CAJ | 학술논문

目的探讨CT三维重建与仿真手术在股骨头骺滑脱治疗中的作用.方法回顾性分析2004～2008年期间,因诊断为股骨头骺滑脱入院,并采用空心螺钉固定,获得随访的29例患儿(31例髋),平均年龄10.4岁.术前均行双髋正侧位X线片和髋关节CT扫描,三维重建和仿真手术.在正位X线片上测量Southwick角.在侧位X线片上测量外侧骺干角(LESA角).利用CT扫描的数据进行髋关节三维重建,并重建一根6.5mm的螺钉进行仿真手术,确认该螺钉固定股骨头骺是否可行.根据X线片评估结果和CT重建仿真手术的结果将患儿分为两组.第一组,仅通过X线片和CT片就能确定可以完成空心螺钉固定,第二组,X线片和CT片不能确定能否完成空心螺钉固定,CT重建仿真手术可以确定.结论所有患儿均在术前X线片、髋关节CT三维重建和仿真手术结果的基础上完成治疗.第一组患儿为24例髋关节,第二组为7例髋关节,两组的Southwick角平均分别为(128.8±9.3)°和(116.3±10.4)°,两组比较差异有统计学意义(P=0.014).两组的LESA角平均分别为(37.4±6.9)°和(56.1±7.7)°,两组比较差异有统计学意义(P＜0.001).在第二组中的7例中,有2例的仿真手术结果不能完成空心螺钉固定,其中1例采取保守治疗,另1例进行股骨头骺下截骨并空心螺钉固定.结论 CT三维重建与仿真手术能有效指导SCFE的治疗,尤其是在滑脱程度严重的病例中.
목적 탐토CT삼유중건여방진수술재고골두후활탈치료중적작용.방법 회고성분석2004～2008년기간,인진단위고골두후활탈입원,병채용공심라정고정,획득수방적29례환인(31례관),평균년령10.4세.술전균행쌍관정측위X선편화관관절CT소묘,삼유중건화방진수술.재정위X선편상측량Southwick각.재측위X선편상측량외측후간각(LESA각).이용CT소묘적수거진행관관절삼유중건,병중건일근6.5mm적라정진행방진수술,학인해라정고정고골두후시부가행.근거X선편평고결과화CT중건방진수술적결과장환인분위량조.제일조,부통과X선편화CT편취능학정가이완성공심라정고정,제이조,X선편화CT편불능학정능부완성공심라정고정,CT중건방진수술가이학정.결론 소유환인균재술전X선편、관관절CT삼유중건화방진수술결과적기출상완성치료.제일조환인위24례관관절,제이조위7례관관절,량조적Southwick각평균분별위(128.8±9.3)°화(116.3±10.4)°,량조비교차이유통계학의의(P=0.014).량조적LESA각평균분별위(37.4±6.9)°화(56.1±7.7)°,량조비교차이유통계학의의(P＜0.001).재제이조중적7례중,유2례적방진수술결과불능완성공심라정고정,기중1례채취보수치료,령1례진행고골두후하절골병공심라정고정.결론 CT삼유중건여방진수술능유효지도SCFE적치료,우기시재활탈정도엄중적병례중.
Objective To evaluate the role of three dimensional reconstruction and virtual operation after CT scanning in the treatment of slipped capital femoral epiphysis(SCFE).Methods Twenty-nine cases of SCFE (31hips) were treated by screw fixation between 2004 and 2008.The Southwick angle and the lateral epiphyseal-shaft angle(LESA) were measured by hip anteroposterior and frog-lateral radiographs.All of them underwent to CT and three dimensional reconstruction.And then virtual operation with a screw was performed.The patients were divided into two groups by the results of X ray,CT and the virtual operation.Internal fixation might be successfully performed as group 1 based on the virtual operation.Otherwise,patients were allocated to the group 2.Results The cases of group 1 were 24 hips,and the cases of group 2 were 7 hips.The Southwick angle in group 1 was significant higher than that of group 2(128.8±9.3 vs 116.3±10.4).The LESA in group 1 was 37.4±6.9,which was significant less than that in group 2(56.1±7.7).In the 7 cases of group 2,the virtual operation results of 2 cases showed the screw fixation could not be performed.One case was treated conservatively,and another case was treated by physeal osteotomy and screw fixation.Conclusions The treatment of SCFE could be effectively directed by three dimensional reconstruction and virtual operation,especially in serious cases.