- 髋关节置换-------提高髋臼假体方向的准确性:避免假体位置不良
- 作者:谭洪波|发布时间:2012-04-07|浏览量:727次
SE1Hip-Adult Reconstruction Hip
Tuesday, Feb 7 - Saturday, Feb 11, 2012, 8:00 AM - 6:00 PM
Scientific SE16
Improving the Accuracy of Acetabular Component Orientation: Avoiding Malposition
提高髋臼假体方向的准确性:避免假体位置不良
Adult Reconstruction Hip
Anatomy and Basic Science; Bearing Surfaces; Dislocations; Total Hip Arthroplasty; Miscellaneous
Joseph T. Moskal, MD, Roanoke, Virginia, United States
Susan G. Capps, PhD, Warsaw, Indiana, United States
Introduction: There are numerous causes of poor acetabular component orientation such as poor visualization, increased patient BMI, mechanical guide inaccuracies, and changes in patient position during implantation. Negative outcomes may include dislocation, impingement, wear, leg length, and revision. The combination of newly developed techniques incorporating patient-specific morphology and quantitative technology may improve acetabular component orientation and thus patient outcomes.有许多原因可能导致髋臼侧假体放置方向欠佳,比如:暴露不良,BMI指数高,机械导向不准以及植入时患者体位改变等。可能导致脱位,撞击,磨损加重,腿长及翻修等。结合依据患者形体个体化的新技术和量化技术能够更好的定位髋臼假体方向和取得更好的术后结果。
Methods: Existing literature was used to review conventional techniques for acetabular component orientation including benefits and disadvantages of using these techniques. Next, more recently developed techniques, including anatomic landmarks and patient-specific morphology, along with quantitative technologies such as computer-aided navigation, were explored; again placing particular attention on the benefits and the disadvantages of these methods.方法:首先利用文献回顾现有技术对髋臼假体定位的优缺点。然后利用更新的技术包括:解剖标志和个体形态学结合定量技术比如导航系统;再次关注这些技术的优缺点。
Results: Acetabular component position using conventional techniques is particularly influenced by variables such as patient size, deformity and/or position regardless of surgeon experience and practice volume. Anatomic landmarks and patient-specific morphology, when used alone or in conjunction with quantitative technology, demonstrate a reduction in intra-and inter-surgeon acetabular component variability.结果:采用传统技术固定的髋臼假体的位置能够被患者体型,畸形和体位(相对术者经验和手术量而言)所影响。单独运用解剖标志和个体化形态学或结合定量技术,均提示减少了不同术者及同一术者得髋臼假体的位置变化。
Discussion and Conclusion: Acetabular component placement has long aimed for standardized safe-zones rather than a patient-individualized target-zone. As the population needing THA increases, the prevalence of complications and problems will increase even if the incidence decreases. Therefore, reliable methods for improving acetabular component alignment should be welcome. Incorporating anatomic landmarks, including patient-specific morphology, has the potential to provide more accurate and individualized target zones particularly when coupled with quantitative technology such as computer-aided navigation, thus improving the precision of acetabular component placement.
讨论和结论:髋臼假体的放置一直以来注重于标准的安全区而不看重个体化的目标区。随着全髋置换患者的增加,并发症的量和问题将增加虽然发生率可能降低。因而,提高髋臼假体对线的可靠的技术应当受欢迎。结合解剖标志,包括个体化形态学,或结合定量技术如:导航技术,具备提供准确和个体化的目标区,进而提高髋臼假体放置的准确性。