CAJ | 학술논문

背景：成人髋臼发育不良髋臼小而浅，臼内有大量骨痂和瘢痕组织等都为人工髋关节置换术中真臼的辨认、臼杯的准确安装带来极大困难，关节置换前对髋臼的全面认识是选择合适的髋臼假体和制定个性化髋臼重建方案的前提。目的：评估三维影像重建技术在成人髋关节发育不良全髋关节置换前臼杯型号选择中的应用价值。方法：对11例准备进行全髋关节置换的髋臼发育不良患者行螺旋CT扫描，多平面重建髋臼，并进行数字化臼杯模板置入拟定术中假体型号，并与置换中实际作吻合度评估。结果与结论：螺旋 CT 扫描可清晰显示髋臼形态，基于此所进行三维关节置换前计划，拟定的臼杯大小数据中71.4%与置换中实际一致，其组内相关系数为0.888，明显较基于X射线平片所作二维置换前计划准确。髋臼发育不良病例髋臼变浅变小，髋臼外上方普遍存在不同程度的骨缺损，为达到骨床对臼杯良好的包容，可借助三维多平面重建能有效评估髋臼形态，其对成人髋关节发育不良术前假体的选择具有较高的参考价值。
배경：성인관구발육불량관구소이천，구내유대량골가화반흔조직등도위인공관관절치환술중진구적변인、구배적준학안장대래겁대곤난，관절치환전대관구적전면인식시선택합괄적관구가체화제정개성화관구중건방안적전제。목적：평고삼유영상중건기술재성인관관절발육불량전관관절치환전구배형호선택중적응용개치。방법：대11례준비진행전관관절치환적관구발육불량환자행라선CT소묘，다평면중건관구，병진행수자화구배모판치입의정술중가체형호，병여치환중실제작문합도평고。결과여결론：라선 CT 소묘가청석현시관구형태，기우차소진행삼유관절치환전계화，의정적구배대소수거중71.4%여치환중실제일치，기조내상관계수위0.888，명현교기우X사선평편소작이유치환전계화준학。관구발육불량병례관구변천변소，관구외상방보편존재불동정도적골결손，위체도골상대구배량호적포용，가차조삼유다평면중건능유효평고관구형태，기대성인관관절발육불량술전가체적선택구유교고적삼고개치。
BACKGROUND:The anatomical strucure of acetabulum is smal and shal ow in adult acetabular dysplasia patients. The large amount of cal us and scar tissues in the acetabulum make it difficult to identify and instal the acetabular cup during arthroplasty. The comprehensive understanding of the acetabulum before arthroplasty is the premise for selecting the appropriate acetabular prosthesis and making the acetabular reconstruction program. OBJECTIVE:To evaluate the application value of three-dimensional reconstruction technique in choosing the size of acetabular cup before total hip arthroplasty for acetabular dysplasia. METHODS:Spiral CT was carried out in the 11 acetabular dysplasia patients who waiting for total hip arthroplasty. The acetabulum was multi-planar reconstructed, and the size of the acetabular cup was determined through digitized acetabular cup template implantation, and then the mathching degree assessment was performed to compare with the actual size. RESULTS AND CONCLUSION:Spiral CT could clearly show the acetabular morphology, and the 71.4%of the acetabular size chosen in the three-dimensional preoperative plan was the same as actual one, the intraclass correlation coefficient was 0.888. The agreement was much higher than that of two-dimensional preoperative plan based on X-ray plain film. For the patients with acetabular dysplasia, the acetabulum became saml er and shal ower, and there were various extents of bone defects in the superior-lateral acetabulum. Three-dimensional multi-planar reconstruction can effectively evaluate the acetabular morphology, and three-dimensional preoperative plan can provide useful information for the choice of implant.