基于三维CT的模拟手术重建高位脱位髋关节全髋置换髋臼
Simulated surgeries of acetabular reconstruction for high-dislocated hips
目的 探讨通过模拟手术,准确重建髋臼.方法 收集28例高位脱位来我院行全髋关节置换的患者资料,共32髋.通过MIMICS软件对患者的CT扫描数据进行三维重建,进行模拟手术重建髋臼臼杯.记录臼杯位于满意位置时旋转中心的坐标,计算不同前倾角时臼杯的骨性覆盖率.结果 为了获得更好的髋臼方位,在重建髋臼臼杯时需要向内挫磨(4.18±2.59) mm,向后(4.61 ±2.59) mm,向上(2.58±2.08) mm.臼杯前倾角为5°时覆盖率为(84±7)%;前倾角为15°时覆盖率为(88±4)%;25°时为(92±7)%;35°时为(93±8)%.每一个臼杯均可以获得大于70%的覆盖率.髋臼的骨性覆盖率随臼杯的前倾增加而增加.结论 我们发现高位脱位臼杯重建时可以适当内移、后移并轻微上移旋转中心.根据患者的个体情况进行精确的术前设计,术中准确地实施,所有的臼杯均可以获得满意的位置、方向和覆盖率.
更多Objective To investigate how to precisely reconstruct the acetabular cup in high developmental dislocated hips.Methods Twenty-eight patients with 32 high developmental dislocated hips were admitted into our hospital for total hip arthroplasties (THAs).After 3-dimensional construction of CT scans,simulated acetabular reconstruction was done by the Mimics software.Three-dimensional coverage of the cup at different anteversion was calculated.Results To get better cup position,we needed to ream the acetabulum (4.18 ± 2.59) mm medially,(4.61 ± 2.59) mm posteriorly,and (2.58 ±2.08) mm superiorly in average.Every cup could get more than 70% coverage.Bony coverage of the cup increased with anteversion.Conclusion Every high dislocated hip can get enough coverage by putting the cup medially,posteriorly and a bit superiorly.Larger anteversion of the cup is suggested for high developmental dislocated hips.
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