| Objective:1.Using finite element technology to make a preoperative finite element plan for DDH patients,and to provide a reference for clinical surgery.2.Follow-up reports on clinical efficacy of 16 patients(19 hips)after CPO in our center.Methods:1.Scanning the CT data of a normal female volunteer and a female DDH patient.A 16-slice spiral CT machine(GE,USA)was used to perform continuous tomography from the iliac crest to the ischial tuberosity of the patient with 2mm intervals along the axial direction.The image data obtained was saved in DICOM format.Using Mimics 21.0 and Hypermesh 2017 to build and edit the model,and using Abaqus2018 for simulation analysis.2.Retrospective follow-up of 16 patients(19 hips)of curved acetabular osteotomy who met the inclusion criteria in our department from 2016 to 2020,aged 11-54 years old,with an average of 28.3 years old.Recording the preoperative and last follow-up time LCEA,ACEA,Sharp angle,Tonnis osteoarthritis grade,Harris score,VAS score,etc.on the standard anterior pelvic X-ray film and lateral X-ray film were analyzed by t-test.Results:1.The stress of the acetabular cartilage of normal people is evenly distributed in the heel landing phase and the mid-phase of single-leg support.The maximum stress is located on the outer and upper side of the acetabular cartilage,which are 5.142 MPa and 6.022 MPa,respectively;the stress distribution of the acetabular cartilage in DDH patients is more lateral On the front side and on the front side,there are stress concentrations in these two places,with the maximum values being 7.432 MPa and 9.712 MPa,respectively.;the hip of the DDH patient The stress distribution of acetabular cartilage is more lateral and anterior.There are stress concentrations in these two places,with the maximum values being 7.432 MPa and 9.712 MPa,respectively.The best rotation angle for heel landing phase is LCEA:30°,ACEA35°,the maximum contact pressure after operation drops to 5.273MPa,the stress distribution of acetabular cartilage moves to the inner side of the acetabulum and the back;the best osteotomy angle in the mid-phase of single-leg support For LCEA:35°,ACEA:35°,the maximum contact pressure drops to 6.463Mpa,and the stress changes are the same as the heel landing phase.Comprehensive consideration,LCEA:35°,ACEA:35° is the best osteotomy correction angle for this patient.2.The length of hospital stay was 9-21 days,with an average of 16 days.The operation time was 2-7.5h,with an average of 3h.Intraoperative bleeding was 300-900ml,with an average of 550ml.The follow-up time was 6 to 52 months,with an average of 32.5 months.In terms of clinical scoring,Harris score and VAS score were significantly improved compared with preoperative.Harris score was 68.68±6.92 points before operation,which rose to 91.21±2.74 points at the last follow-up,which was statistically significant(t=16.748,p<0.001).The VAS score was 5.32±1.11 points before the operation,and dropped to 1.11 ± 0.86 points at the last follow-up,which was statistically significant(t=-16.181,p<0.001).In terms of imaging,LCEA was(3.11 ±9.56)° before surgery,and it rose to(35.10±4.92)° at the last follow-up,which was statistically significant(t=15.208,p<0.001)°.Before ACEA operation(22.38 ±6.82)°,it rose to(36.78±3.93)° at the last follow-up,which was statistically significant(t=9.358,p<0.001).Before the operation,the Sharp angle was(49.19±3.60)°,and it decreased to(36.99 ± 4.20)° at the last follow-up,which was statistically significant(t=-13.865,p<0.001).Before the operation,10 cases of hip Tonnis osteoarthritis were classified as grade 1,and 9 cases of hip were classified as grade 2.At the last follow-up,1 patient progressed from grade 2 to grade 3,and 3 patients progressed from grade 1 to grade 2.In the remaining patients,osteoarthritis did not progress at the last follow-up compared with the preoperative period.As for complications,at the last follow-up,3 patients did not heal the pubic bone osteotomy area,3 patients developed skin paresthesia in the area innervated by the lateral femoral cutaneous nerve after operation,2 patients were completely cut off the posterior column during osteotomy of the sciatic branch,and 1 patient Superficial infection of the incision,one patient had persistent pain in the hip after the operation,without major blood vessels,nerves and other complications.Conclusions:1.Finite element analysis can guide surgeons to make a preoperative plan for DDH patients,so as to formulate the best individualized osteotomy surgery plan.The finite element results of this study show that there is the best correction angle in curved acetabular osteotomy,and the best biomechanics of the hip joint can be obtained under this angle.2.The VAS and Harris scores after curved acetabular osteotomy in this group of DDH patients are significantly improved compared with preoperatively.The imaging measurement indexes,including LCEA,ACEA,and Sharp angle are significantly improved compared with preoperatively,with significant statistical differences.It shows that curved acetabular osteotomy is an effective surgical method for the treatment of adult patients with DDH. |
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