基于三维CT的模拟手术在大龄DDH患儿外科治疗中的应用研究

目的:通过对大龄发育性髋关节脱位(developmental dysplasia of the hip,DDH)患儿进行术前模拟手术,实现术中精确截骨及旋转角度,从而达到个体化治疗,改善患儿预后的目的。方法:本研究按照术前规划方式分为两组,一组为传统手术组;另一组为模拟手术组。共20例患儿均采用骨盆三联截骨术+股骨截骨术治疗,传统手术组10例,模拟手术组10例,手术时平均年龄为11.3岁,平均随访时间24.2个月。所有患儿均于术前行骨盆三维重建CT检查,测量CE角、股骨前倾角及髋臼指数,在mimics软件中,模拟手术方案,确定术中股骨截骨需要旋转的角度及骨盆截骨的位置,术中按照模拟手术的结果进行操作。术前评价指标使用Tonnis分级,术后评价指标使用改进的Trevor评分系统。结果:模拟手术组Tonnis分级3级4髋,Tonnis分级4级8髋;传统手术组Tonnis分级3级4髋,Tonnis分级4级9髋,两组患儿术前严重程度无显著性差异。依据Trevor评分,模拟手术组8髋(67%)优秀,3髋(25%)良好,1髋(8%)一般。传统手术组5髋(38%)优秀,5髋(38%)良好,3髋(23%)一般。两组有显著性差异。并发症:术后传统手术组3例患儿有不同程度的股骨头坏死。结论:大龄DDH患儿术前模拟手术,可以达到术中精确截骨及旋转角度,可改善患儿预后,实现该类患者的个体化治疗。

Application of Simulated Surgery Based on Using Three-dimensional Computed Tomography in Older Children with Developmental Dysplasia of the Hip

ABSTRACT Objective: Through the preoperative surgical simulation in older children with developmental dislocation of the hip (developmental dysplasia of the hip, DDH), accurate osteotomy and rotation angle in operation, so as to achieve individualized treatment, improve the prognosis of the objective. Methods: The study was divided into two groups according to preoperative planning methods, one group was conventional surgery group, the other group was simulated operation group. A total of 20 cases were treated with pelvic triple osteotomy combined with femoral osteotomy. 10 cases in the traditional operation group and 10 cases in the simulated operation group, the average age of the operation was 11.3 years, and the average follow-up time was 24.2 months. All patients had pelvic reconstruction CT examination before the surgery, measure the CE angle, femoral anteversion angle and acetabular index. In the Mimics software, a simulated surgical procedure was performed to determine the angle of rotation and the location of the pelvic osteotomy in the operation of the femoral osteotomy, and the procedure was performed according to the outcome of the simulated operation. The preoperative evalua- tion indexes were graded by Tonnis, and the improved Trevor scoring system was used for postoperative evaluation. Results: In the simu- lated operation group, there were 4 Tonnis type 3 and 8 Tonnis type 4 hips. In the traditional surgery group, there were 4 Tonnis type 3 and 9 Tonnis type 4 hips. There was no significant difference in preoperative severity between the two groups. According to the Trevor score,8 hips (67%) were rated excellent, 3 hips (25%) were good, and 1 hips (8%) were fair in the simulated operation group. In the tradi- tional surgery group, 5 hips (38%) were rated excellent, 5 hips (38%) were good, and 3 hips (23%) were fair. There was significant differ- ence between the two groups. Complications: there were 3 cases of femoral head necrosis in different degree in the traditional operation group after operation.3 hips in the traditional surgery group had osteonecrosis of varying severity. Conclusion: The preoperative simulat- ed surgery of older DDH can achieve accurate osteotomy and rotation angle, improve the prognosis of patients, and achieve individual- ized treatment of this kind of patients.