball Project of Shanghai Jiao Tong University School of Medicine(No.GXQ202007)the Natural Science Foundation of Shanghai(No.20ZR1432000)+2 种基金the Project of Shanghai Collaborative Innovation Center for Translational Medicine(No.TM201814)the Clinical Research Program of the 9th People’s Hospital affiliated to Shanghai Jiao Tong University School of Medicine(No.JYLJ025)the National Natural Science Foundation of China(No.81772425)。
文摘Reconstruction of severe bone defects in revision total knee arthroplasty(TKA)remains a challenge for orthopaedists.The progression of medical imaging and additive manufacturing technology has enabled the rapid manufacture of custom-made implants,and 3D-printed augments with interconnected pore structures have become an alternative approach for the reconstruction of bone defects in revision TKA,especially in patients with complex bone defects.The size and location of the bone defect were determined by thin-layer computed tomography(CT;layer thickness is 1 mm)after reduction of artifacts.The 3D reconstruction models of the host bone were obtained based on thin-layer CT imaging.The custom-made augmentation was designed according to the 3D reconstruction bone model.The augmentation had an interconnected porous structure on the bone-implant interface to achieve biological fixation.After the design was complete,the 3D model of augment was exported in STL format,and augments were fabricated with Ti6Al4V powder using electron beam melting.Thin-layer CT and 3D reconstruction bone models are accurate methods for evaluating periprosthetic bone loss after artifact reduction.The 3D-printed augments perfectly match the bone defects during surgery.3D-printed augmentation is an effective approach for the reconstruction of bone defects in revision TKA.Thus,surgeons and engineers should carefully evaluate the bone defect during augment design to avoid a mismatch between the augment and host bone.
