脊柱骨盆矢状面平衡参数在全髋关节置换术中的临床意义

Clinical significance of spinopelvic sagittal balance parameters in total hip arthroplasty

生物材料工艺水平的提高、人工假体设计的优化及外科手术技术的进步,使全髋关节置换术(THA)后髋臼假体的脱位率明显下降。传统的“Lewinnek安全区”被认为是髋关节假体植入指南,但大量临床研究证实,即使将髋臼假体按传统安全区角度植入,部分患者仍不可避免发生术后假体脱位。为降低假体脱位率,需要了解脊柱、骨盆和股骨间的相互作用,尤其对于因脊柱退行性病变、脊柱融合术、脊柱畸形等因素导致脊柱骨盆矢状面失衡的患者,需要参考“功能性安全区”植入髋臼杯。因此,术前通过标准X线片评估患者的矢状面失衡类型,找到最佳髋臼杯植入角度,对减少THA术后假体脱位有重大意义。

Advances in biomaterials,prosthesis design and surgical techniques have significantly reduced the incidence of adverse events after Total Hip Arthroplasty(THA).The traditional"Lewinnek safe zone"has been used as implant guidance,but numerous studies have confirmed that even when the acetabular implant is placed at the traditional safe zone,postoperative dislocation of the acetabular implant is still inevitable.Therefore,traditional safe zone can not predict THA postoperative security.To further reduce the dislocation rate,it is suggested that the vertebral,pelvic and femoral interaction should be furtherly explored,particularly in the case of spinal spondylopathy,spinal fusion,and spinal deformity.The"functional safe zone"is needed as the reference to implant acetabulum cup.Preoperative standard X-ray film was used to fully evaluate the sagittal imbalance types of patients and find the optimal angle of acetabular cup implantation,which is of great significance to reduce postoperative dislocations of THA.