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三维表面重建技术在高位脱位DDH患者髋臼形态评价中的应用

Techniques and Methods Acetabular Morphological Analysis in Patients with High Dislocated DDH using Three-dimensional Surface Reconstruction Technique

  • 摘要: 目的 对高位脱位髋关节发育不良(DDH)患者的髋臼形态进行三维表面重建和定量分析,以了解其髋臼解剖学特点,提高关节置换术前计划的准确性。方法 利用Mimics软件对13例(13髋)高位脱位DDH继发骨关节炎患者及13例(26髋)正常人的骨盆图像进行三维表面重建。对重建后的髋臼三维图像进行髋臼上下径、前后径、髋臼深度、内壁厚度、外展角及前倾角的测定,结果进行组间比较。结果 高位脱位组髋臼形态不规则,上窄下宽,呈三角形;其髋臼上下径为(38.29±2.71) mm,前后径为(21.74±5.33) mm,髋臼深度为(15.50±2.93) mm,内壁厚度为(6.80±2.97) mm,外展角为(49.29±7.40)°,前倾角为(23.82±11.21)°。与正常对照组相比,高位脱位组在髋臼上下径、前后径及髋臼深度方面均小于对照组(\P<0.05),但其内壁厚度、外展角及前倾角均大于对照组(\P<0.05)。结论 采用三维表面重建技术能够还原髋臼真实形态,完成髋臼形态定量分析,提高术前计划的准确性。高位脱位DDH患者髋臼形态不规则、开口偏小、内壁较厚、外展角及前倾角较大,这些特点在行关节置换时需要注意。

     

    Abstract: Objective To simulate acetabular morphology and perform acetabular quantitative analysis in high dislocated developmental dysplasia of the hip (DDH) patients using three-dimensional (3D) surface reconstruction technique, in order to understand the acetabular anatomic features and develop operative strategies for acetabular reconstruction. Methods 3D pelvic images were reconstructed by Mimics software from CT data of 13 patients (13 hips) with high developmental DDH and 13 normal persons (26 hips). True acetabular superior-inferior diameter, anterior-posterior diameter, acetabular depth, medial wall thickness, abduction angle and anteversion angle were measured and compared between the two groups of participants. Results Irregular acetabular shape was found in high dislocated group, showing a triangle with wide upper and narrow lower. The acetabular quantitative analysis revealed (38.29±2.71) mm superior-inferior diameter, (21.74±5.33) mm anterior-posterior diameter, (15.50±2.93) mm acetabular depth, (6.80±2.97) mm medial wall thickness, (49.29±7.40) ° abduction angle and (23.82±11.21) ° anteversion angle in high dislocated patients. The superior-inferior diameter, anterior-posterior diameter and acetabular depth of high dislocated patients were significantly smaller than those of the normal controls (\P<0.05). However, the medial wall thickness, abduction angle and anteversion angle of high dislocated patients were significantly bigger than those of the normal controls (\P<0.05). Conclusion 3D reconstruction technique can restore true acetabular morphology and perform quantitative analysis. Compared with normal controls, high dislocated DDH patients have acetabular features: irregular shape, lower opening, higher medial wall and bigger abduction and anteversion angles. Joint arthroplasty surgery in high dislocated DDH patients needs to look at these acetabular features.

     

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