Vaughan P D, Singh P J, Teare R, Kucheria R, Singer G C
Department of Trauma and Orthopaedics, Heatherwood and Wexham Park NHS Trust, Slough, Berkshire, UK.
Hip Int. 2007 Oct-Dec;17(4):212-7. doi: 10.1177/112070000701700404.
A posterior entry point, a neutral tip position and neutral stem alignment are recommended to avoid a thin cement mantle and ensure an optimal outcome in total hip arthroplasty (THA). Our aim was to highlight any influence of surgical approach in obtaining an optimal stem orientation.
We examined the post-operative, digitised radiographs of 100 (50 each group) polished, tapered Exeter THA, inserted via the antero-lateral or posterior approaches. Stem tip position was assessed in both coronal and sagittal planes and stem alignment was assessed in the coronal plane.
There was a significant difference between the two approaches in the sagittal stem tip position only (p=0.01).
Our results illustrate that a neutral stem tip position in THA is significantly more difficult to obtain with an antero-lateral approach, when compared to the posterior approach. A posterior approach to the hip avoids the cuff of glutei that can lever the proximal stem anteriorly causing an anterior entry point and a posterior stem tip position. We also illustrate how the anatomy of the proximal femur in the sagittal plane makes a neutral stem alignment difficult to achieve with either approach.
推荐采用后方入路、中立的假体柄尖端位置和中立的假体柄对线，以避免骨水泥壳过薄，并确保全髋关节置换术（THA）获得最佳效果。我们的目的是强调手术入路对获得最佳假体柄方向的任何影响。
我们检查了100例（每组50例）经抛光、锥形的埃克塞特THA的术后数字化X线片，这些假体分别通过前外侧或后方入路植入。在冠状面和矢状面评估假体柄尖端位置，并在冠状面评估假体柄对线。
仅在矢状面假体柄尖端位置上，两种入路之间存在显著差异（p=0.01）。
我们的结果表明，与后方入路相比，采用前外侧入路在THA中更难获得中立的假体柄尖端位置。髋关节的后方入路可避开臀肌袖，臀肌袖会将假体柄近端向前撬起，导致前方入路点和后方假体柄尖端位置。我们还说明了股骨近端在矢状面的解剖结构如何使两种入路都难以实现中立的假体柄对线。
