基于CT相关数据测量的术前规划在全髋关节置换中的临床应用

Clinical Application of Preoperative Planning Based on CT-Related Data Measurement in Total Hip Arthroplasty

摘要: 目的：探讨基于CT相关数据测量的术前规划在全髋关节置换术中的临床应用。方法：收集2022年10月至2023年3月76例初次行单侧非骨水泥全髋关节置换患者进行回顾性分析，将其分为两组，研究组39例通过术前螺旋CT三维重建技术测量髋臼横径，髋臼前倾角、外展角，两侧髋关节旋转中心垂直差值，两侧偏心距差值，双下肢长度差值，股骨颈截面髓腔长径及股骨干峡部的最小髓腔内径数值行术前规划预测假体型号及其位置，对照组37例不进行CT术前规划。比较两组患者术后CT相关参数，手术相关指标(手术时间、术中出血量、术后引流量)，术后1年髋关节Harris评分、VAS评分有无差异。结果：两组术前临床指标及一般资料不存在统计学差异(P > 0.05)；两组术后双下肢长度差值、两侧旋转中心差值、两侧偏心距差值均小于术前，且研究组小于对照组(P < 0.05)。两组术后1年髋关节Harris评分均大于术前，且研究组大于对照组(P < 0.05)。研究组患者的手术时间、术中出血量、术后引流量均小于对照组(P < 0.05)；两组术后1年VAS评分均小于术前(P < 0.05)，但两组之间差异无统计学意义(P > 0.05)。结论：基于CT相关数据测量的术前规划对全髋关节置换术具有极大指导意义。

Abstract: Objective: To investigate the clinical application of preoperative planning based on CT-related data measurements in total hip arthroplasty (THA). Methods: A retrospective analysis was conducted on 76 patients who underwent unilateral non-cemented THA for the first time between October 2022 and March 2023. The patients were divided into two groups: the study group (n = 39) underwent preoperative planning, including measurements of acetabular transverse diameter, acetabular anteversion angle, abduction angle, vertical difference in rotational centers of both hips, difference in offset between hips, difference in bilateral limb lengths, femoral neck cross-section medullary canal length, and minimum medullary canal diameter at the femoral isthmus through spiral CT three-dimensional reconstruction technology to predict the prosthesis size and position; the control group (n = 37) did not undergo CT-based preoperative planning. The postoperative CT-related parameters, surgical indicators (operative time, intraoperative blood loss, postoperative drainage volume), and Harris hip score and VAS score at 1 year postoperatively were compared between the two groups. Results: There were no statistically significant differences in preoperative clinical indicators and general information between the two groups (P > 0.05). Postoperatively, the differences in bilateral limb lengths, rotational center values, and offsets were all reduced compared to preoperative values, and these reductions were more pronounced in the study group compared to the control group (P < 0.05). The Harris hip scores at 1 year postoperatively were significantly higher than preoperative scores in both groups, with higher scores observed in the study group compared to the control group (P < 0.05). The study group had shorter operative times, lower intraoperative blood loss, and reduced postoperative drainage volumes compared to the control group (P < 0.05). The VAS scores at 1 year postoperatively were lower than preoperative scores in both groups (P < 0.05), but there was no statistically significant difference between the two groups (P > 0.05). Conclusion: Preoperative planning based on CT-related data measurements provides significant guidance for THA.