基于三维CT重建的计算机模拟技术 在DDH病人个体化手术方案设计中的应用

目的探讨基于三维CT重建的计算机模拟手术在Bernese髋臼周围截骨术治疗发育性髋关节发育不良（DDH）的术前评估、术前手术设计以及术后评估中的指导作用。方法应用Mimics和Imageware等医学影像处理软件对10例（10髋）DDH病人的CT原始数据进行3D重建、髋关节解剖形态学参数测量，术前评估髋臼开口方向、覆盖缺损的部位及程度，然后通过计算机模拟手术，设计个体化的手术方案，为实际手术提供参考。通过比较术前、术后的髋关节解剖形态学参数及临床功能评分评估效果。结果DDH病人患侧术前髋臼外侧中心边缘角（LCEA）、髋臼前方中心边缘角（ACEA）、髋臼前断面角（AASA）、髋臼后断面角（PASA）均小于正常对照侧（P < 0.05），髋臼前倾角（AAVA）大于正常对照侧（P < 0.05）。按照术前设计，术后病人的LCEA、ACEA、AAVA、AASA均较术前改善（P < 0.05），PASA与术前差异无统计学意义（P>0.05）。术后LCEA、ACEA、AAVA与正常对照侧差异无统计学意义（P>0.05）。术前、术后DDH病人的患侧髋关节功能评分（HHS）和疼痛视觉模拟评分（VAS）与对照侧差异有统计学意义（P < 0.05），末次随访时患侧的HHS和VAS评分均较术前有明显改善（P < 0.05）。结论基于三维CT重建的计算机模拟技术通过对DDH病人的髋关节解剖形态学参数进行测量，实现了术前对DDH病人的解剖结构发育畸形作出精确量化，并设计个体化的手术方案指导实际手术，使术后的影像学参数及临床功能评分获得明显的改善。

Application value of the computer simulation technology based on 3D-CT reconstruction in the design of individualized surgery for DDH patients

ObjectiveTo explore the role of virtual surgery based on 3D-CT reconstruction in the preoperative evaluation, surgical program and postoperative evaluation of Bernese periacetabular osteotomy(PAO) in the treatment of developmental dysplasia of the hip(DDH).MethodsThe 10 hips with DDH were reconstructed using Mimics and Imageware software, the anatomic morphological parameters of each hip were measured, and the direction of acetabular opening and location and extent of covering defect were evaluated before operation.The computer simulating operation and designing individualized surgical program provided the reference in actual operation.The results were evaluated by comparing preoperative and postoperative anatomical and morphological parameters of hip joint, and clinical function scores.ResultsBefore operation, the average values of LCEA, ACEA, AASA and PASA in affected side were less than those in normal side(P < 0.05), and the value of AAVA in affected side was bigger than that in normal side in DDH patients(P < 0.05).Compared with before operation, the mean values of LCEA, ACEA, AAVA, and AASA in PAO patients were significantly improved after PAO surgery(P < 0.05), but the PASA decreased, and the difference of which between before and after operation was not statistically significant(P>0.05).There was no statistical significance in the postoperative LCEA, ACEA and AAVA between affected side and normal side(P>0.05).The differences of the scores of HHS and VAS between two sides in DDH patients before and after surgery were statistically significant(P < 0.05).The scores of HHS and VAS in affected side at the last follow-up were significantly improved compared with those before operation(P < 0.05).ConclusionsThe computer simulation technology based on 3D CT reconstruction can measure the anatomical and morphological parameters of hip joint, accurately quantify the anatomic structural development deformity of DDH patients before surgery, design the individualized surgical plan to guide actual surgery, and significantly improve the imaging parameters and clinical function scores after surgery.