Ecker Timo M, Tannast Moritz, Murphy Stephen B
Center for Computer-Assisted and Reconstructive Surgery, New England Baptist Hospital and Tufts University School of Medicine, Boston, MA 02120, USA.
Clin Orthop Relat Res. 2007 Dec;465:100-5. doi: 10.1097/BLO.0b013e3181591c7d.
Component malpositioning and postoperative leg length discrepancy are the most common technical problems associated with total hip arthroplasty (THA). Surgical navigation offers the potential to reduce the incidence of these problems. We reviewed 317 patients (344 hips) that underwent THA using computed tomography-based surgical navigation, including 112 THAs using a simplified method of measuring leg length. Guided by the navigation system, cups were placed in 40.8 degrees +/- 2 degrees of operative abduction (range, 35 degrees -50 degrees) and 30.8 degrees +/- 3.2 degrees (range, 19 degrees -43 degrees) of operative anteversion. We subsequently measured radiographic abduction on plain anteroposterior pelvic radiographs and calculated abduction and anteversion. Radiographically, 97.1 % of the cups were in the safe zone for abduction and 92.4% for anteversion. The mean incision length was less than 8 cm for 327 of the 344 hips. Leg length change measured intraoperatively was 6.6 +/- 4.1 mm (range, -2-22), similar to measurements from the pre- and postoperative magnification-corrected radiographs. Computer assistance during THA increased the consistency of component positioning and allowed reliable measurement of leg length change during surgery.
组件位置不当和术后下肢长度差异是全髋关节置换术（THA）最常见的技术问题。手术导航有可能降低这些问题的发生率。我们回顾了317例（344髋）接受基于计算机断层扫描的手术导航进行THA的患者，其中112例THA采用了简化的下肢长度测量方法。在导航系统的引导下，髋臼杯置于手术外展40.8度±2度（范围35度-50度）和手术前倾角30.8度±3.2度（范围19度-43度）。随后，我们在骨盆前后位平片上测量了影像学外展角度，并计算了外展和前倾角。影像学显示，97.1%的髋臼杯处于外展安全区，92.4%处于前倾角安全区。344髋中的327髋平均切口长度小于8cm。术中测量的下肢长度变化为6.6±4.1mm（范围-2-22），与术前和术后经放大校正的X线片测量结果相似。THA术中的计算机辅助提高了组件定位的一致性，并能在手术中可靠地测量下肢长度变化。
