切换至 "中华医学电子期刊资源库"
高级检索
中华老年骨科与康复电子杂志

中华老年骨科与康复电子杂志 ›› 2018, Vol. 04 ›› Issue (06) : 369 -373. doi: 10.3877/cma.j.issn.2096-0263.2018.06.010

所属专题： 文献；

综述

CT三维重建应用于成人发育性髋关节发育不良股骨近端形态学研究的进展及意义
沈先月1, 刘潼1, 杨育晖2, 肖建林1, 陈尚钧3, 左建林1, 高忠礼1,†()   
  1. 1. 130033　长春，吉林大学中日联谊医院骨科
    2. 510080　广州，广东省人民医院（广东省医学科学院）骨科中心关节骨病与创伤科
    3. 130021　长春，吉林大学白求恩医学部
  • 收稿日期:2018-06-10 出版日期:2018-12-05
  • 通信作者: 高忠礼
  • 基金资助:
    国家自然科学基金青年基金(81601907); 吉林省科技厅优秀青年基金(20170520019JH)

Research progress and significance of three-dimensional CT reconstruction in the proximal femur morphology of developmental hip dysplasia in adults

Xianyue Shen1, Tong Liu1, Yuhui Yang2, Jianlin Xiao1, Shangjun Chen3, Jianlin Zuo1, Zhongli Gao1,†()   

  1. 1. Department of Orthopedics, China- Japan Union Hospital of Jilin University, Changchun 130033, China
    2. Department of Orthopedics, Guangdong General Hospital (Guangdong Academy of Medical Sciences), Guangzhou 510080, China
    3. Norman Bethune College of Medicine, Jilin University, Changchun 130021, China
  • Received:2018-06-10 Published:2018-12-05
  • Corresponding author: Zhongli Gao
  • About author:
    Corresponding author: Gao Zhongli, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

沈先月, 刘潼, 杨育晖, 肖建林, 陈尚钧, 左建林, 高忠礼. CT三维重建应用于成人发育性髋关节发育不良股骨近端形态学研究的进展及意义[J]. 中华老年骨科与康复电子杂志, 2018, 04(06): 369-373.

Xianyue Shen, Tong Liu, Yuhui Yang, Jianlin Xiao, Shangjun Chen, Jianlin Zuo, Zhongli Gao. Research progress and significance of three-dimensional CT reconstruction in the proximal femur morphology of developmental hip dysplasia in adults[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2018, 04(06): 369-373.

目的

对CT三维重建技术应用于成人发育性髋关节发育不良（DDH）股骨近端形态研究的相对优势，以及DDH CroweⅠ~Ⅳ型股骨近端的测量参数与形态特点进行综述。

方法

在近年DDH股骨形态研究中以"股骨近端形态""成人DDH""全髋关节置换"及"CT三维重建"为关键词，在PubMed和中国知网数据库中检索近年发表的相关文献，对CT三维重建的DDH股骨近端的应用优势、CroweⅠ~Ⅳ型DDH股骨近端的测量参数与形态特点进行分析总结。

结果

DDH是髋关节发生骨性关节炎的重要原因之一。全髋关节置换术（THA）是目前治疗DDH的最有效治疗方法。DDH的髋关节常伴有股骨侧严重的病理改变，尤以CroweⅣ型DDH股骨畸形程度最为严重。术前应用CT三维重建技术可以帮助医生充分认识这些解剖变异，从而可以优化术前设计，缩短手术时间，继而获得良好的手术效果，降低术后并发症。

结论

采用CT三维重建技术能全面显示髋关节的立体形态和各部位解剖结构的空间关系，在DDH的诊断、分型，股骨近端形态个体化建立、股骨侧假体的选择，THA中股骨假体植入准确度的提高及术后并发症的降低都发挥着重要的作用。

关键词: 髋脱位，先天性, 成像，三维, 关节成形术，置换，髋, 股骨近端
Objective

To summarize the advantages, measurement parameters and the proximal femur morphology of CroweⅠ-Ⅳ developmental dysplasia of the hip (DDH) in adults in the CT three-dimensional reconstruction (CT 3DR).

Methods

To search and consult all the literatures available by the key words of the proximal femur morphology, DDH in adults, THA and CT 3DR in the database of Pub Med and CNKI to analyze and summarize the advantages of CT 3DR, measurement parameters and the proximal femur morphology of Crowe Ⅰ-Ⅳ DDH in adults by referring to recent relevant database.

Results

DDH in adults is one of the important causes of osteoarthritis in the hip joint. THA is currently the most effective treatment for DDH. The hip joint of DDH is often accompanied by severe pathological changes in the proximal femur morphology, especially Crowe type Ⅳ. preoperative CT 3DR can recognize the anatomical variations, which can optimize preoperative design, shorten the operation time, and obtain good surgical results and reduce postoperative complications.

Conclusions

CT 3DR displays the morphology and anatomical structure of spatial relations of the hip joint comprehensively and accurately. It plays an important role in the diagnosis and classification of DDH in adults, the individualized formation of the proximal femur, the selection of the femoral prosthesis, and in the improvement of the accuracy of the implantation of the femoral prosthesis and reduction of postoperative complications.

Key words: Hip dislocation, congential, Imaging, three-dimensional, Arthroplasty, replacement, hip, Proximal femur
图2 CT 3D股骨横断面测量示意图。L1为股骨颈轴线；L2股骨内外侧髁后方切面；L1与L2所形成的夹角为前倾角
图6 CT 3D股骨髓腔扭转角测量示意图。a：股骨髓内矢状径；b：最长径；c：股骨髓内冠状径；d：股骨内外侧髁后方切面；b与d的夹角即为扭转角
1
Hartofilakidis G, Karachalios T. Total hip arthroplasty for congenital hip disease[J]. J Bone Joint Surge Am, 2004, 86-A(2):242-250.
2
Jacobsen S, Sonne-Holm S, Soballe K, et al. Hip dysplasia and osteoarthrosis - A survey of 4 151 subjects from the Osteoarthrosis Substudy of the Copenhagen City Heart Study[J]. Acta Orthop, 2005, 76(2):149-158.
3
Greber EM, Pelt CE, Gililland JM, et al. Challenges in total hip arthroplasty in the setting of developmental dysplasia of the hip[J]. J Arthroplasty, 2017, 32(9S):S38-S44.
4
Spangehl MJ, Berry DJ, Trousdale RT, et al. Uncemented acetabular components with bulk femoral head autograft for acetabular Reconstruction in developmental dysplasia of the hip:results at five to twelve years[J]. J Bone Joint Surg Am, 2001, 83-A(10):1484-1489.
5
Sariali E, Mauprivez R, Khiami F, et al. Accuracy of the preoperative planning for cementless total hip arthroplasty. A randomised comparison between three-dimensional computerised planning and conventional templating[J]. Orthop Traumatol Surg Res, 2012, 98(2):151-158.
6
Hassani H, Cherix S, Ek ET, et al. Comparisons of preoperative three-dimensional planning and surgical Reconstruction in primary cementless total hip arthroplasty[J]. J Arthroplasty, 2014, 29(6):1273-1277.
7
Liu S, Zuo J, Li Z, et al. Study of three-dimensional morphology of the proximal femur in developmental adult dysplasia of the hip suggests that the on-shelf modular prosthesis May not be an ideal choice for patients with Crowe type IV hips[J]. Int Orthop, 2017, 41(4):707-713.
8
Noble PC, Kamaric E, Sugano N, et al. Three-dimensional shape of the dysplastic femur: implications for THR[J]. Clin Orthop Relat Res, 2003, 417:27-40.
9
Akiyama M, Nakashima Y, Fujii M, et al. Femoral anteversion is correlated with acetabular version and coverage in Asian women with anterior and global deficient subgroups of hip dysplasia: a CT study[J]. Skeletal Radiol, 2012, 41(11):1411-1418.
10
彭建平，王旭义，朱俊峰,等.发育性髋关节发育不良患者股骨近端畸形特点的研究[J].中华关节外科杂志:电子版, 2017, 03)(3):228-233.
11
Sugano N, Noble PC, Kamaric E, et al. The morphology of the femur in developmental dysplasia of the hip[J]. J Bone Joint Surg Br, 1998, 80(4):711-719.
12
Flecher X, Argenson JN, Parratte S, et al. [Custom cementless stem for osteoarthritis following developmental hip dysplasia][J]. Rev Chir Orthop Reparatrice Appar Mot, 2006, 92(4):332-342.
13
Komeno M, Hasegawa M, Sudo A, et al. Computed tomographic evaluation of component position on dislocation after total hip arthroplasty[J]. Orthopedics, 2006, 29(12):1104-1108.
14
Robertson DD, Essinger JR, Imura S, et al. Femoral deformity in adults with developmental hip dysplasia[J]. Clin Orthop Relat Res, 1996, 327:196-206.
15
Argenson JN, Ryembault E, Flecher X, et al. Three-dimensional anatomy of the hip in osteoarthritis after developmental dysplasia[J]. J Bone Joint Surg Br, 2005, 87(9):1192-1196.
16
Clohisy JC, Nunley RM, Otto RJ, et al. The frog-leg lateral radiograph accurately visualized hip cam impingement abnormalities[J]. Clin Orthop Relat Res, 2007, 462:115-121.
17
Pasquier G, Ducharne G, Sariali E, et al. Total hip arthroplasty offset measurement: Is C T scan the most accurate option?[J]. Orthop Traumatol Surg Res, 2010, 96(4):367-375.
18
张津瑞，左建林，高忠礼.基于假体设计的成人股骨近端形态学研究[J].中国骨与关节损伤杂志, 2016, 02:138-141.
19
Su XY, Zhao JX, Zhao Z, et al. Three-Dimensional analysis of the characteristics of the femoral canal isthmus: an anatomical study[J]. Biomed Res Int, 2015: 459612.
20
Li Y, Lin J, Zhang J, et al. Significance of proximal femoral computed tomography scanning in the prediction of femoral prosthesis before total hip arthroplasty[J]. Eur J Orthop Surg Traumatol, 2013, 23(1):67-72.
21
刘宏伟，徐南伟，张云坤,等. Crowe Ⅳ型成人发育性髋关节发育不良股骨近段形态研究及其临床意义[J].中国修复重建外科杂志, 2015, 29(8):931-935.
22
Noble PC, Alexander JW, Lindahl LJ, et al. The anatomic basis of femoral component design[J]. Clin Orthop Relat Res, 1988, 235:148-165.
23
Laine HJ, Lehto MU, Moilanen T. Diversity of proximal femoral medullary canal[J]. J Arthroplasty, 2000, 15(1):86-92.
24
严亮，夏军，黄钢勇.成人髋关节发育不良患者股骨髓腔形态研究[J].国际骨科学杂志, 2013, 34(5):368-370.
[1] 金鑫, 谢卯, 刘芸, 杨操, 杨述华, 许伟华. 个性化股骨导向器辅助初次全髋关节置换的随机对照研究[J]. 中华关节外科杂志(电子版), 2023, 17(06): 780-787.
[2] 孟繁宇, 周新社, 赵志, 裴立家, 刘犇. 侧位直接前方入路髋关节置换治疗偏瘫肢体股骨颈骨折[J]. 中华关节外科杂志(电子版), 2023, 17(06): 865-870.
[3] 王波, 许珂, 刘林, 张斌飞, 庄岩, 许鹏. 全髋关节置换术在老年髋臼骨折中的应用[J]. 中华关节外科杂志(电子版), 2023, 17(03): 385-390.
[4] 王博永, 张飞洋, 沈灏. 全髋关节置换术后假体周围骨折研究进展[J]. 中华关节外科杂志(电子版), 2023, 17(03): 391-397.
[5] 皮颖, 王高, 张强, 黄志荣. 年轻患者初次髋关节置换术后关节翻修的原因分析[J]. 中华关节外科杂志(电子版), 2023, 17(03): 430-434.
[6] 彭胜男, 李志伟, 徐静, 彭晓星, 蒋微. 髂筋膜阻滞复合全身麻醉在全髋关节置换术中的应用[J]. 中华关节外科杂志(电子版), 2023, 17(02): 195-200.
[7] 王启中, 李辉. 全髋关节置换术中假体位置安全区的研究进展[J]. 中华关节外科杂志(电子版), 2023, 17(02): 261-266.
[8] 吴聪, 刘伦, 贾全忠. 老年股骨颈骨折初次全髋关节置换近期疗效影响因素[J]. 中华关节外科杂志(电子版), 2023, 17(02): 283-287.
[9] 陈丽冰, 欧会芝, 陆映霞. 基于配偶支持的个案管理在全髋关节置换患者中的应用[J]. 中华关节外科杂志(电子版), 2023, 17(02): 292-296.
[10] 费发珠, 张帅, 刘发蓉, 芦佳骏, 任宾, 樊海宁. 三维可视化联合术中ICG荧光引导腹腔镜肝包虫病切除术一例[J]. 中华肝脏外科手术学电子杂志, 2023, 12(05): 577-580.
[11] 李映安, 晋云, 储心昀, 胡苹苹, 王峻峰. 混合现实技术在腹腔镜肝切除术中导航的应用[J]. 中华肝脏外科手术学电子杂志, 2023, 12(04): 401-406.
[12] 王建奇, 陈政良, 刘雨, 俞星新, 耿志达, 姜洪池, 梁英健. 基于160例患者CT三维重建的肝血管解剖变异分析[J]. 中华肝脏外科手术学电子杂志, 2023, 12(04): 427-433.
[13] 高旭东, 王小明, 陈江明, 奚士航, 潘璇. 基于三维可视化技术的脾门区脾动脉三维分型[J]. 中华肝脏外科手术学电子杂志, 2023, 12(04): 434-439.
[14] 王祎, 王峻峰, 杨超, 晋云, 胡苹苹. 数字医学技术在肝脏分段及解剖性肝切除中的应用现状[J]. 中华肝脏外科手术学电子杂志, 2023, 12(01): 16-21.
[15] 张晓萌, 杨杰, 刘海, 王艳华, 张一翀, 张立佳, 熊晨, 唐缪田, 张殿英. 科研创新就在我们身边[J]. 中华肩肘外科电子杂志, 2023, 11(01): 1-6.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号