基于MSCT三维扫描加重建对成人髋关节发育不良全髋关节置换术中髋臼假体的选择及截骨的准确性预测价值

doi:10.3969/j.issn.1006-5725.2024.09.022

Abstract

Abstract:

Objective To explore the effect of MSCT 3D scanning and reconstruction on developmental dysplasia of the hip（DDH）in adult patients with total hip arthroplasty， The predictive value of acetabular prosthesis selection and osteotomy accuracy in THA. Methods Selection in our hospital between February 2021 and February 2023 were 60 adult DDH patients underwent total hip replacement， which USES routine preoperative planning as a control group of 30 patients，and using MSCT + reconstruction of 3 d scanning technology as observation group of 30 patients，planning after the completion of the planning of the surgical operation and implant placement， Relevant information was collected before and after the operation of the two groups. Operation time，intraoperative blood loss，intraoperative fluoroscopy time， acetabular prosthesis selection and matching rate， femur split fracture rate， pelvis and acetabular reduction quality， Majeed score and Harris hip function score were compared between the two groups. The osteotomy distance and sharp shoulder distance of the two groups were compared before planning and in actual conditions，and the correlation between MSCT 3D scanning and reconstruction technology and the accuracy of acetabular prosthesis selection was evaluated. Results Results analysis showed that MSCT 3D scanning+reconstruction technology used in preoperative evaluation of patients in the observation group was correlated with the accuracy of acetabular prosthesis selection（P < 0.05）， and the absolute errors of osteotomy distance and sharp shoulder distance of patients in the observation group were smaller than the actual situation before planning（P < 0.05）. In addition，compared with the control group， the operative time，intraoperative blood loss， intraoperative fluoroscopy time and incidence of femoral split fracture in the observation group were significantly lower，and the matching rate of acetabular prosthesis selection，the Majeed scores and Harris scores were significantly higher in the following 3 months were significantly higher（P < 0.05）. The reduction quality of pelvis and acetabulum was not statistically significant between the two groups（P > 0.05）. Conclusion Msct?based 3D scanning + reconstruction has a high predictive value for the selection of acetabular prosthesis and the accuracy of osteotomy in adult DDH total hip replacement， and the use of this technology for preoperative planning has a significant optimization effect on the actual treatment effect and patient recovery.

Key words: MSCT, preoperative planning, developmental dysplasia of the hip, total hip arthroplasty, osteotomy

CLC Number:

R445.3

Xiaorong CUI,Lihua LAN,Xiangyang LI,Zhifeng. ZHONG. Analysis of the predictive value of acetabular prosthesis selection and osteotomy accuracy in adult developmental dysplasia of the hip total hip arthroplasty based on MSCT 3D scanning + reconstruction[J]. The Journal of Practical Medicine, 2024, 40(9): 1309-1313.

Figures/Tables 8

Tab.1

Comparative analysis of general data between the two groups"

项目	观察组（n = 30）	对照组（n = 30）	t/χ²值	P值
性别（例）			0.069	0.793
男	12	13
女	18	17
年龄（ $x ˉ$ ± s，岁）	44.01 ± 7.12	43.84 ± 7.07	0.093	0.926
病程（ $x ˉ$ ± s，年）	7.18 ± 2.36	7.39 ± 2.14	0.361	0.719
体质量指数（kg/m²）	23.22 ± 2.39	23.19 ± 2.41	0.048	0.962
病侧（例）			0.306	0.760
左侧	11	11
右侧	13	15
双侧	6	4
Crowe分型（例）			0.321	0.749
CroweⅠ	4	3
CroweⅡ	5	4
CroweⅢ	11	13
CroweⅣ	10	10

Tab.1

Tab.2

Tab.3

Tab.4

Tab.5

Tab.6

Tab.7

Tab.8

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组别	例数	手术时间（min）	术中出血量（mL）	术中透视时间（s）
观察组	30	64.18 ± 13.35	244.15 ± 47.39	20.05 ± 5.11
对照组	30	74.81 ± 14.98	323.28 ± 63.90	26.44 ± 5.38
t值		2.902	5.448	4.739
P值		0.005	< 0.001	< 0.001

组别	例数	髋臼假体选择匹配率		股骨劈裂骨折发生率
组别	例数	匹配	未匹配	发生	未发生
观察组	30	26（86.67）	4（13.33）	1（3.33）	29（96.67）
对照组	30	16（53.33）	14（46.67）	8（26.67）	22（73.33）
χ ² 值		7.937		4.706
P值		0.005		0.030

组别	例数	截骨距离			尖肩距
组别	例数	术前规划	实际测量	绝对误差［M（P₂₅，P₇₅）］	术前规划	实际测量	绝对误差［M（P₂₅，P₇₅）］
观察组	30	10.25 ± 3.21	10.31 ± 3.22	-0.09（-0.89，1.04）	16.59 ± 4.30	16.20 ± 4.13	-0.41（-1.00，0.66）
对照组	30	11.92 ± 3.26	10.29 ± 3.28	-1.35（-3.03，0.02）	18.19 ± 5.22	16.96 ± 5.02	-1.09（-1.97，-0.50）
t值		1.999	0.024	-3.216	1.296	0.640	-2.255
P值		0.050	0.981	0.001	0.200	0.525	0.024

组别	例数	骨盆复位质量
组别	例数	优	良	可	差	优良率
观察组	30	23	6	1	0	29（96.67）
对照组	30	20	5	4	1	25（83.33）
χ ² 值						1.667
P值						0.197

组别	例数	髋臼复位质量
组别	例数	解剖复位	满意复位	不满意复位	优良率
观察组	30	26	3	1	29（96.67）
对照组	30	20	7	3	27（90.00）
χ ² 值					0.268
P值					0.605

Analysis of the predictive value of acetabular prosthesis selection and osteotomy accuracy in adult developmental dysplasia of the hip total hip arthroplasty based on MSCT 3D scanning + reconstruction

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组别	例数	Majeed评分			Harris评分
组别	例数	术前	术后3个月	术后6个月	术前	术后3个月	术后6个月
观察组	30	31.48 ± 5.93	68.15 ± 6.68^*	90.32 ± 8.06^*	37.82 ± 5.03	78.01 ± 6.36^*	83.35 ± 6.26^*
对照组	30	32.14 ± 6.48	63.74 ± 7.03^*	88.17 ± 7.97^*	37.66 ± 5.12	73.29 ± 5.79^*	83.37 ± 6.08^*
t值		0.412	2.491	1.039	0.122	3.006	0.013
P值		0.682	0.016	0.303	0.903	0.004	0.990

项目	观察组（n = 30）	对照组（n = 30）	Pearson相关系数	P值
髋臼假体选择匹配率	26	16	0.364	0.004
股骨劈裂骨折发生率	1	8	-0.327	0.011

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