CroweIV型先髋THA中,指导髋臼杯安放的新方法研究

2019-04-08 文章来源:骨科在线 点击量:4   我要说

来源:304关节学术

译者:张蔷

整理:骨科在线

J.Yoshitani等人发表于《Bone Joint J》杂志的一项研究显示,Crowe IV型先髋患者行全髋关节置换术(THA)中,髋臼后壁的中上三分之一位置,可帮助指导髋臼杯中心安放理想位置。

作者希望借助几何形态学分析方法,使用患者的CT数据分析并获得Crowe IV型先髋的THA术中髋臼杯中心的理想安放位置,并通过分析确定该方法的可靠性。研究人员回顾性分析入组了52例Crowe IV型髋关节[42名患者,7男,35女;平均年龄68.5岁(32-82岁)],50例相对正常髋关节[50名患者,8男,42女;平均年龄60.7岁(34-86岁)]的全髋关节置换手术病例。在这一基于CT数据的模拟研究中,他们将髋臼杯安放在真臼位置上,外展角40°,前倾角20°,并使用广义对齐算法(GPA)这一几何形态学方法分析髋臼形态以及髋臼杯中心的安放位置。

三角形状的真臼,髋臼杯中心在后壁的中上三分之一附近(蓝点位置)


黑色箭头指示真臼位置,蓝色箭头指示髋臼杯中心点


结果显示,Crowe IV型先髋的髋臼通常呈现独特的三角形,而髋臼杯中心的理想安放位置在髋臼后壁的上方。在曲线分析中,前两个扭曲点分别可以覆盖34.2%和18.4%的变量,而相对正常组可以覆盖28.6%和18.0%的变量。以后壁的中上三分之一作为髋臼杯中心的参照点,髋臼杯的中心距参照点的平均距离为5.6mm。

作者表示,对于先髋患者,在安放髋臼杯时,后壁的中上三分之一是一个十分重要的骨性标志物。

原文摘要:

Morphometricgeometrical analysis to determine the center of the acetabular componentplacement in Crowe type IV hips undergoing total hip arthroplasty

Aims:

We analyzedthe acetabular morphology of Crowe type IV hips using CT data to identify alandmark for the ideal placement of the center of the acetabular component, asassessed by morphometric geometrical analysis, and its reliability.

Patients and Methods: A total of 52 Crowe IV hips (42 patients; seven male, 35 female; mean age 68.5 years (32to 82)) and 50 normal hips (50 patients; eight male, 42 female; mean age 60.7years (34 to 86)) undergoing total hip arthroplasty were retrospectively identified. In this CT-based simulation study, the acetabular component waspositioned at the true acetabulum with a radiological inclination of 40° andanteversion of 20°. Acetabular shape and the position of the center of theacetabular component were analyzed by morphometric geometrical analysis usingthe generalized Procrustes analysis.

Results:

Theacetabular shapes of Crowe IV hips were distinctively triangular; the idealposition of the center of the acetabular component was superior on theposterior bony wall. The first and second relative warps explained 34.2% and18.4% of the variance, respectively, compared with that of 28.6% and 18.0% innormal hips. We defined the landmark as one-third the distance from top on theposterior bony wall in Crowe IV hips. The average distance from the center ofthe acetabular component was 5.6 mm.

Conclusion:

Crowe IVhips are distinctively triangular; the point one-third from the top on theposterior bony wall was a useful landmark for placing the acetabular component.

文献出处:

J.Yoshitani, T. Kabata, Y. Kajino, T. Ueno, K. Ueoka, T. Nakamura, H. Tsuchiya. Morphometricgeometrical analysis to determine the center of the acetabular componentplacement in Crowe type IV hips undergoing total hip arthroplasty. Cite thisarticle: Bone Joint J 2019; 101-B: 189–197.


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