侧卧位时头尾侧骨盆倾斜对全髋关节置换髋臼杯外展角的影响及校正  

Influence of pelvic obliquity in lateral position to acetabuiar component orientation during total hiparthroplasty

作　　者：秦彦国 李学州[1] 刘潼[1] 肖建林[1] 韩青[1] 张远鹰[1] 高忠礼[1] 

机构地区：[1]吉林大学中日联谊医院骨科,长春130033

出　　处：《中华骨科杂志》2013年第3期220-225,共6页Chinese Journal of Orthopaedics

基　　金：吉林省科学技术厅国际合作项目，吉林省科学技术厅社会发展项目

摘　　要：目的探讨侧卧位时骨盆向头尾侧倾斜的程度及其对髋关节置换术中髋臼假体外展角的影响及校正方法。方法将50例62髋拟行全髋关节置换术的患者随机分为校正组及对照组，均采用侧卧位后外侧人路手术。对照组25例28髋以常规方法放置髋臼假体，校正组25例34髋进行水平仪及铅垂法校正后放置髋臼假体。术后测量两组患者髋臼杯外展角，并比较与术中预估的差异。结果校正组在侧卧位未校正前骨盆整体倾斜一1．647°±4．512°，向头侧倾斜一（4．989°±2．778°），向尾侧倾斜2．587°±1．927°；头侧倾斜偏离大于尾侧，差异有统计学意义。校正组术后髋臼杯外展角为42．685°±3．355°，术中预估与术后测量偏差1．962°±1．515°；对照组术后髋臼杯外展角为44．534°±4．844°，术中预估与术后测量偏差4．244°±3．042°；校正组偏差小于对照组，差异有统计学意义。结论侧卧位时头尾侧骨盆倾斜影响术者对髋臼外展角的判断，可能造成髋臼假体放置角度不准确。通过水平仪及铅垂法进行校正可提高判定髋臼假体外展角的准确性。Objective To explore the influence of pelvis obliquity in lateral position to acetabular component orientation during total hip arthroplasty （THA）, and the method to correct. Methods Fifty pa- tients （62 hips） were performed THA with posterolateral incision in lateral position by the same team. The patients were randomized and divided into experimental group （EX, with 25 cases, 34 hips） and control group （CON, with 25 cases, 28 hips）. In EX group, the acetabular components were placed by means of the gradienter and plumb correcting technique during THA. While in CON group, the acetabular components were placed by traditional method during THA. The acetabular abduction angles were measured postopera- tively, and compared between the two groups. Results The average obliquity of pelvis was -1.647°±4.512° in EX group when putting the patient in lateral position before correcting. Through the application of gradi- enter and plumb, the average abduction angle of acetabular component was 42.685±3.355°postoperatively, with the difference of 1.962°±1.515° compared with the preoperative angles. And in CON group, the average abduction angle of aeetabular component was 44.534°±4.844° postoperatively, with the difference of 4.244°±3.042°. The difference of abduction angle in CON group was much higher than that in EX group （P〈0.05）. Conclusion The pelvic obliquity when putting the patient under lateral position will affect the surgeons＂ judgments of placing acetabular component during THA, furthermore, lead to inconsistency among the ab- duction angles obtained preoperatively, intraoperatively and postoperatively. By applying the correcting method with gradienter and plumb, the discrepancy can reduce obviously between the abduction angle mea- sured postoperatively and that of measured during operation comparing with traditional method.

关 键 词：关节成形术 置换 髋 骨盆 体位 

分 类 号：R687.3[医药卫生—骨科学]