人工全髋关节置换术假体位置参数的计算机辅助优化及临床应用

Total hip arthroplasty (THA) is the standard procedure for the treatment of end-stage hip diseases. However, a mal-positioned implant is related with a restricted range of motion, an increase of post-operative complication rate, and a decrease of survival rate. Besides, more than 40% of primary THAs in China are performed to treat osteoarthritis secondary to developmental dysplasia of the hip (DDH). Distinct hip deformities among DDH patients make THA even more technically challenging, resulting in a higher incidence of implant mal-position. It is necessary to provide surgeons with optimal guiding parameters according to the specific anatomies of DDH patients, however, the optimal orientation parameters are not well documented, let alone intra-operative realization of the optimal placement of implants. Previously, researchers tried to figure out the optimal orientation parameters by performing hip morphometry and clinical follow up studies based on radiographic measurements.However, the anatomic parameters of acetabula and femurs were studied seperately.To further clarify the combined optimal parameters for implant placement and to realise the accurate implantaion intra-operatively, cutting edge medical imaging analysis softwares and motion capture/simulation techniques will be implemented to measure the combined anatomic parameters of hip joints among both male and female healthy volunteers and to capture the individulized hip kinematics.Then, the detailed relationship between hip kinematic parameters and individual's combined anatomic parameters will be analyzed together, and hopefully the individualized and sex-specific orientation parameters could be determined. With the optimal parameters and reverse engineering techniques, we hope to develop a computer aided individualized surgical guidance template to accurately place the implants. Eventually, we hope to develop an individualized, sex-specific implantation technique, which has a potential to improve the accuracy and repeatability of total hip arthroplasty, and to reduce incidences of complications.

人工全髋关节置换术是治疗终末期髋骨关节炎的标准术式。但假体位置不良直接影响关节活动度，增加并发症发生率，降低假体生存率。而我国髋骨关节炎常继发于髋关节发育不良，其髋周畸形使假体植入失去正常参照，更易出现位置不良。既往研究通过临床随访及解剖学测量来探索假体最佳位置，不足之处是仅孤立的分析髋臼侧或股骨侧的各种参数。随着对髋关节运动认识的加深，骨盆/髋臼和股骨侧的联合解剖分析在国外开始起步，但我国尚缺乏相关研究。为阐明国人髋部解剖学联合参数及髋关节运动学之间的内在关系，本研究借助当前生物医学工程领域中前沿的三维图像技术及运动捕捉系统，在国内外首次测量健康男、女志愿者的髋臼及股骨联合解剖参数，结合运动测量及仿真分析，兼顾形态与运动，探索个体化、性别化的假体植入参数。结合相关参数，通过计算机辅助导板技术发展适合我国人体特点的性别差异性髋关节假体植入技术，最终实现关节活动度的优化及生存率的改善。

人工全髋关节置换术是治疗终末期髋骨关节炎的标准术式，但假体位置不良直接影响关节活动度，增加并发症发生率，降低假体生存率。而我国髋骨关节炎常继发于髋关节发育不良（Developmental dysplasia of the hip, DDH），其髋周畸形使假体植入失去正常参照，更易出现位置不良。既往研究通过临床随访及解剖学测量来探索假体最佳位置，但多数是借助二维测量的技术来进行粗略的评估。另外，既往研究仅孤立的分析髋臼侧或股骨侧的各种解剖参数。随着对髋关节解剖及活动认识的加深，骨盆/髋臼和股骨侧的联合解剖分析在国外开始，但我国尚缺乏同类研究。本研究借助当前生物医学工程领域中前沿的医学图像处理技术，在国内外率先开展聚焦国人男、女正常志愿者及DDH患者的髋臼及股骨的解剖参数测量的半自动软件的研发，在实验初期采用商用软件进行骨盆及股骨建模的基础上，根据临床要求进一步提炼骨盆区建模特定模块，实现髋臼、股骨的快速分割建模，实现骨盆及股骨自身三维坐标系的搭建，实现骨盆、髋臼及股骨解剖结构的2D/3D联合自动化测量，实现临床上对测量精度及效率兼顾及平衡。目前为止，已完成国人正常男、女志愿者各超过50例，DDH患者近70例（男20例，女50例）的测量工作。同时，充分利用髋臼邻近解剖复杂结构，实现髋臼定位导板的设计及制造，通过3D打印技术实现髋臼个体化导板的快速制造，同时在个体化导板的基础上，结合国人正常男女性髋臼朝向参数测量结果，实现性别差异性髋臼定向导板的设计及制造。目前，已完成体外试验的准备工作，即将进入临床应用阶段，拟用于指导DDH患者臼杯假体定向的临床前瞻性随机对照研究。我们相信通过计算机辅助导板技术发展适合我国人体特点的性别差异性髋关节假体植入技术，最终实现关节活动度的优化及生存率的改善。