[Application of preoperative digital-template planning in total hip arthroplasty via direct anterior approach].

目的: 探究术前数字化模板计划用于直接前方入路（direct anterior approach，DAA）人工全髋关节置换术（total hip arthroplasty，THA）的准确性，及其对近期疗效的影响。. 方法: 回顾分析 2016 年 1 月—2018 年 5 月收治并符合选择标准的 77 例（109 髋）采用 DAA 行 THA 治疗的股骨头缺血性坏死患者临床资料。其中，40 例（56 髋）术前采用数字化模板计划（A 组），37 例（53 髋）采用传统模板计划（B 组）。两组患者年龄、性别、体质量指数、股骨头缺血性坏死分期以及术前 Harris 髋关节评分（Harris hip score，HHS）比较，差异均无统计学意义（ P>0.05）。记录两组手术时间、术中出血量、术中透视次数及并发症发生情况。比较术前计划与实际假体安放型号，并计算符合率。于术后 3 个月骨盆正位 X 线片测量髋臼杯假体外展角及股骨柄假体力线。采用 HHS 评分评价髋关节功能恢复情况。. Results: The consistency rate of preoperative planning and practical acetabular prosthesis size was significantly higher in group A (80.4%, 45/56) than that in group B (62.3%, 33/53), showing significant difference ( χ2=4.38, P=0.04). But there was no significant difference in the consistency rate of preoperative planning and practical femoral prosthesis size between group A (83.9%, 47/56) and group B (79.2%, 42/53）( χ2=0.40, P=0.53). The prosthesis abductions were (40.7±6.4)° in group A and (38.8±7.3)° in group B; the femoral prosthesis alignment deviations were (0.1±1.8)° in group A and (0.3±1.7)° in group B. There was no significant difference in the prosthesis abduction and femoral prosthesis alignment deviation between 2 groups ( P>0.05). No prosthesis sinking or loosening occurred during follow-up. The operation time and frequencies of intraoperative fluoroscopy were less in group A than those in group B ( P<0.05). But there was no significant difference in intraoperative blood loss between 2 groups ( t=1.92, P=0.06). The complication occurred in 1 hip of group A and 6 hips of group B, with no significant difference ( P=0.06). All patients were followed up 6-22 months (mean 13.8 months) in group A and 6-24 months (mean, 14.6 months) in group B. At last follow-up, the HHS scores were 91.8±3.1 in group A and 92.6±4.2 in group B, and the difference was not significant ( t=1.14, P=0.26). 结论: DAA 行 THA 术前行数字化模板计划准确性高，在不增加并发症发生风险的同时可以减少手术时间及术中透视次数。.