计算机辅助技术在成人髋发育不良中的应用研究

探讨计算机辅助技术在成人髋臼发育不良全髋关节置换术(THA)中的应用价值.选择单侧髋臼发育不良需进行全髋关节置换的患者21例,男性5例5髋,女性16例16髋.按Crowe分型,Ⅱ型6例(6髋),Ⅲ型11例(11髋),Ⅳ型4例(4髋).年龄30~78岁,平均年龄55.3岁.所有患者术前行薄层CT扫描并通过M3D可视化软件进行三维重建、术前观察、测量,手术预演、制定手术方案并行全髋关节置换术.术后21例患者均获得3~32个月随访,平均随访12.8月.术前Harris评分为(48.5±6.2)分,随访时评分为(86.3±4.3)分,差异有统计学意义(P0.05),优17例,良4例.所有病例术后通过骨盆标准前后位X线片测量,1例患者髋臼水平距离,1例髋臼垂直距离超出安全范围,1例影像前倾角超出安全范围,合格率85.7%.术中未出现髋臼戳穿、股骨假体周围骨折,术后所有病例均未出现术口感染,1例出现大腿疼痛,所有病例随访期间均为出现假体松动、下沉.成人髋臼发育不良行THA,计算机辅助技术可以术前把握真臼的解剖特点及其与假臼的相对关系、髋臼壁的缺损类型,量化指导如何选择合适的髋臼及股骨侧假体、选择合适的髋臼重建方式、髋臼假体安放角度等,对于恢复头臼假体同心复位,实现理想的头臼匹配,恢复髋关节解剖结构,重建关节功能具有重要作用.

Computer Aided Technology Stimulation on Total Hip Replacement due to Adult Hip Developmental Dysplasia

To investigate the stimulation worth of computer aided technology on total hip replacement due to adult acetabulum developmental dysplasia.21 cases with unilateral acetabulum developmental dysplasia are selected to proceed total hip replacement operation.Among the selected cases,6 cases are type II,1 1 type Ⅲ and 4 typeⅣaccording to the classification system of CROWE;5 cases are male and 1 9 cases female.The ages range from 30 to 78,the average being 55.3.Thin slice CT scanning is carried out to all the cases before operation.M3D visualization software is employed thereafter for 3-dimentional image reconstruction,preparative observation and measurements,operation rehearsal,schedule planning and the operation itself.All the 21 cases receive 3-32 months follow-up visits after the operations,the average being 1 2.8 months.The score before the operation＇nbsp;according to the grade of HARRIS is 48.5 ±6.2,while the follow-up visit score is 86.3 ±4.3,the difference being statistically significant（P〈0.05 ）.1 7 out of 21 cases have optimal results while the left 4 are good.After the operation the cripetura malformation of the operated limb and limping step are ameliorated obviously.X-ray measurements show that in all cases acetabulum prosthesis are located in the position of real acetabulum and combined tightly with surrounding bony bed.Complications：after operation 1 case suffers thigh pain,1 case suffers the constriction of extending function,not any prosthesis of all cases becomes flexible or submerged.when proceeding the total hip replacement due to adult acetabulum developmental dysplasia,the computer aided technology may help grasp the anatomy characteristics of real acetabulum and the corresponding relationship between real acetabulum and artificial acetabulum,the defect type of acetabulum wall,and guide in detail how to select proper acetabulum and femur head prosthesis to elect appropriate recreation way of acetabulum to choose acetabulum prosthesis laying angle and so on.It may also play an impor