约翰·查恩利奖：杯位错位的危险因素：通过三级医院联合注册中心进行质量改进。
The John Charnley Award: risk factors for cup malpositioning: quality improvement through a joint registry at a tertiary hospital.
机构信息
Harris Orthopaedic Laboratory, Massachusetts General Hospital, 55 Fruit Street, GRJ 1206, Boston, MA 02114, USA.
出版信息
Clin Orthop Relat Res. 2011 Feb;469(2):319-29. doi: 10.1007/s11999-010-1487-1.
BACKGROUND
Few studies have examined factors that affect acetabular cup positioning. Since cup positioning has been linked to dislocation and increased bearing surface wear, these factors affecting cup position are important considerations.
QUESTION/PURPOSES: We determined the percent of optimally positioned acetabular cups and whether patient and surgical factors affected acetabular component position.
METHODS
We obtained postoperative AP pelvis and cross-table lateral radiographs on 2061 consecutive patients who received a THA or hip resurfacing from 2004 to 2008. One thousand nine hundred and fifty-two hips had AP pelvic radiographs with correct position of the hip center, and 1823 had both version and abduction angles measured. The AP radiograph was measured using Hip Analysis Suite™ to calculate the cup inclination and version angles, using the lateral film to determine version direction. Acceptable ranges were defined for abduction (30°-45°) and version (5°-25°).
RESULTS
From the 1823 hips, 1144 (63%) acetabular cups were within the abduction range, 1441 (79%) were within the version range, and 917 (50%) were within the range for both. Surgical approach, surgeon volume, and obesity (body mass index > 30) independently predicted malpositioned cups. Comparison of low versus high volume surgeons, minimally invasive surgical versus posterolateral approach, and obesity versus all other body mass index groups showed a twofold (1.5-2.8), sixfold (3.5-10.7), and 1.3-fold (1.1-1.7) increased risk for malpositioned cups, respectively.
CONCLUSIONS
Factors correlated to malpositioned cups included surgical approach, surgeon volume, and body mass index with increased risk of malpositioning for minimally invasive surgical approach, low volume surgeons, and obese patients. Further analyses on patient and surgical factors' influence on cup position at a lower volume medical center would provide a valuable comparison.
LEVEL OF EVIDENCE
Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
背景
很少有研究探讨影响髋臼杯位置的因素。由于杯位与脱位和增加的轴承面磨损有关，因此这些影响杯位的因素是重要的考虑因素。
问题/目的：我们确定了髋臼杯的最佳位置的百分比，以及患者和手术因素是否影响髋臼部件的位置。
方法
我们获取了 2004 年至 2008 年间接受全髋关节置换术或髋关节表面置换术的 2061 例连续患者的术后骨盆前后位和交叉腿侧位片。1952 髋有正确髋关节中心位置的骨盆前后位片，1823 髋有测量的内外翻角和外展角。使用 Hip Analysis Suite™ 测量前后位片来计算杯倾斜和内外翻角，使用侧位片确定内外翻方向。定义了外展角（30°-45°）和内外翻角（5°-25°）的可接受范围。
结果
从 1823 髋中，1144 髋（63%）髋臼杯在外展范围内，1441 髋（79%）在内外翻范围内，917 髋（50%）在两者范围内。手术入路、外科医生的手术量和肥胖症（体重指数>30）独立预测髋臼杯位置不当。低容量与高容量外科医生、微创手术与后外侧入路、肥胖与所有其他体重指数组之间的比较显示，髋臼杯位置不当的风险分别增加了两倍（1.5-2.8）、六倍（3.5-10.7）和 1.3 倍（1.1-1.7）。
结论
与髋臼杯位置不当相关的因素包括手术入路、外科医生的手术量和体重指数，微创手术入路、低容量外科医生和肥胖患者的髋臼杯位置不当风险增加。在低容量医疗中心对患者和手术因素对杯位影响的进一步分析将提供有价值的比较。
证据水平
2 级，预后研究。有关证据水平的完整描述，请参见作者指南。
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