全髋关节置换术中根据髋臼横韧带确定髋臼杯假体的方向
The use of the transverse acetabular ligament for determining the orientation of the components in total hip replacement: a randomised controlled trial
全髋关节置换术中根据髋臼横韧带确定
髋臼杯假体的方向：一项随机对照研究
译者：张峻
The orientation of the acetabular component can influence both the short- and long-term outcomes of total hip replacement (THR). We performed a prospective, randomised, controlled trial of two groups, comprising of 40 patients each, in order to compare freehand introduction of the component with introduction using the transverse acetabular ligament (TAL) as a reference for anteversion.Anteversion and inclination were measured on pelvic radiographs. With respect to anteversion, in the freehand group 22.5% of the components were outside the safe zone versus 0% in the transverse acetabular ligament group (p = 0.002). The mean angle of anteversion in the freehand group was 21° (2° to 35°) which was significantly higher compared with 17° (2° to 25°) in the TAL group (p = 0.004).
There was a significant difference comparing the variations of both groups (p = 0.008). With respect to inclination, in the freehand group 37.5% of the components were outside the safe zone versus 20% in the TAL group (p = 0.14). There was no significant difference regarding the accuracy or variation of the angle of inclination when comparing the two groups. The transverse acetabular ligament may be used to obtain the appropriate anteversion when introducing the acetabular component during THR, but not acetabular component inclination.
髋臼杯假体安放的位置会影响全髋关节置换术(THR)的短期和长期术后效果。我们将病人分为两组，每组40人，进行了一项前瞻性、随机对照试验，来比较徒手安放（FH）髋臼杯假体和参考髋臼横韧带（TAL）判断其前倾角的差别。
前倾角和外展角通过骨盆平片测量获得。FH组22.5%臼杯前倾角在安全区之外，TAL参考组都在安全区范围内（p = 0.002）。FH组前倾角平均为21°(2° to 35°)，显著高于TAL组17°(2° to 25°) (p = 0.004)。两组间前倾角变异有显著性（p=0.008）。FH组有37.5%的臼杯假体外展角在安全区之外，而TAL组有20%在安全区之外（p=0.14）。
两组在外展角的准确性和变异方面无显著性差异。髋臼横韧带有利于在安放髋臼杯假体时获得准确的前倾角，但对髋臼杯外展角的调整没有帮助。
图1. 术中照片显示后方使用Charnley针暴露髋臼横韧带，前方使用Hohman牵开器，下方使用双叉牵开器。
图2. 术中照片显示假体平行于髋臼横韧带。
图3. 术后平片a）由髋臼假体周长的一半组成的金属定位边，b）外展角和前倾角的测量。外展角是开口椭圆（r）的最大直径与泪滴连线（IT）的夹角。前倾角是开口椭圆的小半径（b）与大半径（r）之比的反正弦（=弧心（b/r））。
文献出处：Meermans G, Van Doorn WJ, Koenraadt K, Kats J. The use of the transverse acetabular ligament for determining the orientation of the components in total hip replacement: a randomised controlled trial. Bone Joint J. 2014 Mar;96-B(3):312-8. doi: 10.1302/0301-620X.96B3.32989. PMID: 24589784.