全髋关节置换术中髋关节旋转中心重建方法的研究进展  

Research progress on rotation center reconstruction in total hip arthroplasty

作　　者：田最 高振中 尹志文 王泽华 郭子瑊 向川[1] Tian Zui;Gao Zhenzhong;Yin Zhiwen;Wang Zehua;Guo Zijian;Xiang Chuan(Department of Orthopedics,the Second Affiliated Hospital of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学第二医院骨科,太原030001

出　　处：《中华解剖与临床杂志》2022年第6期438-443,共6页Chinese Journal of Anatomy and Clinics

基　　金：国家自然科学基金(81972075)。

摘　　要：目的总结全髋关节置换术中髋关节旋转中心(HJC)重建方法的相关研究进展。方法在PubMed、中国知网、万方数据等数据库,分别以“旋转中心”“髋”“置换”以及“rotation center”“hip”“replacement”等为中英文关键词,检索2005年1月—2021年8月关于全髋关节置换术中重建HJC方法研究的相关文献,共检索到652篇,剔除内容不符、质量较低、重复研究、证据等级不高、无法获取全文者,最终纳入43篇文献,对其进行归纳总结。结果常见的HJC重建的相关解剖标志有大粗隆顶点、小粗隆顶点、髋臼切迹、卵圆窝及髋臼泪滴等,参考对侧大、小粗隆顶点以及它们至HJC的距离有助于重建股骨头旋转中心,参考髋臼切迹、卵圆窝及髋臼泪滴等解剖标志有助于重建髋臼旋转中心。3D打印技术通过打印个体化的髋臼模型而准确定位HJC、制作髋臼定位器和股骨头假体定位器,并能为术者提供模拟手术的机会,使手术更加精确化和个体化。计算机辅助导航系统分为图像依赖型和非图像依赖型2类,其工作原理是通过定位点对解剖标志进行注册,建立髋关节模型、定位HJC:前者定位HJC的依据是患者术前的影像学资料,可能因图像显示与实际情况略有差距而影响HJC定位的准确性;后者是参考手术区域解剖标志定位HJC,具有更高的定位精确度。机器人辅助全髋关节置换术系统使用计算机软件,将患者的影像学解剖信息转换为虚拟的、个体化的骨盆三维重建图像,用以规划植入物的最佳定位,术中机器人设备精准地执行个体化手术计划,可提高髋臼假体定位和HJC的精度、降低假体脱位率。结论全髋关节置换术中,针对患者髋关节解剖结构特点,选择合适的解剖学标志和解剖学参数,结合3D打印技术、计算机辅助导航技术、骨科机器人等数字化技术,可以实现HJC的精确重建。Objective To summarize the research progress on hip joint center(HJC)reconstruction in total hip arthroplasty.Methods Studies published from January 2005 to September 2021 in the database of CNKI,Wanfang,and PubMed were searched using the following keywords:"旋转中心""髋""关节置换""rotation center""hip"and"arthroplasty".Of the 652 studies,43 were analyzed and summarized.Other studies were excluded because they were inconsistent with the subject,had no full text,had low quality and level of evidence,and were repeated studies.Results The common anatomic marks related to HJC reconstruction are the tip of the greater trochanter and the lesser trochanter,the acetabular notch,the Harris fossa,and the acetabular teardrop.The femoral head rotation center can be reconstructed with reference to the contralateral greater and lesser trochanter tips and their distance to the HJC.The acetabular rotation center can also be reconstructed with reference to the acetabular notch,the Harris fossa,and the acetabular teardrops.Through 3D printing technology,the HJC can be accurately located by printing an individual acetabular model,and acetabular and femoral head locators can be prepared.Operators can also have an opportunity to simulate and perform this operation more accurately depending on individual needs.Computer-assisted navigation systems are divided into two types:computed tomography-based systems and imageless systems.Their working principle involves registry of anatomical marks through positioning points,establishment of a hip joint model,and localization of the HJC.The former localization of the HJC is based on patients'preoperative imaging data,which may affect the accuracy of HJC localization because of slight differences between image displays and actual situations.By comparison,the latter refers to the anatomical landmarks of a surgical area for localizing the HJC and has higher localization accuracy.Robot-assisted total hip arthroplasty systems use computer software to convert a patient's imaging anatomy info

关 键 词：关节成形术 置换 髋 旋转中心 髋臼切迹 卵圆窝 解剖标志 

分 类 号：R687.4[医药卫生—骨科学]