Frontiers in surgery · 2026
MRI-CT fusion-based digital true hip reconstruction in pediatric developmental dysplasia of the hip: a preliminary feasibility report.
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Wang Wei, Xu WenQiang, Liu ChaoYu, Fan YongFei, Yu HaiYang
Аннотация
PURPOSE: To explore the early clinical feasibility and safety of MRI-CT fusion-based digital "osseous-cartilaginous" hip reconstruction in pediatric developmental dysplasia of the hip (DDH).
METHODS: A retrospective analysis was performed on 15 pediatric DDH patients (1 male, 14 females; age 2-12 years, mean 6.06 ± 3.32 years) treated between January 2017 and December 2024, including 12 unilateral and 3 bilateral cases (18 hips total). Preoperative CT and MRI data were fused to construct individualized three-dimensional (3D) "osseous-cartilaginous" hip models, followed by hybrid 3D printing for physical model fabrication. Measurements included femoral neck-shaft angle, anteversion angle, and both osseous and cartilaginous acetabular parameters (acetabular index and coverage rate) to guide personalized osteotomy planning and computer-aided guide plate design. Surgical parameters (operative time, blood loss, fluoroscopy times) and postoperative complications were recorded. Functional outcomes were evaluated using the Mackay scoring system.
RESULTS: Preoperative measurements showed statistically significant differences between osseous and cartilaginous parameters (acetabular index: 30.77° ± 4.98° vs. 19.07° ± 4.03°; coverage rate: 54.67% ± 4.89% vs. 76.78% ± 8.29%; both P < 0.05). All 18 hips underwent successful surgery as planned. The mean operative time was 2.64 ± 0.74 h, with an average blood loss of 291.67 ± 184.11 mL and fluoroscopy times of 8.50 ± 2.36. Postoperatively, the neck-shaft angle improved to 132.24° ± 8.26°, and the osseous acetabular index decreased significantly to 15.40° ± 4.01° (P < 0.05). All patient-specific guides were successfully seated intraoperatively without adjustment. No major complications occurred during follow-up. Minor complications were recorded in 4 of 18 hips (22.2%), including transient femoral nerve palsy (n = 2), superficial wound dehiscence with fat liquefaction (n = 1), and grade I pressure sore related to spica cast immobilization (n = 1), all of which resolved with conservative management. The Mackay scoring system showed excellent outcomes in 16 hips and good in 2 (excellent-good rate: 100%).
CONCLUSION: MRI-CT fusion-based digital technology offers a feasible and safe approach for individualized surgical planning in pediatric DDH, with satisfactory short-term clinical outcomes. However, as a preliminary case series without quantitative geometric validation, further prospective studies are warranted.
METHODS: A retrospective analysis was performed on 15 pediatric DDH patients (1 male, 14 females; age 2-12 years, mean 6.06 ± 3.32 years) treated between January 2017 and December 2024, including 12 unilateral and 3 bilateral cases (18 hips total). Preoperative CT and MRI data were fused to construct individualized three-dimensional (3D) "osseous-cartilaginous" hip models, followed by hybrid 3D printing for physical model fabrication. Measurements included femoral neck-shaft angle, anteversion angle, and both osseous and cartilaginous acetabular parameters (acetabular index and coverage rate) to guide personalized osteotomy planning and computer-aided guide plate design. Surgical parameters (operative time, blood loss, fluoroscopy times) and postoperative complications were recorded. Functional outcomes were evaluated using the Mackay scoring system.
RESULTS: Preoperative measurements showed statistically significant differences between osseous and cartilaginous parameters (acetabular index: 30.77° ± 4.98° vs. 19.07° ± 4.03°; coverage rate: 54.67% ± 4.89% vs. 76.78% ± 8.29%; both P < 0.05). All 18 hips underwent successful surgery as planned. The mean operative time was 2.64 ± 0.74 h, with an average blood loss of 291.67 ± 184.11 mL and fluoroscopy times of 8.50 ± 2.36. Postoperatively, the neck-shaft angle improved to 132.24° ± 8.26°, and the osseous acetabular index decreased significantly to 15.40° ± 4.01° (P < 0.05). All patient-specific guides were successfully seated intraoperatively without adjustment. No major complications occurred during follow-up. Minor complications were recorded in 4 of 18 hips (22.2%), including transient femoral nerve palsy (n = 2), superficial wound dehiscence with fat liquefaction (n = 1), and grade I pressure sore related to spica cast immobilization (n = 1), all of which resolved with conservative management. The Mackay scoring system showed excellent outcomes in 16 hips and good in 2 (excellent-good rate: 100%).
CONCLUSION: MRI-CT fusion-based digital technology offers a feasible and safe approach for individualized surgical planning in pediatric DDH, with satisfactory short-term clinical outcomes. However, as a preliminary case series without quantitative geometric validation, further prospective studies are warranted.