目的 探讨镜像重建理念在可视化智能辅助系统(visual treatment solution,VTS)辅助全髋关节置换术(total hip arthroplasty,THA)治疗 Crowe Ⅱ、Ⅲ 型发育性髋关节发育不良(developmental dysplasia of the hip,DDH)中应用的可行性和疗效.方法 回顾性分析2022年6月至2023年8月于解放军总医院第四医学中心骨科医学部接受初次THA的单侧Crowe Ⅱ、Ⅲ型DDH患者67例.按旋转中心重建位置不同进行术前规划及手术,依照对侧正常关节旋转中心重建(镜像组)37例,男8例、女29例,年龄为(40.9±13.1)岁;选取骨量丰富区域直接高位重建(高位组)30例,男7例、女23例,年龄为(38.3±11.1)岁.比较两组术后12个月时患侧与健侧髋关节旋转中心高度、大转子高度及股骨偏距,比较两组手术前后组间的Harris髋关节评分(Harris hip score,HHS)和西安大略和麦克马斯特大学(the Western Ontario and McMaster University,WOMAC)骨关节炎指数评分.结果 所有患者均顺利完成手术,镜像组手术时间、术中出血量、随访时间分别为(113.9± 22.9)min、(287.8±181.6)ml、(12.8±1.8)个月,高位组分别为(118.0±26.2)min、(293.3±125.8)ml、(13.7±2.3)个月,组间差异均无统计学意义(P＞0.05).镜像组术后12个月患侧旋转中心高度、大转子高度及股骨偏距分别为(16.1±3.8)、(17.7± 5.2)、(34.4±5.1)mm,与健侧的差异均无统计学意义(P＞0.05);HHS和WOMAC骨关节炎指数评分分别为(84.3±6.3)、(9.4±2.5)分,较术前的(32.3±5.3)、(76.9±5.4)分改善,差异有统计学意义(t=-34.222,P＜0.001;t=64.486,P＜0.001);高位组患侧旋转中心高度、大转子高度及股骨偏距分别为(27.9±3.7)、(25.4±7.9)、(35.4±6.2)mm,较健侧增加,差异有统计学意义(t=-15.706,P＜0.001;t=-6.494,P＜0.001;t=-2.555,P=0.016);HHS 和 WOMAC 骨关节炎指数评分分别为(79.5±4.9)、(13.9±3.3)分,较术前的(30.9±4.8)、(78.7±5.3)分改善,差异有统计学意义(t=-37.339,P＜0.001;t=64.375,P＜0.001).镜像组与高位组术前HHS和WOMAC骨关节炎指数评分术前差异均无统计学意义,两组术后12个月的差异有统计学意义(t=3.404,P=0.001;t=-6.315,P＜0.001).至末次随访所有假体与组件均稳定在位,无患者出现并发症或二次手术.结论 与高位重建相比,VTS导航辅助THA的单侧Crowe Ⅱ、Ⅲ型DDH患者镜像重建术后均取得了令人满意的短期临床与影像学结果,镜像重建技术有助于实现THA术后恢复原生关节解剖结构与功能状态的目标.
Abstract
Objective To analyze the feasibility and clinical efficacy of mirror reconstruction in total hip arthroplasty(THA)assisted by visual treatment solution(VTS)for patients with Crowe type Ⅱ-Ⅲ developmental dysplasia of the hip(DDH).Methods Included in this study were 67 patients(67 hips)with unilateral Crowe type Ⅱ-Ⅲ DDH undergoing primary THA from June 2022 to August 2023.According to the reconstruction position of the rotation center,the patients were divided into mirror group and high group.There were 37 patients(37 hips)in the mirror group,reconstructed by referring to the rotation center of con-tralateral normal hip,with 8 males and 27 females,aged 40.9±16.7 years old and 30 patients(30 hips)in the high group,recon-structed by the"high hip center"strategy,with 7 males and 23 females,aged 38.3±11.1 years old.The radiographic results be-tween the affected hip and the normal hip in 12 months postoperatively and the clinical results before and after the operation were compared.Results All the operations for patients with Crowe type Ⅱ-Ⅲ DDH were completed successfully.The operation time,intraoperative blood loss and the follow-up time in the mirror group were 113.9±22.9 min,287.8±181.6 ml and 12.8±1.8 months,respectively,while those in the high group were 118.0±26.2 min,293.3±125.8 ml and 13.7±2.3 months respectively without signif-icant difference between the two groups.In 12 months postoperatively the rotation center height,greater trochanter height and fem-oral offset of 37 hips in the mirror group were 16.1±3.8 mm,17.7±5.2 mm and 34.4±5.1 mm,respectively,which were not signifi-cantly different from those of the normal side,while the HHS and WOMAC osteoarthritis index were significantly improved com-pared to those before operation from 32.3±5.3 and 76.9±5.4 points to 84.3±6.3 and 9.4±2.5 points(t=-34.222,P＜0.001;t=64.486,P＜0.001).In the high group,the rotational center height,greater trochanter height and femoral offset of 30 hips were 27.9±3.7 mm,25.4±7.9 mm and 35.4±6.2 mm,respectively,which were significantly higher than those in the normal side(t=-15.706,P＜0.001;t=-6.494,P＜0.001;t=-2.555,P=0.016),and the HHS and WOMAC osteoarthritis index were significantly improved compared to those before operation from 30.9±4.8 and 78.7±5.3 points to 79.5±4.9 and 13.9±3.3 points(t=-37.339,P＜0.001;t=64.375,P＜0.001).The HHS and WOMAC osteoarthritis index in the mirror group significantly improved compared with the high group in 12 months postoperatively(t=3.404,P=0.001;t=-6.315,P＜0.001).The X-ray at last follow-up showed that all prostheses were in a stable position.Conclusion Compared with the high hip center reconstruction,satisfactory outcomes in terms of functional recov-ery and radiographic evaluation could be achieved in patients with Crowe type Ⅱ-Ⅲ DDH undergoing VTS-assisted THA of mirror reconstruction.The application of mirror reconstruction is expected to achieve the goal of restoring the anatomical structure and function of the primary hip after THA.
关键词
发育性髋关节发育不良/关节成形术,置换,髋/手术导航系统/镜像重建
Key words
Developmental dysplasia of the hip/Arthroplasty,replacement,hip/Surgical navigation systems/Mirror re-construction
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