Effenberger H, Koebke J, Wilke R, Hautmann J, Witzel U, Imhof M, Richolt J
Orthopädische Universitätsklinik und Poliklinik Friedrichsheim, Frankfurt am Main, Germany.
Orthopade. 2004 Sep;33(9):1042-50. doi: 10.1007/s00132-004-0640-5. Epub 2004 Mar 18.
The anatomy of the hip must be taken into account in order to ensure primary stability of cementless acetabular implants. In this study we analyzed the shapes of osteoarthritic acetabula and compared these to normal non-degenerative acetabula and to pressfit implants. We measured 92 acetabula with osteoarthritic deformations and 35 non-degenerative acetabula. Bone tissue samples from 50 osteoarthritic acetabula were microradiographically analyzed. Furthermore, the size of the entrance plane of 37 pressfit cups was determined. The craniocaudal and ventrodorsal diameters of osteoarthritic acetabula correlate strongly ( r=0.87). In craniocaudal direction, the acetabular diameter correlates significantly to both the radius of the lunate surface ( r=0.42) and the acetabular base ( r=0.54). Osteoarthritic acetabula have a deeper shape as degeneration increases and the entrance plane becomes significantly more circular ( p<0.05). When comparing osteoarthritic and non-arthrotic acetabula, the following values differ significantly (p<0.05): craniocaudal radius of the acetabular base, craniocaudal and ventrodorsal radius of the lunate surface, and ventrodorsal divergence between lunate surface and acetabular base. To reconstruct an acetabular offset which concurs with central points of the femoral head and the radius of the lunate surface, the level of the insert's entrance plane must be outside the entrance planes of the cup and acetabulum. The rims of hemispheric cups need to be trimmed to prevent these cups from extending beyond the acetabular rim.
为确保非骨水泥髋臼植入物的初始稳定性，必须考虑髋关节的解剖结构。在本研究中，我们分析了骨关节炎髋臼的形状，并将其与正常非退行性髋臼以及压配式植入物进行比较。我们测量了92个有骨关节炎变形的髋臼和35个非退行性髋臼。对50个骨关节炎髋臼的骨组织样本进行了显微放射分析。此外，确定了37个压配杯入口平面的尺寸。骨关节炎髋臼的头尾径和腹背径高度相关（r = 0.87）。在头尾方向上，髋臼直径与月状面半径（r = 0.42）和髋臼底部（r = 0.54）均显著相关。随着退变增加，骨关节炎髋臼的形状更深，入口平面变得明显更圆（p < 0.05）。比较骨关节炎髋臼和非关节炎髋臼时，以下数值有显著差异（p < 0.05）：髋臼底部的头尾半径、月状面的头尾半径和腹背半径，以及月状面与髋臼底部之间的腹背发散度。为重建与股骨头中心点和月状面半径相符的髋臼偏移，植入物入口平面的水平必须在髋臼杯和髋臼入口平面之外。半球形髋臼杯的边缘需要修整，以防止这些杯超出髋臼边缘。
