摘要
目的探讨选择CT三维重组图像代替X线图像做术前计划是否可提高人工股骨假体与股骨近端髓腔解剖形态的匹配度。方法选择2013年1月至2015年12月,在广州医科大学附属第一医院关节外科接受初次人工髋关节置换的发育性髋臼发育不良(DDH)患者38例(46髋),排除了髋骨关节炎,股骨头缺血坏死,曾行髋关节截骨矫形术,或者CroweⅣ型的患者。在做术前计划时,双盲随机数字法抽选23髋(X线组)使用标准X线图像测量;23髋(CT组)使用CT三维重建图像测量。术中使用非骨水泥股骨柄。记录术前计划与术中使用假体型号的大小,得到两者的符合率,应用卡方检验比较两组符合率的差异。术后2周内两组患者行CT扫描。利用CT自带的测量软件测量股骨近端髓腔的解剖学参数,包括测量代表假体近段匹配度的股骨颈截骨位置,股骨颈截骨远端2.5 cm位置,代表假体远段匹配度的股骨颈截骨远端7.5 cm位置,股骨干峡部位置的髓腔冠状径、矢状径;以及人工股骨假体在同一解剖位置的冠状径、矢状径。股骨髓腔与人工股骨假体径线之间的差值大小代表了两者的匹配度。配对t检验比较两组间匹配度的差异。结果 X线组术前计划与术中使用假体型号的符合率低于CT组(x^2=5.03,P<0.05)。X线组患者假体与股骨近端髓腔的匹配度较CT组低,包括股骨颈截骨位置、股骨颈截骨远端2.5 cm位置、股骨颈截骨远端7.5 cm位置和股骨干峡部位置(冠状径差值比较,t=2.234、2.081、2.449、2.245,P<0.05;矢状径差值比较,t=2.435、2.033、2.145、2.296,P<0.05)。结论 DDH患者选择使用CT重组图像做人工髋关节置换术前计划,可以提高术中使用人工股骨假体的符合率,也能提高术后人工股骨假体与髓腔的匹配度。
Objective To find out whether three-dimensional reconstruction of CT images in preoperative plan before total hip replacement （ THA ） in developmental dysplasia of the hip （ DDH ） , compared to X-ray could improve the precision of prosthesis matching with the anatomical morphology of proximal femur medullary canal. Methods From Jan 2013 to Dec 2015, 38 cases （46 hips） of DDH undergone THA in the orthopedics department of the first affiliated hospital of Guangzhou Medical University were selected in the study, except for the cases which were suffering osteoarthritis of hip, avascular necrosis of femoral head, DDH of Crowe IV, or accepted osteotomy of hip. All the cases were randomly divided into two groups： standard X-ray images were used in the X-ray group （23 hips） and 3D reconstructions of CT images were used in the CT group （23 hips） respectively in the preoperative plans. All the femur prostheses were cementless fitted. The size of femur prosthesis both anticipated in the preoperative plan and used in THA was recorded and the coincidence rates of the two groups were compared. CT scan was performed at two weeks after the surgery. Parameters of femur medullary and prosthesis, including anteroposterior and trans-diameters at the sites of femoral neck osteotomy, 25mm and 75mm distal to the sites of femoral neck osteotomy, and femoral isthmus were measured with CT software. D-value of diameter between femur medullary and prosthesis was calculated and the indices of compatibility were compared between the two groups by paired t test. Results The coincidence rate of anticipated and actual size of femur prosthesis in the X-ray group were lower than the CT group （χ^2 = 5. 03, P 〈 0.05 ）. The indices of compatibility of femur medullary and prosthesis in X-ray group were lower than the CT group, including anteroposterior and trans-diameters at the sites of femoral neck osteotomy, 25mm and 75mm distal to the sites of femoral neck osteotomy, and femoral isthmus （D-value of anteroposterior di
作者
陈东峰
卢伟杰
李之琛
余楠生
Chen Dongfeng Lu Weijie Li Zhichen Yu Nansheng.(Department of Orthopedics, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China)
出处
《中华关节外科杂志（电子版）》
CAS
2017年第3期36-41,共6页
Chinese Journal of Joint Surgery(Electronic Edition)
关键词
髋脱位
先天性
体层摄影术
X线计算机
髋假体
Hip dislocation, congenital
Tomography, X-ray computed
Hip prosthesis
