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中华关节外科杂志(电子版) ›› 2020, Vol. 14 ›› Issue (03) : 339 -345. doi: 10.3877/cma.j.issn.1674-134X.2020.03.015

所属专题: 文献

综述

髋臼假体前倾角的临床意义及其二维影像测量
肖何1, 郑念野2, 代文立1, 吴宣平1, 史占军1,()   
  1. 1. 510515 广州,南方医科大学南方医院骨科关节与骨病外科
    2. 63110 圣路易斯,华盛顿大学医学院骨科系
  • 收稿日期:2019-05-30 出版日期:2020-06-01
  • 通信作者: 史占军
  • 基金资助:
    南方医科大学南方医院院长基金(2019C021)

Advances in clinical relevance and two-dimentional radiographic measurement of acetabular component anteversion

He Xiao1, Nianye Zheng2, Wenli Dai1, Xuanping Wu1, Zhanjun Shi1,()   

  1. 1. Department of Orthopedic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
    2. Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
  • Received:2019-05-30 Published:2020-06-01
  • Corresponding author: Zhanjun Shi
  • About author:
    Corresponding author: Shi Zhanjun, Email:
引用本文:

肖何, 郑念野, 代文立, 吴宣平, 史占军. 髋臼假体前倾角的临床意义及其二维影像测量[J]. 中华关节外科杂志(电子版), 2020, 14(03): 339-345.

He Xiao, Nianye Zheng, Wenli Dai, Xuanping Wu, Zhanjun Shi. Advances in clinical relevance and two-dimentional radiographic measurement of acetabular component anteversion[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2020, 14(03): 339-345.

髋臼假体前倾角(ACA)是全髋关节置换术(THA)髋臼假体的方向参数之一,对THA手术效果存在显著影响,是THA术中控制及术后评估的重要指标。ACA并非新的概念,但近年来相关研究的深入更新了对ACA临床意义的认识:一方面,ACA的概念混淆和误用降低了众多既往文献的参考价值;另一方面,对于ACA的理想值,长期沿用的"安全区"标准逐渐受到临床证据质疑;新的研究不再孤立地考虑髋臼方向,而是整体分析髋臼方向与周围力学结构来探索ACA的理想值。ACA的影像测量有助于评估手术效果,具有重要的临床和科研意义;但ACA在临床常规的X线片上无法直接测量。针对这一难题,1970年代以来研究者提出了多种间接测算方法,然而现有方法均未能同时突破依赖主观估计和操作复杂这两种局限性,还需改进以便于临床应用。本文回顾既往文献,对ACA的临床意义及其二维影像测量作一综述,以厘清ACA的概念,增补其临床意义的新认识,并总结在常规X线片上测量ACA的各种方法,从而为THA的临床与研究提供参考。

Acetabular component anteversion(ACA) is a direction parameter ofacetabularcomponent in total hip arthroplasty(THA). ACA is routinely controlled intraoperatively and assessed postoperatively for its paramountimpact on outcome of THA.Recent advance in related researches has renewed our knowledge on the clinical significance of ACA.The long-followed Lewinnk’s "safe zone" has been challenged by new proofs and novel standards for ideal ranges of ACA from more integrative and individual perspectives are emerging.Radiographic measurement of ACA is essential for evaluation of THA outcome. However, ACAcannot be directly measured from conventional hip radiographs. Efforts since the 1970s have turned out several methods to calculate anteversion from measurements on radiographs, but none of them can obviatesimultaneously disadvantages of excessive subjective error and complexity in manipulation. Based on the literature, this article reviewed the definitions, clinical relevance and imaging measurement of acetabular component anteversion with an aim to provide reference for the clinical practice and related research of total hip arthroplasty.

图1 Murray定义的髋臼假体前倾角。红色箭头示髋臼假体开口方向;IA-影像前倾角;SA-手术倾角,AA-解剖前倾角
图2 Mclaren法在髋关节正位片上测量前倾角原理。图A为髋臼假体侧视图,其中l为髋臼假体开口平面,k为冠状面,影像学前倾角θ=arcsin n/m;图B为该髋臼在髋关节正位片上的投影,可见m、n分别为髋臼开口投影椭圆的长、短轴
图3 在右髋关节正位X线片上测量髋臼假体前倾角的3种典型方法示意。图A为右髋关节正位X线片,可见髋臼外杯开口投影为椭圆,部分被股骨头假体影遮蔽;图B为图A中髋臼外杯和股骨头假体轮廓的模式图,可见髋臼椭圆短轴顶点S被股骨头遮蔽,假设髋臼影像学前倾角为θ:Pradhan法:在髋臼投影椭圆长轴AB上取点L,使LB=1/5 AB;经L作AB垂线LP与椭圆轮廓相交于P,测量AB和LP,计算θ=arcsin(LP/0.4AB);Liaw法:髋臼投影椭圆的长轴为AB,短轴顶点为S,测量∠ABS即∠β,根据θ=arcsin (tan β)制作测量尺;Bachhal法:在髋臼椭圆轮廓上取未被股骨头遮挡的一点O;经O作长轴AB的垂线,与AB相交于O’,与髋臼顶部轮廓相交于C’;以O为圆心,取O’C’为半径作圆,与长轴AB所在直线相交于C;测量∠ACO即∠θ’,θ=θ’第二类方法利用特制的测量尺来避免计算。包括Fabeck[51],Widmer[47],Liaw[50]法。Liaw[50]法是其中最简单的一种:根据X线片上可测量的角度β与髋臼假体前倾角α的函数关系,制作了一种当真实角度为β时读数为的α的量角器,从而通过测量β角直接得到ACA(图3)。此类方法无需计算但仍需要测量被遮挡的假体结构,未能解决主观误差大的问题。Bachhal[43]在模拟X线片上的研究显示,参考点被股骨头遮挡显著降低了Liaw法的准确度。
表1 在X线正位片上测量髋臼假体前倾角的部分方法特征及准确度
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