摘要
目的探讨经转子间弧形内翻截骨术治疗成人股骨头缺血性坏死(avascular necrosis of the femoral head,ANFH)时,采用虚拟现实(virtual reality,VR)技术进行术前规划的应用价值。方法以2018年6月-11月拟行经转子间弧形内翻截骨术的7例(11髋)ANFH患者作为研究对象。其中,男4例(7髋),女3例(4髋)。年龄14~46岁,平均31.9岁。单髋3例,双髋4例。创伤性1例(1髋),酒精性2例(4髋),激素性2例(3髋),特发性2例(3髋)。ANFH根据国际骨循环学会(ARCO)分期均为Ⅲ期;日本骨坏死研究会(JIC)分型:C1型5髋、C2型6髋;中日友好医院(CJFH)分型:L1型5髋、L2型1髋、L3型5髋。病程5~12个月,平均8个月。术前Harris评分为(53.91±7.66)分。颈干角为128~143°,平均133.9°。术前采用VR技术进行方案设计,将CT数据导入软件构建坏死区域形态,模拟转子间内翻截骨,根据负重区股骨头完整率设计内翻角度。VR术前规划内翻角度为6~16°,平均9.7°。术中按照术前规划进行内翻截骨,C臂X线机透视确认内翻角度和负重区情况。如出现计划内翻角度偏小情况,则在透视下继续增加至获得满意位置。术后2 d摄X线片测量颈干角,计算手术前后差值,并与术前规划内翻角度比较(误差值)。随访时采用Harris评分评估髋关节功能。结果术后切口均Ⅰ期愈合。患者均获随访,随访时间6~11个月,平均8个月。术后2 d复查X线片,颈干角为112~135°,平均123.4°;手术前后差值为6~16°,平均11.0°;其中,5髋颈干角手术前后差值与VR术前规划内翻角度一致,其余6髋误差值为1~4°。术后1例(1髋)出现截骨处骨不连、1例(1髋)发生股骨近端骨折,其余5例(9髋)截骨处愈合良好。末次随访时,Harris评分为(82.18±16.35)分,与术前比较差异有统计学意义(t=-5.195,P=0.000)。结论VR技术为经转子间弧形内翻截骨术治疗ANFH提供了一种新的术前规划方法。
Objective To research the value of virtual reality(VR) technology in the preoperative planning of transtrochanteric curved varus osteotomy for avascular necrosis of the femoral head(ANFH) in adults.Methods Between June 2018 and November 2018, 7 patients(11 hips) with ANFH, who were treated with transtrochanteric curved varus osteotomy, were enrolled in the study. There were 4 males(7 hips) and 3 females(4 hips)with an average age of 31.9 years(range, 14-46 years). Among them, 3 patients were unilateral ANFH and 4 patients were bilateral ANFH. There was 1 patient(1 hip) of traumatic ANFH, 2 patients(4 hips) of alcohol-induced ANFH, 2 patients(3 hips) of hormonal ANFH, and 2 patients(3 hips) of idiopathic ANFH. All hips were Association Research Circulation Osseous(ARCO) stage Ⅲ. There were 5 hips for Japanese Investigation Committee(JIC) type C1 and 6 hips for type C2.There were 5 hips for China-Japan Friendship Hospital(CJFH) type L1,1 for type L2, and 5 for type L3. The disease duration ranged from 5 to 12 months(mean, 8 months). Preoperative Harris score was 53.91±7.66. The neck-shaft angle ranged from 128 to 143°(mean, 133.9°). VR technology was adopted for the preoperative planning. CT data were imported into the software to construct the morphology of necrotic area, and the transrtrochanteric varus osteotomy was simulated. The varus angle was designed according to the integrity rate of femoral head. The planned varus angle was 6 to 16°(mean,9.7°). The transtrochanteric curved varus osteotomy was performed according to the preoperative planning, and the varus angle and loading area were confirmed under fluoroscopy. If the planned varus angle was too small, it would continue to increase under the fluoroscopy until a satisfactory varus angle. Postoperative changes of the neck-shaft angle were calculated and compared with the preoperative planned varus angle(error). The hip function was assessed by using the Harris score.Results All incisions healed by first intention. All patients were followed up 6-11 m
作者
施乐
樊燕鑫
张超
沈计荣
SHI Le;FAN Vanxin;ZHANG Chao;SHEN Jirong(Department of Traumatology & Orthopedics,Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing Jiangsu,210029,P.R.China)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2019年第8期923-928,共6页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
虚拟现实技术
股骨头缺血性坏死
截骨术
术前规划
Virtual reality technology
avascular necrosis of the femoral head
osteotomy
preoperative planning
