Amna Baljoun, Catharine S Bradley, Yashvi Verma, John H Wedge, Martin F Gargan, Simon P Kelley
{"title":"DDH 开颅手术中的术中三维透视：术后 CT/MRI 的有效替代方案。","authors":"Amna Baljoun, Catharine S Bradley, Yashvi Verma, John H Wedge, Martin F Gargan, Simon P Kelley","doi":"10.1097/BPO.0000000000002728","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Computed tomography CT or magnetic resonance imaging (MRI) has been the most used imaging modality to assess hip reduction in developmental dysplasia of the hip (DDH) after open reduction (OR). In 2015, intraoperative 3D fluoroscopy (3D) was introduced at our center as an alternative to CT/MRI. 3D offers the advantage that if hip reduction is insufficient, it can be addressed at the time of surgery. The purpose of this study was to assess the efficacy of 3D in comparison to CT/MRI.</p><p><strong>Methods: </strong>This was a single-centre, retrospective comparative study of two consecutive cohorts: those with OR and 3D between 2015 and 2017 and those with OR and CT/MRI between 2012 and 2014. Time to imaging, re-imaging, length of stay (LOS), re-operation, and redislocation or subluxation after cast removal were evaluated.</p><p><strong>Results: </strong>Forty-two patients (46 hips) had 3D, and 30 patients (32 hips) had CT/MRI. Significant differences were found between groups in time to imaging, cast changes, and LOS. All 3D was intraoperative (46 hips), and only 69% (22 hips) of CT/MRI was on the day of surgery ( P <0.01). In the 3D group, 1 hip (2%) had a cast change under the same anesthetic, and 4 hips (13%) from CT/MRI had cast changes in subsequent surgery ( P =0.03). The mean LOS in days for 3D was 1.72 and 2.20 for CT/MRI ( P =0.03). There were no statistically significant differences between groups in further imaging and subluxations or re-dislocations at cast removal. Two hips (4%) in the 3D group had MRI, but with no further intervention ( P =0.51), and at cast removal, there were 3 subluxations in each group ( P =0.69) and 1 redislocation in the 3D group ( P =1.00).</p><p><strong>Conclusions: </strong>Intraoperative 3D improved time to imaging, allowed for cast changes at surgery and had a shorter LOS. Moreover, there were no significant differences found in adverse outcomes between those who underwent 3D versus CT/MRI. 3D should thus be considered an effective alternative to CT/MRI for assessing hip reduction during OR for DDH.</p><p><strong>Level of evidence: </strong>Diagnostic Study, level II.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.4000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Intraoperative 3D Fluoroscopy During Open Reduction for DDH: An Effective Alternative to Postoperative CT/MRI.\",\"authors\":\"Amna Baljoun, Catharine S Bradley, Yashvi Verma, John H Wedge, Martin F Gargan, Simon P Kelley\",\"doi\":\"10.1097/BPO.0000000000002728\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Computed tomography CT or magnetic resonance imaging (MRI) has been the most used imaging modality to assess hip reduction in developmental dysplasia of the hip (DDH) after open reduction (OR). In 2015, intraoperative 3D fluoroscopy (3D) was introduced at our center as an alternative to CT/MRI. 3D offers the advantage that if hip reduction is insufficient, it can be addressed at the time of surgery. The purpose of this study was to assess the efficacy of 3D in comparison to CT/MRI.</p><p><strong>Methods: </strong>This was a single-centre, retrospective comparative study of two consecutive cohorts: those with OR and 3D between 2015 and 2017 and those with OR and CT/MRI between 2012 and 2014. Time to imaging, re-imaging, length of stay (LOS), re-operation, and redislocation or subluxation after cast removal were evaluated.</p><p><strong>Results: </strong>Forty-two patients (46 hips) had 3D, and 30 patients (32 hips) had CT/MRI. Significant differences were found between groups in time to imaging, cast changes, and LOS. All 3D was intraoperative (46 hips), and only 69% (22 hips) of CT/MRI was on the day of surgery ( P <0.01). In the 3D group, 1 hip (2%) had a cast change under the same anesthetic, and 4 hips (13%) from CT/MRI had cast changes in subsequent surgery ( P =0.03). The mean LOS in days for 3D was 1.72 and 2.20 for CT/MRI ( P =0.03). There were no statistically significant differences between groups in further imaging and subluxations or re-dislocations at cast removal. Two hips (4%) in the 3D group had MRI, but with no further intervention ( P =0.51), and at cast removal, there were 3 subluxations in each group ( P =0.69) and 1 redislocation in the 3D group ( P =1.00).</p><p><strong>Conclusions: </strong>Intraoperative 3D improved time to imaging, allowed for cast changes at surgery and had a shorter LOS. Moreover, there were no significant differences found in adverse outcomes between those who underwent 3D versus CT/MRI. 3D should thus be considered an effective alternative to CT/MRI for assessing hip reduction during OR for DDH.</p><p><strong>Level of evidence: </strong>Diagnostic Study, level II.</p>\",\"PeriodicalId\":16945,\"journal\":{\"name\":\"Journal of Pediatric Orthopaedics\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.4000,\"publicationDate\":\"2024-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Pediatric Orthopaedics\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/BPO.0000000000002728\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/5/23 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Pediatric Orthopaedics","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/BPO.0000000000002728","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/5/23 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
摘要
背景：计算机断层扫描（CT）或磁共振成像（MRI）一直是评估开放复位术（OR）后髋关节发育不良（DDH）的髋关节缩小情况最常用的成像方式。2015 年，我中心引进了术中三维透视（3D），作为 CT/MRI 的替代方法。3D的优势在于，如果髋关节缩小不足，可以在手术时解决。本研究的目的是评估 3D 与 CT/MRI 相比的疗效：这是一项单中心、回顾性比较研究，研究对象为两个连续队列：2015 年至 2017 年期间接受手术和 3D 的队列，以及 2012 年至 2014 年期间接受手术和 CT/MRI 的队列。对成像时间、再次成像、住院时间（LOS）、再次手术以及拆除石膏后的再脱位或半脱位进行了评估：42名患者（46个髋关节）接受了3D检查，30名患者（32个髋关节）接受了CT/MRI检查。两组患者在成像时间、石膏更换和住院时间方面存在显著差异。所有的 3D 都是在术中（46 个髋关节）进行的，只有 69% 的 CT/MRI 是在手术当天进行的（22 个髋关节）：术中三维成像缩短了成像时间，允许在手术中更换石膏，缩短了手术时间。此外，3D与CT/MRI在不良后果方面没有明显差异。因此，在评估DDH手术中的髋关节缩窄情况时，3D应被视为CT/MRI的有效替代方案：诊断研究，II级。
Intraoperative 3D Fluoroscopy During Open Reduction for DDH: An Effective Alternative to Postoperative CT/MRI.
Background: Computed tomography CT or magnetic resonance imaging (MRI) has been the most used imaging modality to assess hip reduction in developmental dysplasia of the hip (DDH) after open reduction (OR). In 2015, intraoperative 3D fluoroscopy (3D) was introduced at our center as an alternative to CT/MRI. 3D offers the advantage that if hip reduction is insufficient, it can be addressed at the time of surgery. The purpose of this study was to assess the efficacy of 3D in comparison to CT/MRI.
Methods: This was a single-centre, retrospective comparative study of two consecutive cohorts: those with OR and 3D between 2015 and 2017 and those with OR and CT/MRI between 2012 and 2014. Time to imaging, re-imaging, length of stay (LOS), re-operation, and redislocation or subluxation after cast removal were evaluated.
Results: Forty-two patients (46 hips) had 3D, and 30 patients (32 hips) had CT/MRI. Significant differences were found between groups in time to imaging, cast changes, and LOS. All 3D was intraoperative (46 hips), and only 69% (22 hips) of CT/MRI was on the day of surgery ( P <0.01). In the 3D group, 1 hip (2%) had a cast change under the same anesthetic, and 4 hips (13%) from CT/MRI had cast changes in subsequent surgery ( P =0.03). The mean LOS in days for 3D was 1.72 and 2.20 for CT/MRI ( P =0.03). There were no statistically significant differences between groups in further imaging and subluxations or re-dislocations at cast removal. Two hips (4%) in the 3D group had MRI, but with no further intervention ( P =0.51), and at cast removal, there were 3 subluxations in each group ( P =0.69) and 1 redislocation in the 3D group ( P =1.00).
Conclusions: Intraoperative 3D improved time to imaging, allowed for cast changes at surgery and had a shorter LOS. Moreover, there were no significant differences found in adverse outcomes between those who underwent 3D versus CT/MRI. 3D should thus be considered an effective alternative to CT/MRI for assessing hip reduction during OR for DDH.
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.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
