全髋关节置换髋臼假体置入解剖学标志的研究进展

Research progress of anatomical marks related with the implantation of acetabular prosthesis in total hip arthroplasty

目的总结以相关解剖学标志指导全髋关节置换术中髋臼假体精准置入的研究进展。方法在中国知网、万方数据、PubMed等中、英文数据库,以“解剖学标志”“全髋关节置换”“髋臼假体置入”以及“anatomical mark”“total hip arthroplasty”“acetabular prothesis implant”等为关键词,检索1999年1月—2019年9月有关骨盆及相关解剖标志指导全髋关节置换的相关文献,共检索到9881篇文献,排除内容不相符、无法获取全文、质量较低、证据等级不高、重复研究的文献,最终纳入文献43篇,对其进行总结、分析。结果全髋关节置换术中常见的指导髋臼假体置入的解剖学标志包括髋臼横韧带、卵圆窝及髋臼切迹、骨盆参考平面、髋臼切迹角、“通道线”以及髋臼外展角顶区等,通过识别、参照以上解剖学标志,有助于精准置入髋臼假体。骨盆参考平面、髋臼切迹角相对抽象,髋臼横韧带、“通道线”以及髋臼外展角顶区适用于髋臼解剖相对正常的患者,卵圆窝及髋臼切迹指导髋臼假体精准置入的方法有待进一步深入研究。数字化科技的发展有利于进一步提高髋臼假体置入的精准性。结论全髋关节置换术中根据患者髋臼的解剖形态特点,正确认识、选择和参照合适的骨盆及相关解剖学标志,结合数字骨科技术,有利于实现髋臼假体个性化的精准置入,减少术后并发症,促进患者快速康复。

Objective To summarize the research progress of anatomical marks related with the implantation of acetabular prosthesis in total hip arthroplasty.Methods The recent literatures in the database of CNKI,Wanfang data and PubMed were searched by the keywords of“解剖学标志”“全髋关节置换”“髋臼假体置入”and“anatomical mark”“total hip arthroplasty”“acetabular prothesis implant”from January 1999 to September 2019.A total of 9881 literatures were searched out totally,and 43 literatures were finally included to be analyzed and summarized after excluding the literatures that were inconsistent to the subject,no full text,low quality and level of evidence and repeated studies.Results The anatomical marks which are used to guide the implantation of acetabular prosthesis in total hip arthroplasty include:transverse acetabular ligament,Harris fossa and acetabular notch,pelvic reference plane,acetabular notch angle,channel line and the top region of acetabular abduction angle,etc.By identifying and referring to the above anatomical marks,it is faciliated to install acetabular prosthesis accurately.However,pelvic reference plane and acetabular notch angle are relatively abstract,transverse acetabular ligament,channel line and the top region of acetabular abduction angle are suitable for patients with relatively normal acetabular anatomy,the guidance method of Harris fossa and acetabular notch for accurate acetabular prosthesis implantation still need further study.The development of digital technology is conducive to further improve the accuracy of acetabular prosthesis installation.Conclusions According to patients’acetabular anatomical morphology in total hip arthroplasty,it is helpful to realize individualized acetabular prosthesis accurate implantation by recognizing,choosing and referring proper pelvis and its related anatomical marks correctly,combining with digital orthopedic technology,which can reduce postoperative complications and promote the rehabilitation of patients.