Study of virtual reality technology combined with reduction plasty of femoral head in treatment of coxa plana_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

QIU Yue , XIA Tianwei , YUAN Zhaofeng , HUAN Dawei , ZHANG Chao ,  SHEN Jirong

Department of Traumatology & Orthopedics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing Jiangsu, 210029, P. R. China;

Corresponding author：

SHEN Jirong, Email: joint66118@sina.com

Keywords：

Virtual reality technology; reduction plasty of femoral head; coxa plana

DOI：

10.7507/1002-1892.202211098

Video：

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Objective To explore the feasibility of virtual reality (VR) technology combined with reduction plasty of the femoral head in the treatment of coxa plana and evaluate its effectiveness. Methods Three patients with coxa plana were selected as the research objects between October 2018 and October 2020, all of them were male, aged 15-24 years. Preoperative surgical planning was performed using VR technology; 256 rows of CT data of hip joint were imported into software to generate three-dimensional (3D) imaging, simulate the surgical process, and determine the matching relationship between the femoral head and acetabulum. According to the preoperative planning, reduction plasty of the femoral head under surgical dislocation, relative lengthening of the femoral neck, and periacetabular osteotomy were performed. The reduction of osteotomy size of femoral head and rotation angle of acetabulum were confirmed by C-arm fluoroscopy. The healing of the osteotomy were assessed by radiological examination after operation. The Harris score of hip function and visual analogue scale (VAS) score were recorded before and after operation. The femoral head roundness index, center-edge (CE) angle, and femoral head coverage were measured by X-ray films. Results Three operations were completed successfully, and the operation time was 460, 450, and 435 minutes, and the intraoperative blood loss was 733, 716, and 829 mL, respectively. All patients were infused with 3 U suspension oligoleucocyte and 300 mL frozen virus inactivated plasma after operation. No postoperative complication occurred, such as infection and deep vein thrombosis. Three patients were followed up 25, 30, and 15 months, respectively. CT showed good healing of the osteotomy at 3 months after operation. The VAS score and Harris score at 12 months after operation and at last follow-up, as well as the femoral head rounding index, hip CE angle, and femoral head coverage at 12 months after operation significantly improved when compared with those before operation; the hip function was evaluated by the Harris score at 12 months after operation, and all three patients were good. Conclusion VR technology combined with reduction plasty of the femoral head can achieve satisfactory short-term effectiveness in the treatment of coxa plana.

Citation： QIU Yue, XIA Tianwei, YUAN Zhaofeng, HUAN Dawei, ZHANG Chao, SHEN Jirong. Study of virtual reality technology combined with reduction plasty of femoral head in treatment of coxa plana. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(3): 284-289. doi: 10.7507/1002-1892.202211098 Copy

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6.	郑潮顺, 李春海. 虚拟现实技术在骨科术前规划中的应用. 中国骨科临床与基础研究杂志, 2017, 9(5): 310-315.
7.	Steppacher SD, Tannast M, Werlen S, et al. Femoral morphology differs between deficient and excessive acetabular coverage. Clin Orthop Relat Res, 2008, 466(4): 782-790.
8.	姜坤, 鲍琨. Perthes病的各治疗方法原理及治疗指征. 中华小儿外科杂志, 2015, 36(12): 948-952.
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10.	杨先腾, 张洪, 罗殿中, 等. 股骨头缩小成形术治疗大头髋或扁平髋畸形的早期疗效. 中华骨科杂志, 2017, 37(15): 942-951.
11.	罗殿中, 张洪. 一项基本的保髋手术技术: 髋关节外科脱位技术. 中华解剖与临床杂志, 2015, (5): 475-480.
12.	Grzegorzewski A, Synder M, Kozłowski P, et al. The role of the acetabulum in Perthes disease. J Pediatr Orthop, 2006, 26(3): 316-321.
13.	Albers CE, Steppacher SD, Ganz R, et al. Impingement adversely affects 10-year survivorship after periacetabular osteotomy for DDH. Clin Orthop Relat Res, 2013, 471(5): 1602-1614.
14.	施乐, 樊燕鑫, 张超, 等. 虚拟现实技术术前规划在经转子间弧形内翻截骨术治疗成人股骨头缺血性坏死中的应用价值. 中国修复重建外科杂志, 2019, 33(8): 923-928.
15.	任鹏鹏, 张启栋, 王卫国. 虚拟现实技术在骨科领域的研究进展. 中国矫形外科杂志, 2018, 26(21): 1980-1983.

1. Chaudhry S, Phillips D, Feldman D. Legg-Calvé-Perthes disease: an overview with recent literature. Bull Hosp Jt Dis (2013), 2014, 72(1): 18-27.
2. Wenger DR, Pandya NK. A brief history of Legg-Calvé-Perthes disease. J Pediatr Orthop, 2011, 31(2 Suppl): S130-S136.
3. Joseph B, Price CT. Principles of containment treatment aimed at preventing femoral head deformation in Perthes disease. Orthop Clin North Am, 2011, 42(3): 317-327.
4. Ganz R, Horowitz K, Leunig M. Algorithm for femoral and periacetabular osteotomies in complex hip deformities. Clin Orthop Relat Res, 2010, 468(12): 3168-3180.
5. Siebenrock KA, Anwander H, Zurmühle CA, et al. Head reduction osteotomy with additional containment surgery improves sphericity and containment and reduces pain in Legg-Calvé-Perthes disease. Clin Orthop Relat Res, 2015, 473(4): 1274-1283.
6. 郑潮顺, 李春海. 虚拟现实技术在骨科术前规划中的应用. 中国骨科临床与基础研究杂志, 2017, 9(5): 310-315.
7. Steppacher SD, Tannast M, Werlen S, et al. Femoral morphology differs between deficient and excessive acetabular coverage. Clin Orthop Relat Res, 2008, 466(4): 782-790.
8. 姜坤, 鲍琨. Perthes病的各治疗方法原理及治疗指征. 中华小儿外科杂志, 2015, 36(12): 948-952.
9. Paley D. The treatment of femoral head deformity and coxa magna by the Ganz femoral head reduction osteotomy. Orthop Clin North Am, 2011, 42(3): 389-399.
10. 杨先腾, 张洪, 罗殿中, 等. 股骨头缩小成形术治疗大头髋或扁平髋畸形的早期疗效. 中华骨科杂志, 2017, 37(15): 942-951.
11. 罗殿中, 张洪. 一项基本的保髋手术技术: 髋关节外科脱位技术. 中华解剖与临床杂志, 2015, (5): 475-480.
12. Grzegorzewski A, Synder M, Kozłowski P, et al. The role of the acetabulum in Perthes disease. J Pediatr Orthop, 2006, 26(3): 316-321.
13. Albers CE, Steppacher SD, Ganz R, et al. Impingement adversely affects 10-year survivorship after periacetabular osteotomy for DDH. Clin Orthop Relat Res, 2013, 471(5): 1602-1614.
14. 施乐, 樊燕鑫, 张超, 等. 虚拟现实技术术前规划在经转子间弧形内翻截骨术治疗成人股骨头缺血性坏死中的应用价值. 中国修复重建外科杂志, 2019, 33(8): 923-928.
15. 任鹏鹏, 张启栋, 王卫国. 虚拟现实技术在骨科领域的研究进展. 中国矫形外科杂志, 2018, 26(21): 1980-1983.

Chinese Journal of Reparative and Reconstructive Surgery

Study of virtual reality technology combined with reduction plasty of femoral head in treatment of coxa plana

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