人工全髋关节置换术“一钻研磨法”研磨髋臼的体会
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摘要
背景:人工全髋关节置换术(THA)传统的髋臼研磨方法存在研磨失误的可能性,影响髋臼假体的成功安放。目的:回顾性分析应用改进的THA研磨髋臼方法,即"一钻研磨法"的临床效果。方法:2013年10月至2018年10月45例45髋行初次THA时,直接使用测定的最大直径型号髋臼钻按标准规定的外展角和前倾角研磨放入髋臼内,即"一钻研磨法"。研磨直至髋臼窝完全消失时停止,再将稍大一号髋臼假体按预定角度打入。结果:45髋均一钻研磨成功,对应型号髋臼假体均被一次打入髋臼底并贴紧,预置角度无异动,检测髋臼假体固定牢靠。结论:"一钻研磨法"简化手术过程,减少研磨失误,提高髋臼研磨的准确性,增加髋臼假体压配合的有效性。
Background: The conventional reaming in total hip arthroplasty(THA) may occur reaming error and lead to unsatisfactory placement of the acetabular prosthesis. Objective: To retrospectively study the clinical efficacy of a modified reaming technique, which was named "single-step reaming". Methods: The "single-step reaming" technique was used in 45 patients who underwent THA from October 2013 to October 2018. According to the acetabular diameter in preoperative templating, we selected the same size of the reamer to prepare for the acetabulum in the appropriate abduction and anteversion reaming down to the medial wall, followed by the press-fit of the prosthesis. Results: The reaming was successfully performed in all the 45 patients. The prostheses were all firmly positioned in satisfactory angles. Conclusions: Compared to the conventional reaming, the"single-step reaming" technique can provide a less possibility of unsatisfactory cup placement and an increase of accuracy in acetabular preparation, which will lead to greater efficacy of the press-fit.
Background: The conventional reaming in total hip arthroplasty(THA) may occur reaming error and lead to unsatisfactory placement of the acetabular prosthesis. Objective: To retrospectively study the clinical efficacy of a modified reaming technique, which was named "single-step reaming". Methods: The "single-step reaming" technique was used in 45 patients who underwent THA from October 2013 to October 2018. According to the acetabular diameter in preoperative templating, we selected the same size of the reamer to prepare for the acetabulum in the appropriate abduction and anteversion reaming down to the medial wall, followed by the press-fit of the prosthesis. Results: The reaming was successfully performed in all the 45 patients. The prostheses were all firmly positioned in satisfactory angles. Conclusions: Compared to the conventional reaming, the"single-step reaming" technique can provide a less possibility of unsatisfactory cup placement and an increase of accuracy in acetabular preparation, which will lead to greater efficacy of the press-fit.
引文
[1]胡海贝,周建生.全髋关节置换术中髋臼假体定位的研究进展.创伤外科杂志,2016,18(3):182-184.
[2]李锐,赵娜,裴晓东.局部解剖与推荐的假体定位方向在全髋关节置换术中的对比研究.中国骨与关节损伤杂志,2016,31(2):113-117.
[3]魏强,徐耀增,朱峰,等.基于三维数据的术前计划指导全髋关节置换术髋臼假体置入的准确性分析.中华骨与关节外科杂志,2017,10(5):372-376.
[4]黄志宇,张志奇,傅明,等.髋臼假体上移放置对髋关节发育不良全髋关节置换术后下肢长度及功能的影响.中华骨科杂志,2014, 34(12):1225.
[5] Pierrepont J, Hawdon G, Miles BP, et al. Variation in functional pelvic tilt in patients undergoing total hip arthroplasty.Bone Joint J, 2017, 99-B(2):184-191.
[6]彭永刚,任姜栋,张坤,等.全髋关节置换术经直接前方入路与后方入路临床效果的Meta分析.实用骨科杂志,2018,24(6):510-515.
[7]李军伟,杨广辉,王义生,等.髋臼卵圆窝在实现术前预期髋臼杯外展角中的参考价值.中华骨科杂志,2012, 32(2):167-172.
[8]戚大春,安新荣.全髋关节置换假体位置的确定方法及生物力学特性.中国组织工程研究,2016, 20(26):3811-3816.
[9]郑栋,王禹基,徐南伟,等.初次人工髋关节置换术后复发性脱位的治疗方法研究.中华骨与关节外科杂志,2018,11(9):683-687.
[10]王雪,刘丙立.全髋关节置换术中髋臼病变的处理.实用骨科杂志,2013,19(11):1027-1028.
[11] S.Terry Canale James H. Beaty著.陈继营,周勇刚主译.坎贝尔骨科手术学(第一卷关节外科).第12版.北京:人民军医出版社,2015:178.
[12] Batailler C, Bonin N, Wettstein M, et al. Outcomes of cup revision for ilio-psoas impingement after total hip arthroplasty:Retrospective study of 46 patients. Orthop Traumatol Surg Res, 2017, 103(8):1147-1153.
[2]李锐,赵娜,裴晓东.局部解剖与推荐的假体定位方向在全髋关节置换术中的对比研究.中国骨与关节损伤杂志,2016,31(2):113-117.
[3]魏强,徐耀增,朱峰,等.基于三维数据的术前计划指导全髋关节置换术髋臼假体置入的准确性分析.中华骨与关节外科杂志,2017,10(5):372-376.
[4]黄志宇,张志奇,傅明,等.髋臼假体上移放置对髋关节发育不良全髋关节置换术后下肢长度及功能的影响.中华骨科杂志,2014, 34(12):1225.
[5] Pierrepont J, Hawdon G, Miles BP, et al. Variation in functional pelvic tilt in patients undergoing total hip arthroplasty.Bone Joint J, 2017, 99-B(2):184-191.
[6]彭永刚,任姜栋,张坤,等.全髋关节置换术经直接前方入路与后方入路临床效果的Meta分析.实用骨科杂志,2018,24(6):510-515.
[7]李军伟,杨广辉,王义生,等.髋臼卵圆窝在实现术前预期髋臼杯外展角中的参考价值.中华骨科杂志,2012, 32(2):167-172.
[8]戚大春,安新荣.全髋关节置换假体位置的确定方法及生物力学特性.中国组织工程研究,2016, 20(26):3811-3816.
[9]郑栋,王禹基,徐南伟,等.初次人工髋关节置换术后复发性脱位的治疗方法研究.中华骨与关节外科杂志,2018,11(9):683-687.
[10]王雪,刘丙立.全髋关节置换术中髋臼病变的处理.实用骨科杂志,2013,19(11):1027-1028.
[11] S.Terry Canale James H. Beaty著.陈继营,周勇刚主译.坎贝尔骨科手术学(第一卷关节外科).第12版.北京:人民军医出版社,2015:178.
[12] Batailler C, Bonin N, Wettstein M, et al. Outcomes of cup revision for ilio-psoas impingement after total hip arthroplasty:Retrospective study of 46 patients. Orthop Traumatol Surg Res, 2017, 103(8):1147-1153.