Kanazawa University, Department of Orthopaedic Surgery, Graduate School of Medical Science, 13-1 Takaramachi, Kanazawa, 920-8641, Japan.
Bone Joint J. 2014 Mar;96-B(3):306-11. doi: 10.1302/0301-620X.96B3.32726.
It has recently been reported that the transverse acetabular ligament (TAL) is helpful in determining the position of the acetabular component in total hip replacement (THR). In this study we used a computer-assisted navigation system to determine whether the TAL is useful as a landmark in THR. The study was carried out in 121 consecutive patients undergoing primary THR (134 hips), including 67 dysplastic hips (50%). There were 26 men (29 hips) and 95 women (105 hips) with a mean age of 60.2 years (17 to 82) at the time of operation. After identification of the TAL, its anteversion was measured intra-operatively by aligning the inferomedial rim of the trial acetabular component with the TAL using computer-assisted navigation. The TAL was identified in 112 hips (83.6%). Intra-observer reproducibility in the measurement of anteversion of the TAL was high, but inter-observer reproducibility was moderate. Each surgeon was able to align the trial component according to the target value of the angle of anteversion of the TAL, but it was clear that methods may differ among surgeons. Of the measurements of the angle of anteversion of the TAL, 5.4% (6 of 112 hips) were outliers from the safe zone. In summary, we found that the TAL is useful as a landmark when implanting the acetabular component within the safe zone in almost all hips, and to prevent it being implanted in retroversion in all hips, including dysplastic hips. However, as anteversion of the TAL may be excessive in a few hips, it is advisable to pay attention to individual variations, particularly in those with severe posterior pelvic tilt.
最近有报道称，横髋臼韧带（TAL）有助于确定全髋关节置换术（THR）中髋臼部件的位置。在这项研究中，我们使用计算机辅助导航系统来确定 TAL 是否可用作 THR 的标志。该研究共纳入 121 例连续接受初次 THR（134 髋）的患者，包括 67 例发育不良髋（50%）。患者中男 26 例（29 髋），女 95 例（105 髋），手术时的平均年龄为 60.2 岁（17 至 82 岁）。在识别 TAL 后，使用计算机辅助导航，通过将试验髋臼部件的下内侧边缘与 TAL 对齐，术中测量其前倾角。在 112 髋（83.6%）中识别出 TAL。TAL 前倾角测量的观察者内重复性较高，但观察者间重复性中等。每位外科医生都能够根据 TAL 前倾角的目标值来对准试验部件，但很明显，方法可能因外科医生而异。TAL 前倾角的测量中，有 5.4%（112 髋中的 6 髋）超出安全范围。总之，我们发现 TAL 在几乎所有髋中作为植入髋臼部件在安全范围内的标志很有用，并且可以防止在所有髋中包括发育不良髋在内植入后倾。然而，由于 TAL 的前倾角在少数髋中可能过大，因此建议注意个体差异，特别是在那些骨盆后倾严重的患者中。
