背景:在全髋关节置换术(THA)之前使用三维(3D)计划变得越来越流行,因为它提供了几个理论上的好处:更好地恢复患者的解剖结构,更少的术中问题,更低的THA成本。据说它比二维(2D)规划更准确,但就我们所知,对于刚开始使用3D规划的外科医生,目前尚无研究调查3D和2D规划之间的植入物尺寸匹配程度.一致的植入物尺寸将使外科医生更容易从一个系统过渡到另一个系统。这导致我们进行了回顾性比较研究,以:1)比较3D规划系统和2D规划方法(使用模板的常规X射线照相术)之间的植入物尺寸匹配程度;2)确定3D系统上计划的尺寸是否与患者使用的植入物匹配;3)确定使用2D方法计划的尺寸是否与患者使用的植入物匹配。
目的:3D和2D计划之间的植入物尺寸匹配良好。
方法:回顾性观察,对2019年1月至2021年9月期间在一家教学医院接受THA的患者进行了单外科医生研究.对于每个病人来说,使用专有软件(OptimizedPositioningSystemTM,Corin)和2D模板。这些患者是该外科医生基于3D计划进行手术的第一人。
结果:纳入49例患者。植入物尺寸在两种计划方法之间完全匹配,适用于20%(10/49)的杯子(35%的臀部(17/49)的3D尺寸更大,而20%的臀部(10/49)的尺寸更大),对于53%(26/49)的股骨干(一个尺寸较小,在53%的髋部(26/49)中3D)和14%(7/49)的完整THA植入系统(杯,股骨干,股骨头)。在3D中计划的尺寸与植入51%(25/49)臀部的杯子尺寸相同,股骨柄大小占65%(32/49),完整的THA系统占22%(11/49)。在88%(43/49)的臀部中,杯子在一个尺寸内,而在98%(48/49)的臀部中,股骨柄在一个尺寸内。2D中计划的尺寸与植入45%(22/49)臀部的杯子尺寸相同,作为股骨干大小的63%(32/49)和完整的THA系统的18%(9/49)。在2D模板下,杯子在86%(42/49)的臀部中处于一种尺寸内,股骨柄在96%(47/49)的臀部中处于一种尺寸内。对于植入的杯子(p=.5)或植入的股骨柄(p=.8),2D和3D技术之间的尺寸匹配没有统计学上的显着差异。
结论:通过3D和2D计划确定的植入物尺寸之间的匹配性差。根据我们的发现,考虑到与3D系统相关的学习曲线,必须逐步完成从2D模板到3D计划的转变。
方法:III;比较回顾性研究。
BACKGROUND: The use of three-dimensional (3D) planning before a total hip arthroplasty (THA) procedure is becoming increasingly popular as it offers several theoretical benefits: better restoration of a patient\'s anatomy, fewer intraoperative problems, and lower THA cost. It is said to be more accurate than two-dimensional (2D) planning, but as far as we know, no study has investigated how well the implant sizes match between 3D and 2D planning for a surgeon who is just starting to use 3D planning. Consistent implant sizes would make it easier for a surgeon to transition from one system to another. This led us to conduct a retrospective comparative study to: (1) compare how well the implant sizes match between a 3D planning system and a 2D planning method (conventional radiography using templates); (2) determine if the sizes planned on the 3D system match the implants that were used in the patient; (3) determine if the sizes planned with the 2D method match the implants that were used in the patient.
OBJECTIVE: There is a good match in the implant sizes between the 3D and 2D planning.
METHODS: A retrospective observational, single-surgeon study was done with patients who underwent THA between January 2019 and September 2021 at a single teaching hospital. For each patient, the size of the THA implants was planned preoperatively in 3D using proprietary software (Optimized Positioning System™, Corin) and 2D
templating. These patients were the first to be operated on by this surgeon based on 3D planning.
RESULTS: Forty-nine patients were included. The implant size matched exactly between the two planning methods for 20% (10/49) of cups [one size larger with 3D in 35% of hips (17/49) and two sizes larger in 20% of hips (10/49)], for 53% (26/49) of femoral stems [one size smaller with 3D in 53% of hips (26/49)] and for 14% (7/49) of complete THA implant systems (cup, femoral stem, femoral head). The size planned in 3D was the same as the cup size implanted in 51% (25/49) of hips, as the femoral stem size in 65% (32/49) and as the complete THA system in 22% (11/49). The cup was within one size in 88% (43/49) of hips and the femoral stem was within one size in 98% (48/49) of hips. The size planned in 2D was the same as the cup size implanted in 45% (22/49) of hips, as the femoral stem size in 63% (32/49) and as the complete THA system in 18% (9/49). The cup was within one size in 86% (42/49) of hips and the femoral stem was within one size in 96% (47/49) of hips with 2D
templating. There was no statistically significant difference in the size matching between the 2D and 3D techniques for either the implanted cup (p=0.5) or the implanted femoral stem (p=0.8).
CONCLUSIONS: There is a poor match between the implant sizes determined by 3D and 2D planning. Based on our findings, the shift from 2D
templating to 3D planning must be done gradually given the learning curve associated with 3D systems.
METHODS: III; comparative retrospective study.