三维术前规划在全髋关节置换术中的应用△

Application of three- dimensional preoperative planning in total hip arthroplasty

摘要:

[目的] 介绍三维术前规划在全髋关节置换术 (total hip arthroplasty, THA) 中的应用方法和临床效果。[方法] 2019 年 5 月—2020 年 6 月采用三维术前规划辅助人工全髋关节置换术 8 例。术前行双髋关节三维 CT 薄层扫描，建立三维立体模型，三维图像上确定解剖标志点，分析原始解剖形态及病理改变，实施模拟手术操作和假体置入。根据术前规划实施真实 THA。[结果] 术后髋臼杯外展角 (41.63±4.63)°、前倾角 (19.13±5.57)°；术后股骨前倾角 (14.38±6.35)°；肢体长度改变为 (-0.40±1.06) mm。三维术前规划髋臼侧假体型号 6 例与术前规划相同，1 例相差 1 号，1 例相差 2 号；股骨侧假体型号 3 例同术前规划，3 例相差 1 号，2 例相差 2 号。[结论]三维术前规划可以较精准的预估假体型号、安放假体位置。

Abstract:

[Objective] To introduce the techniques and preliminary clinical outcomes of three-dimensional preoperative planning in total hip arthroplasty (THA) . [Methods] From May 2019 to June 2020, 8 patients received THA with assistance of three-dimensional pre- operative planning. Three-dimensional CT thin-layer scanning of the hip joints was performed before the operation to establish a three-di- mensional model. Anatomical landmarks were determined on the three-dimensional images, the original anatomical shape and pathological changes were analyzed, and simulated surgical operations and prosthesis implantation were conducted. After that, the real THA was fin- ished according to preoperative planning. [Results] As results of postoperative radiographic measurements, acetabular component was placed with abduction angle of (41.63±4.63)° and anteversion angle of (19.13±5.57)° ; whereas the femoral component was inserted with an- teversion angle of (14.38±6.35)° and limb length change of (-0.40±1.06) mm. Of the 8 patients, 6 patients had same size acetabular prosthe- sis used as three-dimensional preoperative planning, 1 patient had 1 grade difference and another had 2 grade difference. In addition, 3 pa- tients had same size femoral component implanted as three-dimensional preoperative planning, 3 patients had 1 grade difference and other 2 had 2 grade difference. [Conclusion] This three-dimensional preoperative planning does accurately estimate the prosthetic size and posi- tion placed.