计算机模拟在儿童发育性髋关节脱位Salter 骨盆截骨术中的应用

摘要

Objetive To explore the preoperative analysis &plan and postoperative outcome analysis of computer simulation based on 3 —dimensional (3D)computed tomography (CT)reconstruction during Salter’s pelvic osteotomy.Methods From October 2010 to October 2011,there were 18 children (18 hips)of devel-opmental dislocation of hip.Mimics 10.01 software was used for preoperative simulation of Salter’s pelvic oste-otomy.And 3D acetabular index and acetabulum anteversion were measured before operation,after operation and compared with each other.The Mckay’s clinical function and Severin’s imaging evaluation were used for evaluating the postoperative outcomes.Results The preoperative 3D acetabular index and acetabulum antever-sion data had statistically significant differences between affected and contralateral sides.And the preoperative and postoperative data of affected side were statistically different.No significant difference existed between af-fected and contralateral sides postoperatively.For 14 hips (77.8%),acetabular index and anteversion im-proved as preoperative design.Acetabular index improved inadequately in 2 hips.And acetabular anteversion improved inadequately in 1 hip.Acetabular index and anteversion improved inadequately both in 1 hip.Ac-cording to the Mckay’s functional criteria,the outcomes were excellent (n =10)and good (n =8).Based up-on the Severin’s imaging criteria,the outcomes were excellent (n =12),good (n =4)and fair (n =2). Conclusions Computer simulation of Salter’s pelvic osteotomy may facilitate an understanding of proper osteot-omy site,rotation angle and triangular bone block size.And it offers better preoperative evaluations and postop-erative outcome analysis.%目的：观察基于三维 CT 重建的计算机模拟在 Salter 骨盆截骨术治疗儿童发育性髋关节脱位的术前评估、术前手术设计以及术后效果分析的使用效果。方法从2010年10月至2011年10月，我们对18例（18髋）发育性髋关节脱位儿童，通过 Mimics 10.01软件的专用截骨工具进行术前模拟Salter 骨盆截骨。测量术前、术后的三维髋臼指数及髋臼前倾角并进行比较。采用 Mckay 临床功能评定标准，Severin 影像学评定标准，对术后效果进行评价。结果18髋患侧术前与对侧比较，术后与术前比较，P ＜0.01，差异有统计学意义。术后患侧与对侧比较，P ＞0.05，差异无统计学意义。术后14髋（77.8％）髋臼指数获改善，髋臼前倾角改善与术前设计相符。2髋髋臼指数改善不良，1髋髋臼前倾角改善不良，1髋髋臼指数与髋臼前倾角均改善不良。按照 Mckay 临床功能评定标准，优10例，良8例。Severin 影像学评定标准，优12例，良4例，可2例。结论基于三维 CT 重建的 Salter 骨盆截骨计算机模拟可使术者了解合适的截骨位置、截骨远端旋转角度以及截取三角骨块大小，以指导实际的截骨手术。三维重建也有利于更好的术前评估和术后效果分析。