手术入路和髋臼磨锉深度对全髋置换术旋转中心的影响

martinbigbird 2022-04-14

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来源：304关节学术

Background: Changes in acetabular or hip center of rotation (HCOR) commonly occur during acetabular component preparation during total hip arthroplasty (THA). HCOR displacement in mediolateral or superoinferior directions is known to influence offset and leg length, but the incidence and range of HCOR change in the anteroposterior direction is less understood as the sagittal plane cannot be measured on standard anteroposterior radiographs. This study assessed the 3-dimensional displacement of HCOR after cup implantation and evaluated for potential factors associated with increased acetabular component translations.

Methods: A total of 894 THAs were performed using a posterior, lateral, or direct anterior approach. Only intraoperative data from the navigation device were included in the analysis. All THAs performed between September 2015 and October 2017 were included. Paired t -tests were used to compare native HCOR and new HCOR values.

Results: The mean HCOR displacement in 3 directions was 4.97mm medially (P < .001), 0.83mm superiorly (P < .001), and 0.64mm posteriorly (P < .001). Subgroup analysis revealed greater posterior HCOR displacement with the anterior approach than the lateral/posterior approach (2.32mm vs 0.44mm; P < .001). Increasing medial HCOR displacement also resulted in increased superior and posterior HCOR displacement across surgical cases (P < .001).

Conclusions: HCOR displacement is commonly observed in medial, superior, and posterior directions. HCOR changes are influenced by surgical approach, potentially secondary to patient positioning, with greater posterior HCOR displacement observed in anterior cases. Surgeons should be aware of these factors, particularly in cases with deficient or reduced posterior column bone stock.

手术入路和髋臼磨锉深度

对全髋关节置换术旋转中心的影响

译者：马云青

背景: 髋臼或髋关节旋转中心(HCOR)的改变通常发生在全髋关节置换术(THA)髋臼侧手术操作中。旋转中心内外侧或上下移动会影响偏心距和肢体长短，但旋转中心在矢状面前后移位的发生率和移动范围由于无法在站立前后位X线片上测量而很少有人提及。这项研究评估了HCOR的三维位移情况从而了解增大髋臼假体型号的潜在相关因素。

方法: 所有2015年9月至2017年10月的采用导航辅助下髋关节置换的病例纳入研究，共894例髋关节置换，手术采用后外侧路、外侧路或直接前路。术中数据来自导航装置。采用成对 t 检验比较术前HCOR与术后HCOR 值。

结果: HCOR在3个方向平均位移分别为4.97 mm (p < 0.001) ，0.83 mm (p < 0.001) ，0.64 mm (p < 0.001)。不同入路的比较分析显示较后侧和外侧入路，前入路患者会出现更多HCOR后移(2.32 mm VS 0.44 mm，p < 0.05)。对于所以病例增加HCOR内移，同时也会导致其向上和后侧位移增加(p < . 001)。

结论: HCOR移位通常会发生在向内侧、上侧和后侧。HCOR的变化受手术入路的影响，可能继发于患者的术中体位不同，在前入路患者中观察到较大的HCOR后移位，在此情况下，对后柱骨量不足或减少的患者外科医生应特别注意。

Surgical Approach and Reaming Depth Influence the Direction and Magnitude of Acetabular Center of Rotation Changes During Total Hip Arthroplasty

文献出处：Benson JR, Govindarajan M, Muir JM, Lamb IR, Sculco PK. Surgical Approach and Reaming Depth Influence the Direction and Magnitude of Acetabular Center of Rotation Changes During Total Hip Arthroplasty. Arthroplast Today. 2020 Jun 17;6(3):414-421. doi: 10.1016/j.artd.2020.04.003. PMID: 32577487; PMCID: PMC7305266.

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