Singh Nishant Kumar, Rai Sanjay Kumar, Rastogi Amit
School of Biomedical Engineering, Indian Institute of Technology (Banaras Hindu University), Varanasi, Uttar Pradesh, India.
Department of Orthopaedics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
Indian J Orthop. 2017 Jul-Aug;51(4):447-454. doi: 10.4103/ortho.IJOrtho_224_16.
Vascular injury during minimally invasive total hip arthroplasty (THA) is uncommon, yet a well-recognized and serious issue. It emerges because of non-visibility of vascular structures proximal to the pelvic bone during reaming, drilling holes, and fixing of screws. Numerous studies have found that screw fixation during cementless THA is beneficial for the initial stability of cup; yet, no anatomical guidelines support angular eccentric screw fixation.
In this study, we obtained the pelvic arterial-phase computed tomographic data of thirty eight humans and reconstructed the three-dimensional models of osseous and vessel structures. We performed the surgical simulation to fix these structures with cementless cups and screws with angular eccentricities.
The effect of screw eccentricities (angular eccentricities of ±17° and ±34°) on the vascular injury was determined. Measurement between screw and adjoining vessels was performed and analyzed statistically to ascertain a comparative risk study for blood vessels that are not visible during surgery.
Authors similarly discussed the significant absence of appreciation of quadrant systems proposed by Wasielewski . on eccentric screws. Adjustment of quadrant systems provided by Wasielewski . is required for acetabular implants with eccentric holes for fixation of acetabular screws.
微创全髋关节置换术（THA）期间的血管损伤并不常见，但却是一个公认的严重问题。它是由于在扩孔、钻孔和螺钉固定过程中骨盆骨近端血管结构不可见而出现的。许多研究发现，非骨水泥型THA期间的螺钉固定有利于髋臼杯的初始稳定性；然而，尚无解剖学指南支持角向偏心螺钉固定。
在本研究中，我们获取了38例人类的骨盆动脉期计算机断层扫描数据，并重建了骨骼和血管结构的三维模型。我们进行了手术模拟，用非骨水泥髋臼杯和具有角向偏心度的螺钉固定这些结构。
确定了螺钉偏心度（±17°和±34°的角向偏心度）对血管损伤的影响。对螺钉与相邻血管之间的距离进行测量并进行统计学分析，以确定手术中不可见血管的比较风险研究。
作者同样讨论了Wasielewski提出的象限系统在偏心螺钉方面明显缺乏认识的问题。对于带有偏心孔以固定髋臼螺钉的髋臼植入物，需要调整Wasielewski提供的象限系统。
