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

A CT Study of Acetabular Component Anteversion Positioning with Transverse Acetabular Ligament Orientation

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 40 patients(44 hips)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.