中国组织工程研究

中国组织工程研究 ›› 2021, Vol. 25 ›› Issue (27): 4322-4326.doi: 10.12307/2021.190

• 人工假体 artificial prosthesis • 上一篇    下一篇

髋臼横韧带作为全髋关节置换髋臼假体前倾定位标志的价值

李  龙，王海龙，康  朋，陈胜国，伊力哈木•托合提   

  1. 1新疆医科大学第六附属医院运动损伤科，新疆维吾尔自治区乌鲁木齐市   830000；2新疆医科大学解剖教研室，新疆维吾尔自治区乌鲁木齐市   830000
  • 收稿日期:2020-09-25 修回日期:2020-09-28 接受日期:2020-11-21 出版日期:2021-09-28 发布日期:2021-04-10
  • 通讯作者: 伊力哈木•托合提，博士，主任医师，副教授，新疆医科大学第六附属医院运动损伤科，新疆维吾尔自治区乌鲁木齐市 830000
  • 作者简介:李龙，男，2015年新疆医科大学毕业，硕士，主治医师，讲师，主要从事骨科方面的研究。 伊力哈木•托合提，博士，主任医师，副教授，主要从事骨科方面的研究。
  • 基金资助:
    新疆维吾尔自治区自然科学基金(2017D01C263)，项目负责人：伊力哈木•托合提

Transverse acetabular ligament as a marker for acetabular prosthesis anteversion in total hip arthroplasty

Li Long, Wang Hailong, Kang Peng, Chen Shengguo, Yilihamu•Tuoheti   

  1. 1Department of Sports Injury, Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi 830000, Xinjiang Uygur Autonomous Region, China; 2Department of Anatomy, Xinjiang Medical University, Urumqi 830000, Xinjiang Uygur Autonomous Region, China
  • Received:2020-09-25 Revised:2020-09-28 Accepted:2020-11-21 Online:2021-09-28 Published:2021-04-10
  • Contact: Yilihamu•Tuoheti, MD, Chief physician, Associate professor, Department of Sports Injury, Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi 830000, Xinjiang Uygur Autonomous Region, China
  • About author:Li Long, Master, Attending physician, Lecturer, Department of Sports Injury, Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi 830000, Xinjiang Uygur Autonomous Region, China Yilihamu•Tuoheti, MD, Chief physician, Associate professor, Department of Sports Injury, Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi 830000, Xinjiang Uygur Autonomous Region, China
  • Supported by:
    the Natural Science Foundation of Xinjiang Uygur Autonomous Region, No. 2017D01C263 (to YT)

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摘要：

文题释义：
髋臼横韧带：为位于髋臼的前下方、连接髋臼两端的韧带，此韧带与髋臼切迹围成一孔，孔内有神经血管通过。韧带的走形方向基本与髋臼平面方向水平，按照此韧带水平方向置入髋臼假体能使其与髋臼骨质更大面积地接触。
髋关节置换：是将人工假体(包含股骨部分和髋臼部分)利用骨水泥或螺丝钉固定在正常的骨质上，以取代病变的关节，重建患者髋关节的正常功能，是一种较成熟、可靠的治疗手段。

背景：目前髋关节置换过程中髋臼假体放置方式参照标准多样，很多医师固定髋臼假体时仅靠目测标准前倾外展角的方法，此文以髋臼横韧带为参照点进行研究。
目的：探讨髋臼横韧带在全髋关节置换过程中作为髋臼假体前倾定位标志的价值。
方法：在新鲜髋关节标本上对髋臼横韧带进行解剖学描述性研究，明确其走行及起止点的位置，为三维重建中的髋臼横韧带重塑提供依据。将行髋关节CT检查的共192例(384髋)髋关节正常的成年人纳入研究，其中男84例，女108例，年龄>18岁。经1名影像科医生及1名骨科医生诊断双侧髋臼形态正常，无肿瘤、畸形、严重骨赘等情况。然后在CT的数字化三维重建中测量髋臼横韧带影像学解剖前倾角，测量的结果与Lewinnek安全区及骨性髋臼解剖前倾角进行比较。
结果与结论：①髋臼横韧带桥接髋臼切迹构成一个完整的圆，当把人站立时髋臼的最高点定义为12点时，髋臼横韧带大致位于6点至9点之间(以左侧为例)；②髋臼横韧带前倾角平均为(12.9±3.3)°，3髋(6%)的髋臼横韧带前倾角在Lewinnek定义的安全区(15±10)°之外；髋臼前倾角平均为(17.7±3.8)°，比髋臼横韧带前倾角平均大4.7°；③髋臼横韧带前倾角与髋臼前倾角有显著相关性(r=0.759，P < 0.01)；④提示在髋臼形态正常的髋关节中，髋臼横韧带前倾与髋臼前倾的走行并非完全一致，但二者之间有明显的相关性，因此髋臼横韧带可作为全髋关节置换过程中定位髋臼杯前倾的解剖标志。
https://orcid.org/0000-0002-9056-2271 (李龙) 

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 全髋关节置换, 髋臼横韧带, 髋臼前倾角, 解剖学, 定位标志

Abstract: BACKGROUND: There are a variety of reference standards for the placement of acetabular prosthesis in hip arthroplasty at present. Many surgeons only rely on visual measurement of standard anteversion abduction angle when fixing acetabular prosthesis. The transverse acetabular ligament was used as a reference point in this study.  
OBJECTIVE: To study the value of transverse acetabular ligament as a marker of acetabular anteversion in total hip arthroplasty.
METHODS:  The anatomic descriptive study of transverse acetabular ligament was carried out on fresh hip joint specimens to determine its course and position of starting and ending points, so as to provide the basis for the reconstruction of transverse acetabular ligament in three-dimensional reconstruction. Totally 192 adults (384 hips) with normal joints undergoing hip CT scan were selected, including 84 males and 108 females, at the age of > 18 years. A radiologist and an orthopedic surgeon diagnosed that bilateral acetabulum morphology was normal, without tumor, deformity, or severe osteophyte. Acetabular transverse ligament anteversion was measured in CT digital three-dimensional reconstruction. The results were compared with those of Lewinnek safe area and bony acetabulum.  
RESULTS AND CONCLUSION: (1) Transverse acetabular ligament bridged the acetabular notch to form a complete circle. When the highest point of acetabulum was defined as 12 o'clock, transverse acetabular ligament was roughly located between 6 o'clock and 9 o'clock (taking the left side as an example). (2) The mean anteversion angle of transverse acetabular ligament was (12.9 ± 3.3)°, and the anteversion angle of three hips (6%) was beyond the safe area defined by Lewinnek (15±10)°. The average acetabular anteversion was (17.7±3.8)°, which was 4.7° larger than that of transverse acetabular ligament. (3) There was a significant correlation between transverse acetabular ligament anteversion and acetabular anteversion (r=0.759, P < 0.01). (4) It is concluded that in the hip joint with normal acetabular morphology, the alignment of transverse acetabular ligament anteversion and acetabular anteversion is not completely consistent, but there is an obvious correlation between them. Therefore, transverse acetabular ligament can be used as an anatomical marker for locating acetabular cup anteversion in total hip arthroplasty.

Key words: total hip arthroplasty, transverse acetabular ligament, anatomical anteversion, anatomy, location mark

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