【摘要】 背景:模板测量在全髋关节置换术前计划中的应用包括髋臼侧模板测量和股骨侧模板测量,有胶片模板测量和数字化测量两种形式。各家报道的测量准确度不同,但少有分析可能影响测量准确性的因素。目的:探讨胶片模板测量的准确性,并分析可能影响测量准确性的原因。方法:收集北京积水潭医院矫形骨科某手术组2017年4月至2017年10月行初次全髋关节置换术的120例患者(126髋)做研究对象。术前分别由组内1名住院医师和1名高年资主治医师单独完成髋关节的模板测量并将测量结果同手术实际使用假体进行比对。同时考察患者身体体重指数(BMI)、下肢长度、髋臼覆盖和健侧测量是否是影响测量准确性的因素。结果:住院医师组和高年资主治医师组测量髋臼假体相差1个型号以内的符合率分别为88.89%和93.18%,相差2个型号以内为98.41%和98.86%;股骨假体相差1个型号以内符合率为89.68%和93.18%,相差2个型号以内为98.41%和100%。两组测量结果组内相关系数(ICC)髋臼侧为0.893、股骨侧为0.977。BMI和测量偏失结果之间髋臼侧相关系数r=0.019,P=0.835,股骨侧相关系数r=0.008,P=0.927。下肢长度和测量偏失结果之间髋臼侧相关系数r=0.039,P=0.785,股骨侧相关系数r=0.028,P=0.779。髋臼覆盖和测量偏失结果之间髋臼侧相关系数r=0.087,P=0.332。髋臼侧患侧测量较健侧测量准确度高(t=-4.094,P=0.000);股骨侧患侧测量和健侧测量没有统计学差异(t=1.391,P=0.169)。结论:术前胶片模板测量对于全髋关节置换术中假体型号选择具有较好的预测作用,BMI、下肢长度及髋臼覆盖和测量准确度之间没有明显相关性。髋臼侧患侧测量较健侧测量准确度高,而股骨侧患侧测量和健侧测量没有差异。更多还原

【Abstract】 Background:The use of templating in total hip arthroplasty(THA) includes acetabulum templating and femur templating.There are traditional acetate X-ray film templating and digital templating in clinic.And there are many different reports on the accuracy of templating.But few reports can be seen in analyzing factors related to the accuracy.Objective:To explore the accuracy of preoperative X-ray film templating in THA and to investigate the factors related to the accuracy.Methods:A total of 120 patients(126 hips) undergoing primary THA between April 2017 and October 2017 in Jishuitan hospital were enrolled in this study.Preoperative templating measurement was conducted to determine the size of acetabulum implant and femoral stem by one resident and one chief attending surgeon alone.The correlation between the accuracy of preoperative templating plan and the body mass index(BMI),length of the lower limb,covering of the acetabulum,and the measurement from the healthy hip were investigated.Results:The coincidence within one size unit for acetabulum was88.89% and 93.18%,within 2 size unit was 98.41% and 98.86% in the resident and chief attending surgeon,respectively.The coincidence within one size unit for femoral stem was 89.68% and 93.18%,within 2 size unit was 98.41% and 100% in the resident and chief attending surgeon.The interobserver reliability for acetabular and femoral component had interclass correlation coefficient(ICC) of 0.893 and 0.977,respectively.The correlation coefficient(r value) was 0.019(P=0.835) between BMI and inaccuracy of acetabulum,and the r value was 0.008(P=0.927) between BMI and inaccuracy of femoral stem.The r value was 0.039(P=0.785) between lower limb length and inaccuracy of acetabulum,and the r value was 0.028(P=0.779) between lower limb length and inaccuracy of femoral stem.The r value was 0.087(P=0.332) between acetabulum covering and inaccuracy of acetabulum.The templating from ailing aceatabulum was more accurate than healthy one(t=-4.094,P=0.000).There was no significant difference in the accuracy between the femoral stems of healthy and ailing hips(t=1.391,P=0.169).Conclusions:The preoperative templating plan can predict intraoperative selection of acetabularand femoral component well.The templating inaccuracy has no relation with BMI,lower limb length or acetabulum covering.The healthy acetabulum templating is more accurate than the ailing one,but there is no statistical difference in the measurement accuracy between the femoral stems of healthy and ailing hips.更多还原