全髋关节置换术中计算机导航髋臼组件置入时骨盆前平面的可靠性：使用EOS成像系统的前瞻性研究
The reliability of the anterior pelvic plane for computer navigated acetabular component placement during total hip arthroplasty: prospective study with the EOS imaging system.
作者信息
Barbier O, Skalli W, Mainard L, Mainard D
机构信息
Service de chirurgie orthopédique, hôpital central, 29, avenue de Lattre-de-Tassigny, 54000 Nancy, France; Laboratoire de biomécanique, école nationale supérieure des arts et métiers Paris tech, boulevard de l'Hôpital, 75013 Paris, France; Service de chirurgie orthopédique, hôpital d'instruction des Armées-Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France.
Laboratoire de biomécanique, école nationale supérieure des arts et métiers Paris tech, boulevard de l'Hôpital, 75013 Paris, France.
出版信息
Orthop Traumatol Surg Res. 2014 Oct;100(6 Suppl):S287-91. doi: 10.1016/j.otsr.2014.07.003. Epub 2014 Aug 14.
INTRODUCTION
Computer navigated total hip arthroplasty is mostly based on the use of the anterior pelvic plane (APP) as a reference. EOS is a new imaging system that provides three-dimensional analysis of the pelvis in a functional position with a low dose of radiation. The aim of this study was to evaluate the reliability of the APP for placement of the cup during computer navigated THA using EOS.
HYPOTHESIS
The reliability of the APP is limited for the placement of the acetabular cup during computer navigated THA.
MATERIALS AND METHODS
This was a prospective monocentric study using the EOS imaging system evaluating 44 patients in the standing position three months after computer navigated THA (Orthopilot). Reproducibility of EOS measurements were analyzed using SterEOS software and the reliability of the navigation data for the position of the cup were assessed.
RESULTS
Intra and interobserver reproducibility of the measurements of the orientation of the cup by EOS were good with correlation coefficients above 93% and 95% and confidence intervals of less than ±5°. Mean cup inclination and anteversion were 41.3° and 20.9° and 44.3° and 29.5° respectively in operatively and post-operatively. The differences between measurements of operative cup inclination using computer assisted navigation and the post-operative EOS measurements were significant (P<0.05) with a correlation coefficient of less than 40%.
DISCUSSION
Our study confirms the lack of precision of the APP as a reference for positioning of the acetabular component, especially in relation to anteversion. Although for many years the APP was considered to be a global reference, in fact, it is subject to significant inter-individual variations and variations during changes in position. These factors, associated with the difficulty of determining the preoperative APP, explain the lack of reliability of this reference. Preoperative evaluation of the orientation of APP by EOS and its integration into the navigation system could help the operator position these components.
LEVEL OF EVIDENCE
Level III Prospective diagnostic case controlled study.
引言
计算机导航全髋关节置换术主要基于使用骨盆前平面（APP）作为参考。EOS是一种新型成像系统，能在低辐射剂量下对处于功能位的骨盆进行三维分析。本研究的目的是评估在使用EOS进行计算机导航全髋关节置换术时，APP用于髋臼杯置入的可靠性。
假设
在计算机导航全髋关节置换术中，APP用于髋臼杯置入的可靠性有限。
材料与方法
这是一项前瞻性单中心研究，使用EOS成像系统评估44例患者在计算机导航全髋关节置换术（Orthopilot）三个月后站立位的情况。使用SterEOS软件分析EOS测量的可重复性，并评估髋臼杯位置导航数据的可靠性。
结果
EOS测量髋臼杯方向的观察者内和观察者间可重复性良好，相关系数分别高于93%和95%，置信区间小于±5°。手术时和术后髋臼杯平均倾斜度和前倾角分别为41.3°和20.9°以及44.3°和29.5°。使用计算机辅助导航测量的手术髋臼杯倾斜度与术后EOS测量值之间的差异具有统计学意义（P<0.05），相关系数小于40%。
讨论
我们的研究证实，APP作为髋臼部件定位参考缺乏精确性，尤其是在前倾角方面。尽管多年来APP被视为一个通用参考，但实际上它存在显著的个体差异以及体位改变时的变化。这些因素，再加上确定术前APP的困难，解释了该参考缺乏可靠性的原因。通过EOS对APP方向进行术前评估并将其整合到导航系统中，可能有助于手术医生定位这些部件。
证据水平
III级前瞻性诊断病例对照研究。
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