初次全髋关节置换术前数字虚拟手术的意义△

Significance of digital virtual planning before primary total hip replacement

摘要:

[目的]评价初次全髋置换（total hip arthroplasty, THA）术前数字影像虚拟的临床意义。[方法]2017 年 8 月—2021 年 6 月在本院行初次 THA 患者 60 例纳入本研究。依据医患沟通结果，30 例采用术前虚拟 THA，30 例采用常规 THA。比较两组围手术期、随访和影像学指标。[结果]两组患者均顺利完成手术，无严重并发症。虚拟组手术时间 [(97.3±20.5) min vs (131.2± 19.3) min, P＜0.05]、术中失血量 [(245.2±20.4) ml vs (322.1±25.6) ml, P＜0.05]、下地行走时间 [(5.2±4.4) d vs (9.2±3.7) d , P＜0.05] 均显著优于常规组。两组随访时间平均（14.2±3.6）个月，虚拟组恢复完全负重活动时间显著早于常规组 [(10.3±2.2) 周 vs (14.2±4.2) 周, P＜0.05]。随时间推移，两组患者 Harris 评分、髋关节伸屈 ROM 均显著增加（P＜0.05），VAS 评分显著减少（P＜0.05）。末次随访时，虚拟组在 Harris 评分 [(93.2±10.9) vs (81.2±8.5), P＜0.05]、髋伸-屈 ROM [(84.5±11.2)° vs (71.6±11.4)°, P＜0.05] 显著优于常规组。影像方面，虚拟组术后髋臼假体外翻角 [(45.6±3.6)° vs (40.1±3.3)°, P＜0.05] 和前倾角 [(14.1±2.5)° vs (10.1±2.1)°, P＜0.05] 均显著优于常规组。此外，术后虚拟组纵向 HCOR [(2.2±1.7) mm vs (5.2±3.1) mm, P＜0.05] 和横向 HCOR [(3.3±1.6) mm vs (4.9±3.1) mm, P＜ 0.05] 显著优于常规组（P＜0.05），但 LLD 的差异无统计学意义（P＞0.05）。此外，虚拟组股骨柄假体位置 [中置/偏置, (28/2) vs (21/ 9), P＜0.05] 及大小 [适当/偏小, (29/1) vs (23/7), P＜0.05] 显著优于常规组。[结论]术前数字影像虚拟规划可减少全髋关节置换手术创伤，有效提高假体匹配的准确性，促进患者术后早期髋关节功能恢复。

Abstract:

[Objective] To evaluate the clinical significance of digital virtual planning (DVP) before primary total hip arthroplasty (THA). [Methods] A total of 60 patients who were undergoing primary THA in our hospital from August 2017 to June 2021 were included in this study. According to the doctor- patient communication, 30 patients received the DVP THA, while the remaining 30 patients received conventional THA. The perioperative period, follow-up and imaging data were compared between the two groups. [Results] All patients in both groups had THA performed successfully with no serious complications. The DVP group proved significantly superior to the conventional group in terms of operative time [(97.3±20.5) min vs (131.2±19.3) min, P＜0.05], intraoperative blood loss [(245.2±20.4) ml vs (322.1±25.6) ml, P＜0.05] and postoperative ambulation [(5.2±4.4) days vs (9.2±3.7) days, P＜0.05]. All of them were followed up for (14.2± 3.6) months on a mean, the DVP group resumed full weight-bearing activities significantly earlier than the conventional group [(10.3±2.2) weeks vs (14.2± 4.2) weeks, P＜0.05]. The Harris score and hip flexion- extension range of motion (ROM) significantly increased (P＜0.05), while the VAS score significantly decreased in both groups over time (P＜0.05). The DVP group proved significantly better than the conventional group at the latest follow-up in terms of Harris score [(93.2±10.9) vs (81.2±8.5), P＜0.05] and hip ROM [(84.5±11.2)° vs (71.6±11.4)°, P＜0.05]. Radio- graphically, the DVP group got significantly more proper postoperative acetabular abduction [(45.6±3.6)° vs (40.1±3.3)°, P＜0.05] and ante- version of the acetabular component [(14.1±2.5)° vs (10.1±2.1)°, P＜0.05], with significantly less deviations of hip center of rotation (HCOR) longitudinally [(2.2±1.7) mm vs (5.2±3.1) mm, P＜0.05] and transversely [(3.3±1.6) mm vs (4.9±3.1) mm, P＜0.05] than the conventional group. In addition, the DVP group gained significantly accurate femoral component in position [medium/displaced, (28/2) vs (21/9), P＜0.05] and size [appropriate/small, (29/1) vs (23/7), P＜0.05] than the conventional group, despite that there was no statistical significance in leglength discrepancy (LLD) between the two groups (P＞0.05). [Conclusion] Preoperative digital image virtual planning does reduce the trau-ma of THA, effectively improve the accuracy of prosthesis matching, and promote the early hip functional recovery.