数字化导航模板在Salter截骨术中的临床应用

doi:10.13418/j.issn.1001-165x.2017.04.019

中国临床解剖学杂志 ›› 2017, Vol. 35 ›› Issue (4): 448-452.doi: 10.13418/j.issn.1001-165x.2017.04.019

数字化导航模板在Salter截骨术中的临床应用

吴显奎¹，　李培²，　李旭³，　史强³，　刘亮洪¹，　谢庆祥¹

1.东莞市中医院骨科，广东东莞 523106；　2.东莞市茶山医院骨科，广东东莞 523000；
3.南方医科大学第三附属医院（广东省骨科研究院）儿童骨科, 广州 510600

收稿日期:2017-03-20 发布日期:2017-08-30
通讯作者: 李旭，副教授，硕士生导师，E-mail: drlxyinger@aliyun.com
作者简介:吴显奎（1979-），男，广东阳东人，硕士研究生，主治医师，研究方向：数字化骨科技术，Tel：13713363779，E-mail:wxksoso@126.com
基金资助:
广东省东莞市医疗卫生科技计划重点项目（2011105102005）

Clinical application of computer-assisted navigational template for Salter osteotomy

WU Xian-kui¹, LI Pei², LI Xu³, SHI Qiang³, LIU Liang-hong¹, XIE Qing-xiang¹

1. Department of Orthopedics, Dongguan Hospital of Traditional Chinese Medicine, Dongguan 523106, China;2. Department of Orthopedics, Dongguan Chashan Hospital, Dongguan 523000, China; 3. Department of Pediatric Orthopaedics, the Third Affiliated Hospital of the Southern Medical University(Institute of Orthopaedics Research of Guangdong Province), Guangzhou 510600, China

Received:2017-03-20 Published:2017-08-30

摘要/Abstract

摘要：

目的　利用数字化技术为Salter截骨术设计一种导航模板，并探讨其临床应用效果。方法　自2012年4月~2015年6月，收集21例单侧发育性髋关节脱位行Salter截骨术患儿的术前骨盆CT原始数据，应用数字化技术，模拟Salter截骨术，设计并生产辅助截取三角形髂骨植骨块的导航模板，辅助术中截骨。分析双侧髋关节手术前后及末次随访的髋臼指数（AI），采用Mckay临床疗效评定标准和Severin X线评定标准评定手术疗效。结果　双侧髋关节手术前后及末次随访的髋臼指数进行重复测量因素的方差分析，不同测量时间之间（F= 357.72，P=0.00）、部位之间（F= 221.05,P=0.00）存在显著的主效应。时间与部位之间存在显著的交互效应（F= 1984.82，P=0.00）。所有时间水平间均存在显著差异（P=0.00）。Pearson相关性分析表明，患侧髋臼指数术后改善的角度与导航模板的角度或三角形髂骨植骨块顶角的角度均成正相关，相关系数分别为（r=0.91，P=0.00）及（r=0.96，P=0.00）。改良Severin 影像学分类为优14例、良5例、可2例，优良率90.48%。改良Mckay功能评价为优13例、良7例、可1例，优良率95.24%。结论　数字化导航模板可辅助Salter截骨术快速、精确截取三角形髂骨植骨块，提高手术精确度和成功率，缩短手术时间。

关键词: 髋关节脱位, 　截骨术, 　计算机辅助设计

Abstract:

Objective　To develop and validate a navigational template for Salter osteotomy by digital technology.　Methods　Between April 2012 and June 2015, 21 children with unilateral developmental dislocation of the hip underwent Salter osteotomy. Preoperative CT scan pelvic images were obtained. Applying digital technology, Salter osteotomy were simulated and navigational templates for assisting in accurately cutting out a triangular bone graft from ilium were designed and manufactured. Then the navigational templates were use in the operations. The acetabular indexes(AI) of both hips were measured before and after surgery and at the latest follow-up. The efficacy wasevaluated according to Mckay clinical effects grading standard and Severin X rays grading standard.　Results　The AIs of both hips measured before and after surgery and at the last follow-up were analyzed with repeated measures analysis of variance. There is significant main effect in time(F=357.72, P=0.00) and in part (F=221.05, P=0.00). There is significant interaction effect between time and part（F=1984.82, P=0.00）. There is significant difference between all the time levels（P=0.00）.The Pearson correlation analysis indicates that the reduction of AIs of the disordered hip joints is positively related to the angels of the navigational templates（r=0.91，P=0.00） or to the apex angles of the triangular bone grafts from iliums（r=0.96，P=0.00）. According to Severin X rays grading standard, 14 cases were excellent, 5 cases were good, and 2 cases were poor. The excellent and good rate was 90.48%. According to Mckay clinical effects grading standard, 13 cases were excellent, 7 cases were good, and 1 case was poor. The excellent and goodrate was 95.24%.　Conclusion　The computer-assisted navigational templates can assist in cutting out triangular bone grafts from ilium more rapidly and more accurately in Salter osteotomy. It can improve the success rate and accuracy of the operations, and shorten the operation time.

Key words: Hip dislocation;　Osteotomy, 　Computer-aided design

吴显奎，李培，李旭，史强，刘亮洪，谢庆祥. 数字化导航模板在Salter截骨术中的临床应用[J]. 中国临床解剖学杂志, 2017, 35(4): 448-452.

WU Xian-kui, LI Pei, LI Xu, SHI Qiang, LIU Liang-hong, XIE Qing-xiang. Clinical application of computer-assisted navigational template for Salter osteotomy[J]. Chinese Journal Of Clinical Anatomy, 2017, 35(4): 448-452.

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数字化导航模板在Salter截骨术中的临床应用

Clinical application of computer-assisted navigational template for Salter osteotomy

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