三角骨块导板在Salter骨盆截骨术治疗儿童发育性髋关节脱位中的应用
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摘要
目的探讨3D打印三角骨块导板在Salter骨盆截骨术治疗儿童发育性髋关节脱位(DDH)中应用的可行性及效果。方法回顾性分析自2016-09—2017-03诊治的13例儿童DDH,术前所有患儿均行骨盆CT断层扫描,并将数据导入Mimics软件,重建骨盆三维模型。参照正常髋臼前倾角和髋臼指数进行Salter骨盆截骨术前模拟,设计并3D打印维持截骨端稳定所需的三角骨块导板。术中用导板获取骨块,旋转截骨远端。结果 13例均获得随访,随访时间平均14.7(12～18)个月。末次随访时患儿双髋活动未见明显受限,未出现股骨头再脱位、股骨髋臼撞击征、股骨头坏死等并发症。末次随访时患侧髋关节功能Harris评分为(90.4±0.8)分,较术前明显提高,差异有统计学意义(P <0.05)。术后患侧髋臼前倾角、髋臼指数较术前明显改善,差异有统计学意义(P <0.05),与正常值比较差异无统计学意义(P>0.05)。结论 3D打印三角骨块导板辅助Salter骨盆截骨术治疗儿童DDH可获得满意效果,术者可提前评估矫正后的髋臼前倾角、髋臼指数,便于制定手术方案,避免术中透视无法评估髋臼前倾角和术中主要依靠术者经验等局限性。
Objective To explore the feasibility and effect of using a triangular bone navigation template based on CT 3 D reconstruction in Salter pelvic osteotomy for the treatment of developmental dislocation of hip joint(DDH) in children.Methods Thirteen DDH patients treated from September 2016 to March 2017 were retrospectively reviewed. CT scans were performed in all patients, and the imaging data were transferred into the Mimics software to reconstruct the 3 D pelvic model.Referring to the normal acetabular anterversion angle(AAA) and acetabular index(AI), preoperative simulation of Salter pelvic osteotomy was finished in the software, and then a triangular bone navigation template to maintain the stability of the displacement of osteotomy was designed and manufactured by 3 D printing technology. In operation, triangular bone navigation template was utilized to obtain the bone block and to complete the accurate rotation displacement of osteotomy. Results All the thirteen patients were followed up, with the average time of 14.7 months(range, 12 to 18). No serious complications like limited movement of hip joints, redislocation, femoroacetabular impingement and avascular necrosis occurred. At the final visit,the Harris score(90.4 ±0.8) of the involved hip was statistically significantly superior to the preoperative value(P <0.05).Postoperative AAA and AI value were statistically significantly improved(P <0.05), and were similar to the normal value(P >0.05).Conclusion Application of the triangular bone navigation template based on CT 3 D reconstruction in Salter pelvic osteotomy can achieve satisfactory results for the treatment of DDH in children. The surgeons can evaluate the simulated corrected AAA and AI, and formulate the accurate operation scheme in advance. Limitations during operation can be avoided, including failure to evaluate the accurate AAA under fluoroscopy, which is mainly determined according to the experience of surgeons.
Objective To explore the feasibility and effect of using a triangular bone navigation template based on CT 3 D reconstruction in Salter pelvic osteotomy for the treatment of developmental dislocation of hip joint(DDH) in children.Methods Thirteen DDH patients treated from September 2016 to March 2017 were retrospectively reviewed. CT scans were performed in all patients, and the imaging data were transferred into the Mimics software to reconstruct the 3 D pelvic model.Referring to the normal acetabular anterversion angle(AAA) and acetabular index(AI), preoperative simulation of Salter pelvic osteotomy was finished in the software, and then a triangular bone navigation template to maintain the stability of the displacement of osteotomy was designed and manufactured by 3 D printing technology. In operation, triangular bone navigation template was utilized to obtain the bone block and to complete the accurate rotation displacement of osteotomy. Results All the thirteen patients were followed up, with the average time of 14.7 months(range, 12 to 18). No serious complications like limited movement of hip joints, redislocation, femoroacetabular impingement and avascular necrosis occurred. At the final visit,the Harris score(90.4 ±0.8) of the involved hip was statistically significantly superior to the preoperative value(P <0.05).Postoperative AAA and AI value were statistically significantly improved(P <0.05), and were similar to the normal value(P >0.05).Conclusion Application of the triangular bone navigation template based on CT 3 D reconstruction in Salter pelvic osteotomy can achieve satisfactory results for the treatment of DDH in children. The surgeons can evaluate the simulated corrected AAA and AI, and formulate the accurate operation scheme in advance. Limitations during operation can be avoided, including failure to evaluate the accurate AAA under fluoroscopy, which is mainly determined according to the experience of surgeons.
引文
[1]李连永,赵群.幼儿发育性髋脱位髋臼病理形态的三维CT研究[J].中华小儿外科杂志,2005,26(11):572-575.
[2] Bayhan IA,Beng K,Yildirim T,et al. Comparison of Salter osteotomyand Tonnis lateral acetabuloplasty with simultaneous open reductionfor the treatment of developmental dysplasia of the hip:midterm re-sults[J]. J Pediatr Orthop B,2016,25(6):493-498.
[3] Pekmezci M,Yazici M. Salter osteotomy:an overview[J]. Acta Or-thop Traumatol Turc,2007,41 Suppl 1:37-46.
[4] Castaneda P,Vidal-Ruiz C,Mendez A,et al. How often doesfemoroacetabular impingement occur after an innominate osteotomyfor acetabular dysplasia?[J]. Clin Orthop Relat Res,2016,474(5):1209-1215.
[5] Lequesne M,Bellaiche L. Anterior femoroacetabular impingement:an update[J]. Joint Bone Spine,2012,79(3):249-255.
[6]周游,徐小山,李川,等. 3D打印导板在Bernese髋臼周围截骨术中的应用[J].中华创伤骨科杂志,2016,18(1):17-23.
[7]王忆茗,阎作勤,黄佳军,等. 3D打印技术辅助髋臼周围截骨术治疗成人髋关节发育不良[J].中华骨科杂志,2016,36(19):1229-1234.
[8]吴显奎,李培,李旭,等.数字化导航模板在Salter截骨术中的临床应用[J].中国临床解剖学杂志,2017,35(4):448-452.
[9] Novais EN,Pan Z,Autruong PT,et al. Normal percentile referencecurves and correlation of acetabular index and acetabular depth ratioin children[J]. J Pediatr Orthop,2018,38(3):163-169.
[10]吕秀敏,陈珽,范清,等. Salter骨盆截骨手术中髋臼骨块空间移位的模拟与分析[J].临床小儿外科杂志,2010,9(3):186-188.
[11] Turker M,Cirpar M,Cetik O,et al. Comparison of two techniquesin achieving planned correction angles in femoral subtrochantericderotation osteotomy[J]. J Pediatr Orthop B,2012,21(3):215-219.
[12] Wang CW,Wang TM,Wu KW,et al. The comparative,long-termeffect of the Salter osteotomy and Pemberton acetabuloplasty onpelvic height,scoliosis and functional outcome[J]. Bone Joint J,2016,98(8):1145-1150.
[13]吕学敏,郭源,朱振华,等.骨盆Salter截骨远端旋转方式对髋臼前倾角影响研究[J].中国矫形外科杂志,2009,17(17):1281-1284.
[14] Dora C,Mascard E,Mladenov K,et al. Retroversion of the acetabu-lar dome after Salter and triple pelvic osteotomy for congenital dis-location of the hip[J]. J Pediatr Orthop B,2002,11(1):34-40.
[15] Reynolds D,Lucas J,Klaue K. Retroversion of the acetabulum. Acause of hip pain[J]. J Bone Joint Surg Br,1999,81(2):281-288.
[16]杨建平.切开复位、Salter骨盆截骨、股骨近端短缩旋转截骨术治疗发育性髋关节脱位[J].中华骨科杂志,2010,30(12):1252-1258.
[17] Rab GT. Biomechanical aspects of Salter osteotomy[J]. Clin OrthopRelat Res,1978,132:82-87.
[18] Kobayashi D,Satsuma S,Kinugasa M,et al. Does Salter innominateosteotomy predispose the patient to acetabular retroversion inadulthood?[J]. Clin Orthop Relat Res,2015,473(5):1755-1762.
[19]钟华,陈劲,李建炜,等.腹直肌旁入路结合3D打印技术个性化手术治疗复杂骨盆髋臼骨折[J].中国骨与关节损伤杂志,2017,32(3):310-311.
[20] Yang P,Du D,Zhou Z,et al. 3D printing-assisted osteotomy treat-ment for the malunion of lateral tibial plateau fracture[J]. Injury,2016,47(12):2816-2821.
[21] Ahmed E,Mohamed A,Wael H. Surgical treatment of the late-presenting developmental dislocation of the hip after walking age[J]. Acta Ortop Bras,2013,21(5):276-280.
[22]江君,任爽,刘敏. Salter骨盆截骨术对发育性髋关节脱位髋臼影响的研究[J].中国修复重建外科杂志,2015,29(11):1332-1336.
[2] Bayhan IA,Beng K,Yildirim T,et al. Comparison of Salter osteotomyand Tonnis lateral acetabuloplasty with simultaneous open reductionfor the treatment of developmental dysplasia of the hip:midterm re-sults[J]. J Pediatr Orthop B,2016,25(6):493-498.
[3] Pekmezci M,Yazici M. Salter osteotomy:an overview[J]. Acta Or-thop Traumatol Turc,2007,41 Suppl 1:37-46.
[4] Castaneda P,Vidal-Ruiz C,Mendez A,et al. How often doesfemoroacetabular impingement occur after an innominate osteotomyfor acetabular dysplasia?[J]. Clin Orthop Relat Res,2016,474(5):1209-1215.
[5] Lequesne M,Bellaiche L. Anterior femoroacetabular impingement:an update[J]. Joint Bone Spine,2012,79(3):249-255.
[6]周游,徐小山,李川,等. 3D打印导板在Bernese髋臼周围截骨术中的应用[J].中华创伤骨科杂志,2016,18(1):17-23.
[7]王忆茗,阎作勤,黄佳军,等. 3D打印技术辅助髋臼周围截骨术治疗成人髋关节发育不良[J].中华骨科杂志,2016,36(19):1229-1234.
[8]吴显奎,李培,李旭,等.数字化导航模板在Salter截骨术中的临床应用[J].中国临床解剖学杂志,2017,35(4):448-452.
[9] Novais EN,Pan Z,Autruong PT,et al. Normal percentile referencecurves and correlation of acetabular index and acetabular depth ratioin children[J]. J Pediatr Orthop,2018,38(3):163-169.
[10]吕秀敏,陈珽,范清,等. Salter骨盆截骨手术中髋臼骨块空间移位的模拟与分析[J].临床小儿外科杂志,2010,9(3):186-188.
[11] Turker M,Cirpar M,Cetik O,et al. Comparison of two techniquesin achieving planned correction angles in femoral subtrochantericderotation osteotomy[J]. J Pediatr Orthop B,2012,21(3):215-219.
[12] Wang CW,Wang TM,Wu KW,et al. The comparative,long-termeffect of the Salter osteotomy and Pemberton acetabuloplasty onpelvic height,scoliosis and functional outcome[J]. Bone Joint J,2016,98(8):1145-1150.
[13]吕学敏,郭源,朱振华,等.骨盆Salter截骨远端旋转方式对髋臼前倾角影响研究[J].中国矫形外科杂志,2009,17(17):1281-1284.
[14] Dora C,Mascard E,Mladenov K,et al. Retroversion of the acetabu-lar dome after Salter and triple pelvic osteotomy for congenital dis-location of the hip[J]. J Pediatr Orthop B,2002,11(1):34-40.
[15] Reynolds D,Lucas J,Klaue K. Retroversion of the acetabulum. Acause of hip pain[J]. J Bone Joint Surg Br,1999,81(2):281-288.
[16]杨建平.切开复位、Salter骨盆截骨、股骨近端短缩旋转截骨术治疗发育性髋关节脱位[J].中华骨科杂志,2010,30(12):1252-1258.
[17] Rab GT. Biomechanical aspects of Salter osteotomy[J]. Clin OrthopRelat Res,1978,132:82-87.
[18] Kobayashi D,Satsuma S,Kinugasa M,et al. Does Salter innominateosteotomy predispose the patient to acetabular retroversion inadulthood?[J]. Clin Orthop Relat Res,2015,473(5):1755-1762.
[19]钟华,陈劲,李建炜,等.腹直肌旁入路结合3D打印技术个性化手术治疗复杂骨盆髋臼骨折[J].中国骨与关节损伤杂志,2017,32(3):310-311.
[20] Yang P,Du D,Zhou Z,et al. 3D printing-assisted osteotomy treat-ment for the malunion of lateral tibial plateau fracture[J]. Injury,2016,47(12):2816-2821.
[21] Ahmed E,Mohamed A,Wael H. Surgical treatment of the late-presenting developmental dislocation of the hip after walking age[J]. Acta Ortop Bras,2013,21(5):276-280.
[22]江君,任爽,刘敏. Salter骨盆截骨术对发育性髋关节脱位髋臼影响的研究[J].中国修复重建外科杂志,2015,29(11):1332-1336.