髋臼横韧带和关节囊修复在降低脱位率中的作用
经后路用直径22mm股骨头假体行全髋关节置换术：
髋臼横韧带和关节囊修复在降低脱位率中的作用
译者：张峻
尽管缺乏长期随访，但在全髋关节置换术（THR）中使用大直径股骨头的趋势越来越明显，部分原因是人们认为这种方法具有较低的脱位率。然而，增加股骨头的尺寸并不是降低脱位率的唯一方法；最佳的假体位置和后关节囊修复也可以达到类似的效果。在这项前瞻性研究中，研究了在2004年至2011年间512例单侧骨水泥THR(男：女 230：282），目的是确定使用9/10莫氏锥形柄22 mm股骨头假体的脱位率，这些患者经后路进行了关节囊修复，并使用髋臼横韧带（TAL）作为安放髋臼假体位置参考。手术患者平均年龄67岁（35～89岁）。平均随访2.8年（0.5～6.6）。术前和术后评估包括Oxford hip，SF-12和改良加州大学洛杉矶分校和Merle D'Aubigne评分。利用放射学软件测量髋臼假体的外展角和前倾角。结果脱位4例（0.78%）均为前脱位。总之，THR使用直径为22mm的股骨头假体，同时经后路行后关节囊修复，并以TAL作为安放髋臼假体位置的参考，可以降低脱位率。
Total hip replacement through a posterior approach using a 22 mm diameter femoral head : the role of the transverse acetabular ligament and capsular repair in reducing the rate of dislocation
Despite a lack of long-term follow-up, there is an increasing trend towards using femoral heads of large diameter in total hip replacement (THR), partly because of the perceived advantage of lower rates of dislocation. However, increasing the size of the femoral head is not the only way to reduce the rate of dislocation; optimal alignment of the components and repair of the posterior capsule could achieve a similar effect. In this prospective study of 512 cemented unilateral THRs (Male:Female 230:282) performed between 2004 and 2011, we aimed to determine the rate of dislocation in patients who received a 22 mm head on a 9/10 Morse taper through a posterior approach with capsular repair and using the transverse acetabular ligament (TAL) as a guide for the alignment of the acetabular component. The mean age of the patients at operation was 67 years (35 to 89). The mean follow-up was 2.8 years (0.5 to 6.6). Pre- and post-operative assessment included Oxford hip, Short Form-12 and modified University of California Los Angeles and Merle D'Aubigne scores. The angles of inclination and anteversion of the acetabular components were measured using radiological software. There were four dislocations (0.78%), all of which were anterior. In conclusion, THR with a 22 mm diameter head performed through a posterior approach with capsular repair and using the TAL as a guide for the alignment of the acetabular component was associated with a low rate of dislocation.
文献出处：Kumar V, Sharma S, James J, Hodgkinson JP, Hemmady MV. Total hip replacement through a posterior approach using a 22 mm diameter femoral head : the role of the transverse acetabular ligament and capsular repair in reducing the rate of dislocation. Bone Joint J. 2014 Sep;96-B(9):1202-6. doi: 10.1302/0301-620X.96B9.31831. PMID: 25183591.