摘要
目的:探讨虚拟现实技术(Virtual Reality,VR)辅助下经股骨颈基底部旋转截骨术治疗股骨头坏死(Osteonecrosis of the Femoral Head,ONFH)的临床效果。方法:以2018年4月至2019年11月拟行经股骨颈基底部旋转截骨术的11例(11髋)ONFH患者作为研究对象,分期均为国际骨循环学会(Association Research Circulation Osseous,ARCO)Ⅲ期。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,模拟旋转截骨,根据负重区股骨头完整率设计旋转角度。术中按照术前规划进行旋转截骨,C臂机下透视确认旋转角度和负重区情况。如出现计划旋转角度偏小情况,则在透视下继续增加旋转角度。术后第2天通过摄X线片评估旋转效果,与术前规划旋转角度比较。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10~26个月。术后均达到VR术前规划旋转角度。10例(10髋)截骨处愈合良好,1例(1髋)出现截骨处延迟愈合。术前Harris评分为(55.00±4.73)分,末次随访时Harris评分为(72.73±10.93)分,与术前比较差异有统计学意义(t=4.937,P<0.001)。末次随访时髋关节评分优1髋,较好2髋,良5髋,差3髋,优良率为72.7%。结论:虚拟现实技术辅助下经股骨颈基底部旋转截骨术治疗股骨头坏死短期疗效满意。
Objective:To study the clinical efficacy of virtual reality(VR)assisted rotational osteotomy through the base of the femoral neck in the treatment of osteonecrosis of the femoral head(ONFH).Methods:A total of 11 patients(11 hips)with ONFH underwent rotational osteotomy through the base of femoral neck from April 2018 to November 2019 was studied.All patients were in ARCOⅢ.VR technique was used to design the scheme before operation.The CT datum were imported into the software to construct the morphology of necrotic area to simulate the rotational osteotomy,and to design the rotational angle according to the intact rate of the femoral head in the loading area.The rotatory osteotomy was performed according to the preoperative plan.The rotatory angle and the weight-bearing area were confirmed by X-ray fluoroscopy.If the planned angle was too small,the rotation would be increased to a satisfactory position under the fluoroscopy.The efficacy of rotational osteotomy was evaluated by X-ray film on the 2 nd day after operation and we compared it with the preoperative planned rotational angle.Hip function was evaluated with Harris score during follow-up.Results:All the incisions healed well after operation.Patients were followed up 10 to 26 months.The planned rotational angle by VR preoperative design were achieved in all patients.The osteotomy healed well in 10 cases(10 hips),and delayed healing occurred in 1 case(1 hip).The preoperative Harris score was(55.00±4.73)during the last follow-up.Harris score(72.73±10.93)was significantly higher than that before operation(t=4.937,P<0.001).At the last follow-up,the hip function was excellent 1 hip,good 2 hips,fair 5 hips,poor 3 hips,the excellent rate is 72.7%.Conclusion:It is satisfactory that the short-term efficacy of virtual reality assisted rotational osteotomy through the base of the femoral neck in the treatment of osteonecrosis of femoral head.
作者
高润子
夏天卫
环大维
邱越
刘金柱
张超
施乐
黄桂成
沈计荣
GAO Runzi;XIA Tianwei;HUAN Dawei;QIU Yue;LIU Jinzhu;ZHANG Chao;SHI Le;HUANG Guicheng;SHEN Jirong(Nanjing University of Chinese Medicine,Nanjing 210023,China;Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing 210029,China)
出处
《中国中医骨伤科杂志》
CAS
2021年第5期51-55,共5页
Chinese Journal of Traditional Medical Traumatology & Orthopedics
