全髋关节置换术采用髋臼横韧带作髋臼假体前倾定位的CT研究
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摘要
目的本文通过对全髋关节置换术前髋臼解剖前倾角度和术后髋臼假体前倾角度的CT测量,评估使用髋臼横韧带定位法安放髋臼假体前倾角度的准确性。方法 2015年1月至2016年1月,选择我院关节外科收治初次全髋关节置换术的40例44髋髋关节病患者纳入本研究。术中髋臼假体的前倾角以髋臼横韧带为参照标志,使髋臼假体开口平行韧带进行安放。采用CT测量术前髋臼解剖前倾角和术后髋臼假体前倾角,对手术前后前倾角数据进行统计分析,探讨应用髋臼横韧带定位法安放髋臼假体的准确性。结果本组手术中所有病例都能对髋臼横韧带进行辨认。术后切口Ⅰ期愈合。随访10～18个月,平均14个月,均未发生髋关节脱位。术后髋臼假体平均前倾角为(21.37±9.69)°,与术前髋臼解剖前倾角(19.22±6.76)°比较,差异无统计学意义(P>0.05)。其中,术后假体前倾角女性为(24.59±11.57)°,男性为(20.28±8.76)°,与术前女性和男性髋臼解剖前倾角比较差异无统计学意义(P>0.05)。女性术前解剖前倾角比男性术前解剖前倾角大,差异有统计学意义(P<0.05)。结论在髋臼解剖学相对正常的初次全髋关节置换中,以髋臼横韧带为解剖标志,对髋臼假体前倾角度的精确植入可起到较可靠的参照作用。
Objective To measure native acetabular anteversion before total hip arthoplasty(THA)and acetabular component anteversion after THA using computed tomography(CT)method,and to evaluate the accuracy of acetabular component anteversion positioning with transverse acetabular ligament(TAL)orientation.Methods Totally 40patients(44hips)undergoing primary THA in our hospital from January 2015 to January 2016 were enrolled in this study.All the arthroplasty were performed by one surgeon.we used posterior approach and positioned the acetabular component anteversion with TAL orientation,in which the inferomedial rim of the cup had been positioned parallel to the transverse acetabular ligament intraoperatively.Preoperatively and postoperatively,all the patients were examined by CT scan.We measured radiographic cup anteversion angle and native acetabular anteversion using a CT scan method.Acetabular component anteversion and native acetabular anteversion were statistically analyzed.Results In all the 44 hips,TAL were identified.The mean acetabular component anteversion was(21.37±9.69)°,which was no significantly different from preoperatively native acetabular anteversion(P>0 05).Among them,acetabular component anteversion of women and men were(24.59±11.57)°,(20.28±8.76)°respectivly,which was no significantly different from those preoperatively native acetabular anteversion(P>0.05).The preoperatively native acetabular anteversion was significantly higher in females than in males(P<0.05).Conclusion We suggest that the transverse acetabular ligament is a practical anatomical landmark for precise determining cup anteversion in primary THA.
Objective To measure native acetabular anteversion before total hip arthoplasty(THA)and acetabular component anteversion after THA using computed tomography(CT)method,and to evaluate the accuracy of acetabular component anteversion positioning with transverse acetabular ligament(TAL)orientation.Methods Totally 40patients(44hips)undergoing primary THA in our hospital from January 2015 to January 2016 were enrolled in this study.All the arthroplasty were performed by one surgeon.we used posterior approach and positioned the acetabular component anteversion with TAL orientation,in which the inferomedial rim of the cup had been positioned parallel to the transverse acetabular ligament intraoperatively.Preoperatively and postoperatively,all the patients were examined by CT scan.We measured radiographic cup anteversion angle and native acetabular anteversion using a CT scan method.Acetabular component anteversion and native acetabular anteversion were statistically analyzed.Results In all the 44 hips,TAL were identified.The mean acetabular component anteversion was(21.37±9.69)°,which was no significantly different from preoperatively native acetabular anteversion(P>0 05).Among them,acetabular component anteversion of women and men were(24.59±11.57)°,(20.28±8.76)°respectivly,which was no significantly different from those preoperatively native acetabular anteversion(P>0.05).The preoperatively native acetabular anteversion was significantly higher in females than in males(P<0.05).Conclusion We suggest that the transverse acetabular ligament is a practical anatomical landmark for precise determining cup anteversion in primary THA.
引文
[1]张福江,高志国,于建华,等.全髋关节置换术中髋臼横韧带对髋臼假体前倾定位的研究[J].中国修复重建外科杂志,2008,22(5):625-626.
[2] Beverland D.The transverse acetabular ligament:optimizing version[J].Orthopedics,2010,33(9):631-631.
[3] Masahiro Inoue,Tokifumi Majima,Satomi Abe,et al.Using the transverse acetabular ligament as a landmark for acetabular anteversion:an intraoperative measurement[J].J Orthop Surg(Hong Kong),2013,21(2):189-194.
[4] Sameer Jain,Joseph Aderinto,Peter Bobak.The role of the transverse acetabular ligament in total hip arthroplasty[J].Acta orthopaedica Belgica,2013,79(2):135-140.
[5]覃文报,赵秉诚,覃义淳,等.改良髋臼横韧带定位法植入髋臼假体的准确性研究[J].中华骨与关节外科杂志,2016,9(6):493-497.
[6] Barrack RL,Lavernia C,Ries M,et al.Virtual reality computer animation of the effect of component position and design on stability after total hip arthroplasty[J].Orthop Clin North Am,2001,32(4):569-577.
[7] Jolles BM,Zangger P,Leyvraz PF.Factors presdisposing to dislocation after primary total hip prosthesis:a multivariate analysis[J].J Arthroplasty,2002,17(3):282-288.
[8] Moskal JT,Capps SG,Scanelli JA.Improving the accuracy of acetabular component orientation:avoiding malposition[J].J Bone Joint Surg(Am),2013,95(11):1044.
[9] Gwam CU,Mistry JB,Mohamed NS,et al.Current epidemiology of revision total hip arthroplasty in the united states:National inpatient sample 2009to 2013[J].J Arthroplasty,2017,32(7):2088-2092.
[10] Bozic KJ,Kurtz SM,Lau E,et al.The epidemiology of revision total hip arthroplasty in the United States[J].J Bone Joint Surg(Am),2009,91(1):128-133.
[11] Olivecrona H,Weidenhielm L,Olivecrona L,et al.A new CT method for measuring cup orientation after total hip arthroplasty:a study of 10patients[J].Acta Orthopaedica Scandinavica,2004,75(3):252-260.
[12] Wassilew GI,Perka C,Koenig C,et al.3DCT analysis of combined cup and stem anteversion in cases of cup navigation in hip arthroplasty[J].Orthopedics,2010,33(10Suppl):48-51.
[13] Lin F,Lim D,Wixson RL,et al.Validation of a computer navigation system and a CT method for determination of the orientation of implanted acetabular cup in totalhip arthroplasty:a cadaver study[J]Clin Biomech,2008,23(8):1004-1011.
[14] Lewinnek GE,Lewis JL,Tarr R,et al.Dislocations after total hip replacement arthroplasties[J].J Bone Joint Surg Am,1978,60(2):217-220.
[15] Abdel MP,Von Roth P,Jennings MT,et al.What safe Zone the vast majority of dislocated THAs are within the lewinnek safe Zone for acetabular component position[J].Clin Orthop Relat Res,2016,474(2):386-391.
[16] Maruyama M,Feinberg JR,Capello WN,et al.The Frank Stinchfield Award:morphologic features of the acetabulum and femur:anteversion angle and implant positioning[J].Clin Orthop Relat Res,2001(393):52-65.
[17]韩莹莹,肖成双,杨麒巍,等.CT三维重建下髋臼形态的测量及其意义[J].吉林大学学报(医学版),2011,37(6):1136-1140.
[18] DiGioia AM,Jaramaz B,Plakseychuk AY,et al.Comparison of a mechanical acetabular alignment guide with computer placement of the socket[J].J Arthroplasty,2002,17(3):359-364.
[19]郭晓忠,窦宝信,刘庆,等.计算机辅助下的小切口人工全髋关节置换术[J].中华创伤骨科杂志,2007,9(8):748-751.
[20]姚辉,卢华定,侯刚,等.小切口人工全髋关节置换术中使用计算机导航对于提高髋臼置入精度的临床观察[J].中国矫形外科杂志,2013,21(20):1293-1297.
[21] Wentzensen A,Zheng G,Vock B,et al.Image-based hip navigation[J].IntOrthop,2003,27(suppl.1):43-46.
[22] Kalteis TA,Handel M,Herold T,et al.Greater accuracy in positioning of the acetabular cup by using an image-free navigation system[J].Int Orthop,2005,29(5):272-276.
[23] Ryan JA,Jamali AA,Bargar WL.Accuracy of computer navigation for acetabular component placement in THA[J].Clin Orthop Relat Res,2010,468(1):169-177.
[24] Sotereanos NG,Miller MC,Smith B,et al.Using intraoperative pelvic landmarks for acetabular component placement in total hip arthroplasty[J].J Arthroplasty,2006,21(6):832-840.
[25] Archbold HAP,Mockford B,Molloy D,et al.The transverse acetabular ligament:an aid to orientation of the acetabular component during primary total hip replacement:apreliminary study of 1000cases investigating postoperative stability[J].J Bone Joint Surg(Br),2006,88(7):883-886.
[26] Meftah M,Yadav A,Wong AC,et al.A novel method for accurate and reproducible functional cup positioning in total hip arthroplasty[J].J Arthroplasty,2013,28(7):1200-1205.
[27] Callanan MC,Jarrett B,Bragdon CR,et al.The John Charnley Award:risk factors for cup malpositioning:quality improvement through a joint registry at a tertiary hospital[J].Clin Orthop Relat Res,2011,469(2):319-329.
[28] Wright JM,Crockett HC,Delgado S,et al.Mini-incision for total hip arthroplasty:aprospective,controlled investigation with 5-year follow-up evaluation[J].Arthroplasty,2004,19(5):538-545.
[29] Toshiya Kanoh,Yukiharu Hasegawa,Tetsuo Masui,et al.Accurate acetabular component orientation after total hip arthroplasty using an acetabular alignment guide[J].J Arthroplasty,2010,25(1):81-86.
[2] Beverland D.The transverse acetabular ligament:optimizing version[J].Orthopedics,2010,33(9):631-631.
[3] Masahiro Inoue,Tokifumi Majima,Satomi Abe,et al.Using the transverse acetabular ligament as a landmark for acetabular anteversion:an intraoperative measurement[J].J Orthop Surg(Hong Kong),2013,21(2):189-194.
[4] Sameer Jain,Joseph Aderinto,Peter Bobak.The role of the transverse acetabular ligament in total hip arthroplasty[J].Acta orthopaedica Belgica,2013,79(2):135-140.
[5]覃文报,赵秉诚,覃义淳,等.改良髋臼横韧带定位法植入髋臼假体的准确性研究[J].中华骨与关节外科杂志,2016,9(6):493-497.
[6] Barrack RL,Lavernia C,Ries M,et al.Virtual reality computer animation of the effect of component position and design on stability after total hip arthroplasty[J].Orthop Clin North Am,2001,32(4):569-577.
[7] Jolles BM,Zangger P,Leyvraz PF.Factors presdisposing to dislocation after primary total hip prosthesis:a multivariate analysis[J].J Arthroplasty,2002,17(3):282-288.
[8] Moskal JT,Capps SG,Scanelli JA.Improving the accuracy of acetabular component orientation:avoiding malposition[J].J Bone Joint Surg(Am),2013,95(11):1044.
[9] Gwam CU,Mistry JB,Mohamed NS,et al.Current epidemiology of revision total hip arthroplasty in the united states:National inpatient sample 2009to 2013[J].J Arthroplasty,2017,32(7):2088-2092.
[10] Bozic KJ,Kurtz SM,Lau E,et al.The epidemiology of revision total hip arthroplasty in the United States[J].J Bone Joint Surg(Am),2009,91(1):128-133.
[11] Olivecrona H,Weidenhielm L,Olivecrona L,et al.A new CT method for measuring cup orientation after total hip arthroplasty:a study of 10patients[J].Acta Orthopaedica Scandinavica,2004,75(3):252-260.
[12] Wassilew GI,Perka C,Koenig C,et al.3DCT analysis of combined cup and stem anteversion in cases of cup navigation in hip arthroplasty[J].Orthopedics,2010,33(10Suppl):48-51.
[13] Lin F,Lim D,Wixson RL,et al.Validation of a computer navigation system and a CT method for determination of the orientation of implanted acetabular cup in totalhip arthroplasty:a cadaver study[J]Clin Biomech,2008,23(8):1004-1011.
[14] Lewinnek GE,Lewis JL,Tarr R,et al.Dislocations after total hip replacement arthroplasties[J].J Bone Joint Surg Am,1978,60(2):217-220.
[15] Abdel MP,Von Roth P,Jennings MT,et al.What safe Zone the vast majority of dislocated THAs are within the lewinnek safe Zone for acetabular component position[J].Clin Orthop Relat Res,2016,474(2):386-391.
[16] Maruyama M,Feinberg JR,Capello WN,et al.The Frank Stinchfield Award:morphologic features of the acetabulum and femur:anteversion angle and implant positioning[J].Clin Orthop Relat Res,2001(393):52-65.
[17]韩莹莹,肖成双,杨麒巍,等.CT三维重建下髋臼形态的测量及其意义[J].吉林大学学报(医学版),2011,37(6):1136-1140.
[18] DiGioia AM,Jaramaz B,Plakseychuk AY,et al.Comparison of a mechanical acetabular alignment guide with computer placement of the socket[J].J Arthroplasty,2002,17(3):359-364.
[19]郭晓忠,窦宝信,刘庆,等.计算机辅助下的小切口人工全髋关节置换术[J].中华创伤骨科杂志,2007,9(8):748-751.
[20]姚辉,卢华定,侯刚,等.小切口人工全髋关节置换术中使用计算机导航对于提高髋臼置入精度的临床观察[J].中国矫形外科杂志,2013,21(20):1293-1297.
[21] Wentzensen A,Zheng G,Vock B,et al.Image-based hip navigation[J].IntOrthop,2003,27(suppl.1):43-46.
[22] Kalteis TA,Handel M,Herold T,et al.Greater accuracy in positioning of the acetabular cup by using an image-free navigation system[J].Int Orthop,2005,29(5):272-276.
[23] Ryan JA,Jamali AA,Bargar WL.Accuracy of computer navigation for acetabular component placement in THA[J].Clin Orthop Relat Res,2010,468(1):169-177.
[24] Sotereanos NG,Miller MC,Smith B,et al.Using intraoperative pelvic landmarks for acetabular component placement in total hip arthroplasty[J].J Arthroplasty,2006,21(6):832-840.
[25] Archbold HAP,Mockford B,Molloy D,et al.The transverse acetabular ligament:an aid to orientation of the acetabular component during primary total hip replacement:apreliminary study of 1000cases investigating postoperative stability[J].J Bone Joint Surg(Br),2006,88(7):883-886.
[26] Meftah M,Yadav A,Wong AC,et al.A novel method for accurate and reproducible functional cup positioning in total hip arthroplasty[J].J Arthroplasty,2013,28(7):1200-1205.
[27] Callanan MC,Jarrett B,Bragdon CR,et al.The John Charnley Award:risk factors for cup malpositioning:quality improvement through a joint registry at a tertiary hospital[J].Clin Orthop Relat Res,2011,469(2):319-329.
[28] Wright JM,Crockett HC,Delgado S,et al.Mini-incision for total hip arthroplasty:aprospective,controlled investigation with 5-year follow-up evaluation[J].Arthroplasty,2004,19(5):538-545.
[29] Toshiya Kanoh,Yukiharu Hasegawa,Tetsuo Masui,et al.Accurate acetabular component orientation after total hip arthroplasty using an acetabular alignment guide[J].J Arthroplasty,2010,25(1):81-86.