Kosiyatrakul Arkaphat, Luenam Suriya, Chotanaphuti Thanainit
Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand.
J Med Assoc Thai. 2009 Dec;92 Suppl 6:S128-33.
Malposition of the acetabular cup is the major risk factor of dislocation after total hip arthroplasty. Postoperatively, measuring of acetabular cup anteversion is very difficult. The new method for measuring acetabular cup anteversion on the plain radiograph of the hip with one of the circle theorems in the basic geometry was created.
An all-polyethylene acetabular cup with known angle of radiographic anteversion was mouthed to the pelvic bone. Antero-posterior hip and pelvis radiographs were taken with the cup in randomly 15 different angles of anteversion. These were reviewed by 3 orthopedic residents. All data from 3 observers were collected and examined for the accuracy, inter-observers reliability and intra-observer reliability of this method. Two films (AP radiograph of the hip and the pelvis) method was used for distinguish between anteversion and retroversion.
The measurements of radiographic anteversion have the accuracy of plus or minus 2 degrees. The reliability coefficients of inter-observer variation in the first and second measurements for all definitions of anteversion are high. Pair t-test showed no significant different between value of the first and the second measurements for all definitions in all observers. The intra- and inter-observer variations were 3 degrees or less for all definitions.
The Acetabular cup anteversion measurement using the circle theorem iseasily to perform with high accuracy and consistency for all definitions of cup anteversion.
髋臼杯位置不当是全髋关节置换术后脱位的主要危险因素。术后,测量髋臼杯前倾角非常困难。利用基础几何中的一个圆定理,创建了一种在髋关节正位X线片上测量髋臼杯前倾角的新方法。
将一个已知X线片前倾角的全聚乙烯髋臼杯安装到骨盆骨上。以髋臼杯处于15个随机不同前倾角的状态拍摄髋关节和骨盆前后位X线片。由3名骨科住院医师对这些片子进行评估。收集3名观察者的所有数据,并检查该方法的准确性、观察者间可靠性和观察者内可靠性。采用双片(髋关节和骨盆前后位X线片)法区分前倾角和后倾角。
X线片前倾角测量的准确度为正负2度。所有前倾角定义下,观察者间变异的可靠性系数在第一次和第二次测量中都很高。配对t检验显示,所有观察者所有定义下第一次和第二次测量值之间无显著差异。所有定义下,观察者内和观察者间变异均为3度或更小。
使用圆定理测量髋臼杯前倾角操作简便,对髋臼杯前倾角的所有定义都具有高精度和一致性。