Beverland David
The Primary Joint Unit, Musgrave Park Hospital, Belfast, United Kingdom.
Orthopedics. 2010 Sep 7;33(9):631. doi: 10.3928/01477447-20100722-22.
In total hip arthroplasty (THA), excessive retroversion is associated with posterior instability, anterior impingement, and resultant groin pain. Excessive anteversion can lead to anterior instability and posterior impingement. The transverse acetabular ligament straddles the inferior limit of the bony acetabulum. It is a strong load-bearing structure and, in the normal hip, in association with the labrum, provides part of the load-bearing surface for the femoral head. It is our hypothesis that the transverse acetabular ligament defines normal version for the acetabulum. In Belfast, we found that using the transverse acetabular ligament helped reduce our primary dislocation rate from 3.7% to 1%. The key is good intraoperative exposure. A grading of 1 to 4 was based on 1000 consecutive cases: (1) normal transverse acetabular ligament easily visible on exposure of the acetabulum, 49%; (2) covered by soft tissue, 35.1%--cleared by blunt dissection; (3) covered by osteophytes, 15.6%--cleared using an acetabular reamer; (4) no transverse acetabular ligament identified, 0.3%. As can be seen, the transverse acetabular ligament is only immediately visible in 49% of cases. In the other 51%, soft tissue or bone must be cleared to define the ligament. The advantages of the transverse acetabular ligament are many. It is independent of patient positioning. The cup version can be individualized by the patient. The surgeon can avoid estimating version angle of 15° to 20° intraoperatively. It is easy to teach and consistently present. It is valuable in minimally invasive surgery. Using the transverse acetabular ligament provides an acceptable dislocation rate with the posterior approach. If the cup is cradled by the transverse acetabular ligament, it helps restore acetabular joint center. However, the transverse acetabular ligament does not help with inclination. We recommend 35° of operative inclination when using the posterior approach.
在全髋关节置换术（THA）中，髋臼过度后倾与后方不稳定、前方撞击以及由此导致的腹股沟疼痛相关。髋臼过度前倾可导致前方不稳定和后方撞击。髋臼横韧带跨越骨性髋臼的下缘。它是一个强大的承重结构，在正常髋关节中，与盂唇一起为股骨头提供部分承重表面。我们的假设是髋臼横韧带定义了髋臼的正常旋转角度。在贝尔法斯特，我们发现使用髋臼横韧带有助于将我们的初次脱位率从3.7%降至1%。关键是术中要有良好的暴露。基于1000例连续病例进行了1至4级分级：（1）髋臼暴露时髋臼横韧带容易看到，占49%；（2）被软组织覆盖，占35.1%——通过钝性分离清除；（3）被骨赘覆盖，占15.6%——使用髋臼铰刀清除；（4）未发现髋臼横韧带，占0.3%。可以看出，髋臼横韧带仅在49%的病例中能立即看到。在其他51%的病例中，必须清除软组织或骨才能确定韧带。髋臼横韧带的优点众多。它与患者体位无关。髋臼杯的旋转角度可根据患者个体化调整。外科医生可避免在术中估计15°至20°的旋转角度。它易于传授且始终存在。在微创手术中很有价值。使用髋臼横韧带采用后入路可提供可接受的脱位率。如果髋臼杯由髋臼横韧带支撑，有助于恢复髋臼关节中心。然而，髋臼横韧带对倾斜度没有帮助。我们建议采用后入路时手术倾斜度为35°。
