From the Hospital for Special Surgery, Adult Reconstruction and Joint Replacement, New York, NY.
J Am Acad Orthop Surg. 2021 Mar 1;29(5):e208-e216. doi: 10.5435/JAAOS-D-20-00693.
Preoperative templating provides several benefits to the patient, surgeon, and hospital. Appropriate implant selection and sizing optimizes surgical workflow and leads to efficient care-delivery systems. Accurate templating establishes intraoperative targets for component position and reduces complications such as leg length inequality, impingement, wear, dislocation, and fracture, all of which lead to decreased patient satisfaction. Recent technological advances in preoperative imaging include a better understanding of patient-specific pelvic motion allowing the surgeon to preoperatively address the risk of lumbar pathology with adjustments in component placement and bearing choice. The introduction of two-dimensional to three-dimensional (3D) radiographs, biplanar low-dose radiographs, and computed tomography scans with 3D reconstructions have all allowed for a more comprehensive preoperative planning in 3D. This article will review the fundamentals of templating before total hip arthroplasty with an emphasis on how to incorporate and implement patient-specific pelvic motion and 3D templating into practice.
术前模板为患者、外科医生和医院提供了多项益处。适当的植入物选择和尺寸优化了手术流程,建立了高效的医疗护理体系。准确的模板制定了术中组件位置的目标,减少了下肢长度不等、撞击、磨损、脱位和骨折等并发症,所有这些都导致了患者满意度的降低。术前成像的最新技术进步包括更好地了解患者特定的骨盆运动,使外科医生能够在术前通过调整组件位置和轴承选择来解决腰椎病变的风险。二维到三维(3D)射线照片、双平面低剂量射线照片以及具有 3D 重建的计算机断层扫描的引入,都允许在 3D 中进行更全面的术前规划。本文将回顾全髋关节置换术前模板的基本原理,重点介绍如何将患者特定的骨盆运动和 3D 模板纳入实践。