Novel Use of the O-Arm Following Open Reduction of a Dislocated Hip for a Walking Age Patient Provides a Low-Radiation Alternative to CT.

IF 1.5 3区 医学 Q3 ORTHOPEDICS
Journal of Pediatric Orthopaedics Pub Date : 2025-09-01 Epub Date: 2025-07-21 DOI:10.1097/BPO.0000000000003003
Alexander Aretakis, Jordyn Adams, Rachael Martino, Patrick Carry, Jennifer Stickel, Nancy Hadley-Miller, Gaia Georgopoulos, Courtney Selberg
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引用次数: 0

Abstract

Background: Surgical treatment of a dislocated hip at walking age includes open reduction (OR) with or without osteotomies of the pelvis and/or femur. Three-dimensional imaging, such as computerized tomography (CT), can be utilized postoperatively to determine femoral head position following cast placement. Alternatively, intraoperative 3D imaging (O-arm) may be used for the same purpose. Disadvantages of CT include limited access to the patient's airway and high radiation dose. The current study aimed to determine the ability of O-arm imaging to visualize femoral head position following surgical treatment of a dislocated hip, and compare radiation dosage between CT and O-arm.

Methods: Thirteen patients (16 hips) with a dislocated hip at walking age who underwent OR with pelvic ± femoral osteotomies at a single institution were retrospectively reviewed. All patients underwent CT or O-arm evaluation following surgery and spica cast application. Total radiation dose per kilogram was compared between the CT (n=8 hips) and O-Arm 14 (n=8 hips) groups. Radiographic parameters and complication rates were analyzed. Image quality was blindly assessed by 3 fellowship-trained pediatric orthopedic surgeons with hip expertise.

Results: The mean age was 4.68 years (range: 3.1-7.8) in the CT group and 4.31 (range: 1.2-7.5) in the O-Arm group. The average radiation dose from the O-arm was lower than CT (4.51 19 mGy/kg vs. 6.12 mGy/kg, P =0.37). Five hips in the CT cohort were scanned post-extubation. All surgeons agreed that femoral head position was adequately visualized in all images from both groups. No patient in either group required a cast change post-scanning due to a malpositioned femoral head.

Conclusion: The O-arm is a reasonable alternative to CT following surgical treatment of a dislocated hip. It may decrease radiation dose and provides adequate visual information to determine femoral head position following surgical intervention and casting. Utilization of the O-arm keeps the patient in the operating room during the study, allowing for immediate revision of the cast position or revision reduction if necessary, while maximizing access to the patient's airway and minimizing risk for adverse anesthetic events.

Level of evidence: Level III, retrospective comparative study.

o型臂在行龄患者髋关节脱位切开复位后的新应用为CT提供了一种低辐射替代方法。
背景:行走年龄髋关节脱位的手术治疗包括骨盆和/或股骨截骨或不截骨的切开复位(OR)。三维成像,如计算机断层扫描(CT),可用于术后确定股骨头位置。另外,术中3D成像(o型臂)也可用于相同目的。CT的缺点是进入患者气道受限,辐射剂量大。本研究旨在确定o型臂成像在髋关节脱位手术后显示股骨头位置的能力,并比较CT和o型臂的放射剂量。方法:回顾性分析13例(16髋)行走年龄髋关节脱位患者在同一医院行OR骨盆±股骨截骨术。所有患者在手术和石膏石膏应用后均行CT或o型臂评估。比较CT组(n=8髋)和o - 14组(n=8髋)的每千克总辐射剂量。分析影像学参数及并发症发生率。图像质量由3名接受过奖学金培训的具有髋关节专业知识的儿科骨科医生进行盲目评估。结果:CT组平均年龄为4.68岁(范围:3.1 ~ 7.8岁),O-Arm组平均年龄为4.31岁(范围:1.2 ~ 7.5岁)。o型臂的平均辐射剂量低于CT (4.51 19 mGy/kg vs. 6.12 mGy/kg, P=0.37)。拔管后对CT队列中的5个髋部进行扫描。所有的外科医生都认为股骨头位置在两组的所有图像中都能充分地显示出来。两组均无患者在扫描后因股骨头错位需要更换铸型。结论:o型臂是髋关节脱位手术治疗后CT的合理选择。它可以减少辐射剂量,并提供足够的视觉信息,以确定手术干预和铸造后股骨头的位置。在研究期间,使用o型臂使患者保持在手术室中,允许立即调整石膏位置或必要时调整复位,同时最大限度地进入患者气道并将麻醉不良事件的风险降至最低。证据等级:III级,回顾性比较研究。
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来源期刊
CiteScore
3.30
自引率
17.60%
发文量
512
审稿时长
6 months
期刊介绍: ​Journal of Pediatric Orthopaedics is a leading journal that focuses specifically on traumatic injuries to give you hands-on on coverage of a fast-growing field. You''ll get articles that cover everything from the nature of injury to the effects of new drug therapies; everything from recommendations for more effective surgical approaches to the latest laboratory findings.
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