脊柱矢状面平衡对髋臼假体朝向的影响及其临床意义  

The influence of spinal sagittal balance on acetabular component orientation and its clinical relevance

作　　者：陈康明 黄钢勇 赵广雷 柳昌全 夏军 Chen Kangming;Huang Gangyong;Zhao Guanglei;Liu Changquan;Xia Jun(Department of Orthopedics,Huashan Hopsital affiliated to Fudan University,Shanghai200040,China)

机构地区：[1]复旦大学附属华山医院骨科,上海200040

出　　处：《中华骨科杂志》2020年第2期103-109,共7页Chinese Journal of Orthopaedics

摘　　要：全髋关节置换术临床应用广泛,髋臼假体的放置对于全髋关节置换术的效果及并发症的发生至关重要。自髋臼假体放置的“安全区”的概念提出以来,“安全区”一直是关节外科医生遵循的原则,而近年受到了挑战。临床中发现即使是髋臼假体放置在“安全区”,亦可能会发生全髋关节置换术的术后髋臼假体脱位。通过检索PubMed、Web of Science等数据库,根据纳入和排除标准进行筛选,最终纳入40篇文献,并查阅了相关专著。新近的研究表明,矢状面脊柱的平衡以及脊柱-骨盆活动度可以影响髋臼假体的空间位置。脊柱退变、长节段腰椎融合和脊柱强直等因素可导致矢状面脊柱不平衡和/或影响脊柱骨盆活动度,从而影响骨盆的后倾。合适的骨盆后倾是一种代偿方式,有利于髋关节置换术后假体的稳定。因而,有必要重新认识“安全区”,在行髋关节置换术前,有必要理解矢状面脊柱的平衡以及脊柱骨盆的活动度,以期进一步减少全髋关节置换术后脱位风险。本文以近年来国外文献中常见的脊柱-骨盆活动相关参数、髋臼假体空间朝向定义为切入口,介绍了脊柱矢状面平衡的定义、代偿机制,以此为基础并根据不同体位来讨论脊柱矢状面平衡和脊柱活动度在脊柱-骨盆活动下的意义。Total hip arthroplasty(THA)is a well developed technique to which the spatial orientation of acetabular component is crucial.Since the idea of“safe zone”being proposed,such idea has long been obeyed by hip surgeons but has also been challenged in recent years.This is because post-operative instability could happen even if acetabular components are placed within“safe zone”.The latest researches have demonstrated that sagittal spinal balance and spino-pelvic mobility can affect the spatial orientation of acetabular components.Factors including spinal degenerative changes,long lumbosacral changes and spinal ankyloses can lead to sagittal spinal imbalance and/or influence spino-pelvic mobility,which subsequently affect pelvic retroversion.Proper pelvic retroversion is a way to compensate for sagittal spinal imbalance and is beneficial to post-operative stability.It is necessary for hip surgeons to rethink“safe zone”before performing THA and understand spinal balance as well as spinopelvic mobility.The goal is to reduce the rate of dislocation.This review started by introducing the related spinopelvic parameters frequently seen in papers published recently and the definitions of acetabular cup orientations.After the spinal sagittal balance and its compensatory mechanisms session,discussed its clinical relevance,as well as the significance of spinal mobility,in spinopelvic motion under three different postures.

关 键 词：全髋关节置换术 髋臼假体 脊柱矢状面 代偿机制 脊柱强直 髋关节置换术后 关节外科 不同体位 

分 类 号：R687[医药卫生—骨科学]