数字化术前计划在发育性髋关节发育不良患者髋臼重建中的作用_《中国修复重建外科杂志》

作者：

赵潇艺 , 康焱 , 邬培慧 , 张紫机 , 张志奇 , 傅明 , 廖威明

中山大学附属第一医院关节外科（广州，510080）;

关键词：

发育性髋关节发育不良人工全髋关节置换数字化术前计划

DOI：

10.7507/1002-1892.20130311

视频：

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目的评价数字化术前计划对人工全髋关节置换（total hip arthroplasty，THA）治疗发育性髋关节发育不良（development dysplasia of the hip，DDH）中髋臼重建的作用。方法将2009年1月－2011年12月收治并符合选择标准的42例DDH患者纳入研究，根据术前计划方法不同随机分为两组，其中23例（A组）行常规术前影像学分析，19例（B组）采用TraumaCad软件进行术前计划。两组患者性别、年龄、体重指数、DDH分型及术前Harris评分比较，差异均无统计学意义（P gt; 0.05），具有可比性。记录两组手术时间、术中出血量以及相关并发症发生情况；于术后7 d复查骨盆标准前后位X线片，采用TraumaCad软件测量髋臼假体水平距离、垂直距离、影像学前倾角、影像学外倾角和假体大小，比较两组髋臼假体放置合格率，以及B组术前预测和实际放置假体大小符合率。结果A、B组手术时间分别为（119.25 ± 47.16）、（155.31 ± 84.03）min，术中出血量分别为（410.00 ± 200.39）、（387.50 ± 251.99）mL，两组比较差异均无统计学意义（P gt; 0.05）。术后3例发生并发症，其中A组切口感染1例，假体前脱位1例；B组假体后脱位1例。患者均获随访，A组随访时间1年1个月～4年1个月，平均2年8个月；B组1年3个月～4年，平均2年7个月。末次随访时，A组Harris评分为（91.09 ± 5.35）分，B组为（91.72 ± 3.48）分，均较术前显著提高（P lt; 0.05）；但两组间比较差异无统计学意义（t=0.41，P=0.69）。TraumaCad软件测量示，B组髋臼假体放置合格率为78.95%（15/19），明显高于A组的43.48%（10/23）（χ2=5.43，P=0.02）。B组髋臼假体术前预测大小与实际放置符合率为68.42%（13/19）。结论THA治疗DDH时数字化术前计划能进一步优化髋臼重建。

引用本文： 赵潇艺,康焱,邬培慧,张紫机,张志奇,傅明,廖威明. 数字化术前计划在发育性髋关节发育不良患者髋臼重建中的作用. 中国修复重建外科杂志, 2013, 27(12): 1419-1423. doi: 10.7507/1002-1892.20130311 复制

1.	Bertz A, Indrekvam K, Ahmed M, et al. Validity and reliability of preoperative templating in total hip arthroplasty using a digital templating system. Skeletal Radiol, 2012, 41(10): 1245-1249.
2.	Kumar PG, Kirmani SJ, Humberg H, et al. Reproducibility and accuracy of templating uncemented THA with digital radiographic and digital TraumaCad templating software. Orthopedics, 2009, 32(11): 815.
3.	Steinberg EL, Shasha N, Menahem A, et al. Preoperative planning of total hip replacement using the TraumaCad™ system. Arch Orthop Trauma Surg, 2010, 130(12): 1429-1432.
4.	Zhao X, Zhu ZA, Zhao J, et al. The utility of digital templating in Total Hip Arthroplasty with Crowe type II and III dysplastic hips. Int Orthop, 2011, 35(5): 631-638.
5.	Ranawat CS, Dorr LD, Inglis AE. Total hip arthroplasty in protrusio acetabuli of rheumatoid arthritis. J Bone Joint Surg (Am), 1980, 62(7): 1059-1065.
6.	Antoniades J, Pellegrini VD Jr. Cross-sectional anatomy of the ilium: implications for acetabular component placement in total hip arthroplasty. Clin Orthop Relat Res, 2012, 470(12): 3537-3541.
7.	Murayama T, Ohnishi H, Okabe S, et al. 15-year comparison of cementless total hip arthroplasty with anatomical or high cup placement for Crowe I to III hip dysplasia. Orthopedics, 2012, 35(3): e313-318.
8.	Dorr LD, Tawakkol S, Moorthy M, et al. Medial protrusio technique for placement of a porous coated, hemispherical acetabular component without cement in a total hip arthroplasty in patients who have acetabular dysplasia. J Bone Joint Surg (Am), 1999, 81(1): 83-92.
9.	Fabi D, Gonzalez M, Goldstein W, et al. Acetabular cup revision with the use of the medial protrusio technique at an average follow-up of 6.6 years. J Arthroplasty, 2010, 25(2): 197-202.
10.	Murray DW. The definition and measurement of acetabular orientation. J Bone Joint Surg (Br), 1993, 75(2): 228-232.
11.	Mulroy RD Jr, Harris WH. Failure of acetabular autogenous grafts in total hip arthroplasty. Increasing incidence: a follow-up note. J Bone Joint Surg (Am), 1990, 72(10): 1536-1540.
12.	Lewinnek GE, Lewis JL, Tarr R, et al. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg (Am), 1978, 60(2): 217-220.
13.	de Jong PT, Haverkamp D, van der Vis HM, et al. Total hip replacement with a superolateral bone graft for osteoarthritis secondary to dysplasia: a long-term follow-up. J Bone Joint Surg (Br), 2006, 88(2): 173-178.
14.	Hendrich C, Mehling I, Sauer U, et al. Cementless acetabular reconstruction and structural bone-grafting in dysplastic hips. J Bone Joint Surg (Am), 2006, 88(2): 387-394.
15.	Kim M, Kadowaki T. High long-term survival of bulk femoral head autograft for acetabular reconstruction in cementless THA for developmental hip dysplasia. Clin Orthop Relat Res, 2010, 468(6): 1611-1620.
16.	Johnston RC, Brand RA, Crowninshield RD. Reconstruction of the hip. A mathematical approach to determine optimum geometric relationships. J Bone Joint Surg (Am), 1979, 61(5): 639-652.
17.	Zhang H, Huang Y, Zhou YX, et al. Acetabular medial wall displacement osteotomy in total hip arthroplasty: a technique to optimize the acetabular reconstruction in acetabular dysplasia. J Arthroplasty, 2005, 20(5): 562-567.
18.	Chougle A, Hemmady MV, Hodgkinson JP. Severity of hip dysplasia and loosening of the socket in cemented total hip replacement. A long-term follow-up. J Bone Joint Surg (Br), 2005, 87(1): 16-20.
19.	卢伟杰, 金大地, 李之琛, 等. 全髋关节置换术后髋臼假体外倾角的临床研究. 中国临床解剖学杂志, 2012, 30(2): 233-236.
20.	Seki M, Yuasa N, Ohkuni K. Analysis of optimal range of socket orientations in total hip arthroplasty with use of computer-aided design simulation. J Orthop Res, 1998, 16(4): 513-517.
21.	Biedermann R, Tonin A, Krismer M, et al. Reducing the risk of dislocation after total hip arthroplasty: the effect of orientation of the acetabular component. J Bone Joint Surg (Br), 2005, 87(6): 762-769.
22.	Nakamura N, Nishii T, Kitada M, et al. Application of computed tomography-based navigation for revision total hip arthroplasty. J Arthroplasty, 2013. [Epub ahead of print].
23.	Ryan JA, Jamali AA, Bargar WL. Accuracy of computer navigation for acetabular component placement in THA. Clin Orthop Relat Res, 2010, 468(1): 169-177.
24.	李勇, 喻忠. 计算机导航辅助下植入髋臼假体的临床研究. 中华关节外科杂志(电子版), 2008, 2(2): 192-197.

1. Bertz A, Indrekvam K, Ahmed M, et al. Validity and reliability of preoperative templating in total hip arthroplasty using a digital templating system. Skeletal Radiol, 2012, 41(10): 1245-1249.
2. Kumar PG, Kirmani SJ, Humberg H, et al. Reproducibility and accuracy of templating uncemented THA with digital radiographic and digital TraumaCad templating software. Orthopedics, 2009, 32(11): 815.
3. Steinberg EL, Shasha N, Menahem A, et al. Preoperative planning of total hip replacement using the TraumaCad™ system. Arch Orthop Trauma Surg, 2010, 130(12): 1429-1432.
4. Zhao X, Zhu ZA, Zhao J, et al. The utility of digital templating in Total Hip Arthroplasty with Crowe type II and III dysplastic hips. Int Orthop, 2011, 35(5): 631-638.
5. Ranawat CS, Dorr LD, Inglis AE. Total hip arthroplasty in protrusio acetabuli of rheumatoid arthritis. J Bone Joint Surg (Am), 1980, 62(7): 1059-1065.
6. Antoniades J, Pellegrini VD Jr. Cross-sectional anatomy of the ilium: implications for acetabular component placement in total hip arthroplasty. Clin Orthop Relat Res, 2012, 470(12): 3537-3541.
7. Murayama T, Ohnishi H, Okabe S, et al. 15-year comparison of cementless total hip arthroplasty with anatomical or high cup placement for Crowe I to III hip dysplasia. Orthopedics, 2012, 35(3): e313-318.
8. Dorr LD, Tawakkol S, Moorthy M, et al. Medial protrusio technique for placement of a porous coated, hemispherical acetabular component without cement in a total hip arthroplasty in patients who have acetabular dysplasia. J Bone Joint Surg (Am), 1999, 81(1): 83-92.
9. Fabi D, Gonzalez M, Goldstein W, et al. Acetabular cup revision with the use of the medial protrusio technique at an average follow-up of 6.6 years. J Arthroplasty, 2010, 25(2): 197-202.
10. Murray DW. The definition and measurement of acetabular orientation. J Bone Joint Surg (Br), 1993, 75(2): 228-232.
11. Mulroy RD Jr, Harris WH. Failure of acetabular autogenous grafts in total hip arthroplasty. Increasing incidence: a follow-up note. J Bone Joint Surg (Am), 1990, 72(10): 1536-1540.
12. Lewinnek GE, Lewis JL, Tarr R, et al. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg (Am), 1978, 60(2): 217-220.
13. de Jong PT, Haverkamp D, van der Vis HM, et al. Total hip replacement with a superolateral bone graft for osteoarthritis secondary to dysplasia: a long-term follow-up. J Bone Joint Surg (Br), 2006, 88(2): 173-178.
14. Hendrich C, Mehling I, Sauer U, et al. Cementless acetabular reconstruction and structural bone-grafting in dysplastic hips. J Bone Joint Surg (Am), 2006, 88(2): 387-394.
15. Kim M, Kadowaki T. High long-term survival of bulk femoral head autograft for acetabular reconstruction in cementless THA for developmental hip dysplasia. Clin Orthop Relat Res, 2010, 468(6): 1611-1620.
16. Johnston RC, Brand RA, Crowninshield RD. Reconstruction of the hip. A mathematical approach to determine optimum geometric relationships. J Bone Joint Surg (Am), 1979, 61(5): 639-652.
17. Zhang H, Huang Y, Zhou YX, et al. Acetabular medial wall displacement osteotomy in total hip arthroplasty: a technique to optimize the acetabular reconstruction in acetabular dysplasia. J Arthroplasty, 2005, 20(5): 562-567.
18. Chougle A, Hemmady MV, Hodgkinson JP. Severity of hip dysplasia and loosening of the socket in cemented total hip replacement. A long-term follow-up. J Bone Joint Surg (Br), 2005, 87(1): 16-20.
19. 卢伟杰, 金大地, 李之琛, 等. 全髋关节置换术后髋臼假体外倾角的临床研究. 中国临床解剖学杂志, 2012, 30(2): 233-236.
20. Seki M, Yuasa N, Ohkuni K. Analysis of optimal range of socket orientations in total hip arthroplasty with use of computer-aided design simulation. J Orthop Res, 1998, 16(4): 513-517.
21. Biedermann R, Tonin A, Krismer M, et al. Reducing the risk of dislocation after total hip arthroplasty: the effect of orientation of the acetabular component. J Bone Joint Surg (Br), 2005, 87(6): 762-769.
22. Nakamura N, Nishii T, Kitada M, et al. Application of computed tomography-based navigation for revision total hip arthroplasty. J Arthroplasty, 2013. [Epub ahead of print].
23. Ryan JA, Jamali AA, Bargar WL. Accuracy of computer navigation for acetabular component placement in THA. Clin Orthop Relat Res, 2010, 468(1): 169-177.
24. 李勇, 喻忠. 计算机导航辅助下植入髋臼假体的临床研究. 中华关节外科杂志(电子版), 2008, 2(2): 192-197.

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《中国修复重建外科杂志》

数字化术前计划在发育性髋关节发育不良患者髋臼重建中的作用

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