保髋截骨治疗髋关节发育不良(6)：患者个体化导板和电磁导航辅助双侧髋臼周围截骨术分期矫正双侧外伤导致

保髋截骨治疗髋关节发育不良(6)：患者个体化导板和电磁导航辅助双侧髋臼周围截骨术分期矫正双侧外伤导致的髋关节发育不良：病例报告

作者：Peter Brumat, Rene Mihalič, Črt Benulič, Anže Kristan, Rihard Trebše.

作者单位: Valdoltra Orthopaedic Hospital, Jadranska cesta 31, Ankaran 6280, Slovenia.

译者：陶可（北京大学人民医院骨关节科）

摘要

髋臼周围截骨术(PAO)治疗骨盆骨折后遗症对保髋手术提出了挑战，因为该手术涉及创伤后解剖结构改变和技术要求高等复杂情况，且手术风险高。为了应对这些挑战并避免潜在的严重并发症，可以使用患者专用导板(PST)和电磁导航(EMN)引导相结合来提高手术的安全性和髋臼重新定位的准确性。在此，我们报告了我们利用患者专用导板(PST)和电磁导航(EMN)辅助双侧髋臼周围截骨术(PAO)分期矫正双侧严重损伤引起的髋关节发育不良的经验。本病例报告描述了一种独特的方法，该方法结合了3D打印技术(PST)和术中电磁计算机辅助导航(EMN)辅助技术的手术程序(PAO)，成功治疗因严重双侧损伤引起的髋关节发育不良，强调了在复杂病理解剖情况的患者中，进行保髋手术时使用患者专用导板(PST)和电磁导航(EMN)的益处。

Fig. 1. At the age of 20, patient was involved in a motor vehicle-pedestrian accident, sustaining a comminuted fracture of the sacrum and bilateral superior and inferior complicated fracture of the pubis with Morel-Lavallee lesion. X-rays of primary injury management (middle and right).

图1. 患者20岁时遭遇机动车与行人相撞事故，骶骨粉碎性骨折，双侧耻骨上下骨折，伴有Morel-Lavallee损伤。原发性损伤治疗时的X线片（中和右）。注意：患者在损伤时（左图）就已经出现髋关节发育不良的影像学表现。

Fig. 2. The imaging studies showed residual injury-induced alterations of the lumbosacral spine and pelvis with heavily altered bony anatomy.

图2. 影像学研究显示，残留损伤导致腰骶椎和骨盆改变，骨解剖结构严重改变。

Fig. 3. Patient personalized 3-D-based virtual pre-operative planning: 3D model of hips and pelvis is generated from the DICOM files obtained by the pre-operative CT scan of hips and pelvis. Lateral views (left and right) and anteroposterior view (middle).

图3. 患者个性化的3-D虚拟术前规划：根据术前髋部和骨盆CT扫描获得的DICOM文件生成髋部和骨盆的3D模型。侧位图（左和右）和前后视图（中）。

Fig. 4. The design of the PST congruent to the exposed bone with two holes for guidance of the Kirschner wires along with the planned retroacetabular cut and a plane for the guidance of the supraacetabular cut for the left side PAO (left, middle). The PST made of biocompatible plastic (VisiJet, 3D systems, Rock Hill, SC, USA) for guiding the supra- and retro-acetabular osteotomy (right).

图4. PST设计与暴露的骨骼相一致，具有两个孔用于引导克氏针以及计划的髋臼后切口，以及一个平面用于引导左侧PAO的髋臼上切口（左，中）。PST由生物相容性塑料（VisiJet，3D系统，美国）制成，用于引导髋臼上和髋臼后截骨术（右）。

Fig. 5. EMN system (Guiding Star, Ekliptik d.o.o., Ljubljana, Slovenia).

图 5. EMN系统。

Fig. 6. No clinical or radiological complications were seen on the regular follow-up visit 6 months after the second surgery. Axial view (left) and anteroposterior view (right).

图6. 第2次手术后6个月的定期随访中未见临床或放射学并发症。轴位视图（左）和前后视图（右）。

Fig. 7. On the final in-office follow-up 30 months after the second surgery patient reported bilaterally undisturbed hip function and complete resolution of hip pain. Imaging showed correction according to the pre-operative plan.

图7. 在第二次手术后30个月的最后一次门诊随访中，患者报告双侧髋关节功能未受干扰，髋关节疼痛完全消失。影像显示矫正过程按照术前计划进行。

Patient-specific template and electromagnetic navigation assisted bilateral periacetabular osteotomy for staged correction of bilateral injury-induced hip dysplasia: a case report

Abstract

Periacetabular osteotomy (PAO) for pelvic fracture sequelae presents a challenge in hip preservation surgery due to a combination of complex conditions involving post-traumatic altered anatomy and technically demanding procedure, with high surgical risk involved. To address these challenging conditions and evade potential devastating complications, a combination of patient-specific template (PST) and electromagnetic navigation (EMN) guidance can be used to increase the safety of the procedure and the accuracy of the acetabular reorientation. Herein we report our experience utilizing a combined PST- and EMN-assisted bilateral PAO for staged correction of bilateral severe, injury-induced hip dysplasia. The presented case report describes a unique method of successful surgical treatment of severe, bilateral injury-induced hip dysplasia with combined 3-D printing technology (PST) and intra-operative electromagnetic computer-assisted navigation (EMN) aided technically demanding surgical procedure (PAO), which emphasizes the benefits of PST and EMN use in hip preservation surgery in patients with complex pathoanatomic circumstances.

文献出处：Peter Brumat, Rene Mihalič, Črt Benulič, Anže Kristan, Rihard Trebše. Patient-specific template and electromagnetic navigation assisted bilateral periacetabular osteotomy for staged correction of bilateral injury-induced hip dysplasia: a case report. J Hip Preserv Surg. 2021 Aug 24;8(2):192-196. doi: 10.1093/jhps/hnab054. eCollection 2021 Jul.