臼杯边缘与髋臼骨性边缘位置关系影像解剖学研究  

Anatomical study on the relationship between the edge of the acetabular cup and the edge of the osseous acetabulum

作　　者：周雪明 黄桂武 刘彬[1] 谢荏棠 邬培慧[2] 吴润柏 Zhou Xueming;Huang Guiwu;Liu Bin;Xie Rentang;Wu Peihui;Wu Runbai(Department of Joint Surgery,Affiliated Dongguan People's Hospital,Southern Medical University,Dongguan 523059,Guangdong Province,China;Department of Joint Surgery,the First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,Guangdong Province,China)

机构地区：[1]南方医科大学附属东莞人民医院关节外科,广东东莞523059 [2]中山大学附属第一医院关节外科,广州510080

出　　处：《中国临床解剖学杂志》2021年第3期297-301,共5页Chinese Journal of Clinical Anatomy

基　　金：东莞市社会科技发展重点项目(2018507150011650);广东省科技计划项目(2017B020227005)。

摘　　要：目的利用影像资料构建骨盆三维模型,探究臼杯边缘与髋臼骨性边缘的解剖位置关系,辅助全髋关节置换术中徒手臼杯定位。方法选取正常髋臼及CroweⅡ/Ⅲ型DDH患者髋臼的CT断层图像,使用三维规划软件BOHOLO模拟全髋关节置换术植入目标臼杯(方位:前倾角20°,外展角40°,骨床-臼杯覆盖率>75%),在右侧髋臼的1、4、7、10点钟4个方向,测量臼杯外露长度即臼杯边缘与髋臼骨性边缘的距离,并作统计分析。结果对于正常髋臼及CroweⅡ/Ⅲ型DDH髋臼,臼杯目标方位的垂直高度分别为(16.26±0.93)mm,(22.09±4.10)mm;各方向髋臼边缘外露长度,髋臼正常组与DDH组有统计学差异(P<0.05),正常髋臼后下壁(右髋7点钟,左髋5点钟)的外露长度为(9.71±1.68)mm,变异度较小,不同性别、年龄无明显差异。结论髋臼后下壁的外露长度可作为正常臼杯定位相对恒定的解剖学参照,据此原位重建臼杯可获得满意的骨床-臼杯覆盖率,而对于CroweⅡ/Ⅲ型患者,各向髋臼骨缘外露长度的变异较大。Objective To explore the anatomical positional relationship between the edge of the acetabular cup and the edge of the osseous acetabulum by utilizing the imaging data to reconstruct pelvis 3D model,and to improve the accuracy of intraoperative freehand acetabular cup orientation.Methods Based on the CT data of normal acetabulum and Crowe Ⅱ/Ⅲ DDH acetabulum,3D planning software was used to stimulate the implantation of target acetabular cup in total hip arthroplasty(orientation:anteversion angle was20°,abduction angle was 40°,acetabular bony coverage rate was more than 75%).In the 1,4,7,10 o’clock four directions of the right acetabulum,the exposed length of the acetabulum cup,which was the distance between the edge of the acetabular cup and the bony edge of the acetabular,was recorded and statistically analyzed.Results The optimal vertical height of the cup implantation for normal acetabulum and Crowe type Ⅱ/Ⅲ DDH acetabulum were(16.26±0.93)mm and(22.09±4.10)mm,respectively.There was statistical differences(P<0.05)between the normal group and the DDH group of exposed length in four directions.The exposed length of the posterior inferior wall of the normal acetabulum(7 o’clock direction in the right hip,5 o’clock direction in the left hip)was(9.71±1.68)mm.The coefficient of variation of the exposed distance in other directions has no obvious difference in different genders and ages.Conclusions The exposed length of the posterior inferior acetabular wall is relatively constant to be utilized as an anatomical reference landmark for THA in normal acetabulum,while for Crowe type Ⅱ/Ⅲ patients,there is a great variation in the length of the acetabulum edge exposure in all directions.

关 键 词：发育性髋关节发育不良 人工髋关节 臼杯 影像解剖学 计算机模拟手术 

分 类 号：R323.5[医药卫生—人体解剖和组织胚胎学] R687.42[医药卫生—基础医学]