Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT.
J Arthroplasty. 2021 Jul;36(7S):S104-S110. doi: 10.1016/j.arth.2021.01.007. Epub 2021 Jan 12.
The spinopelvic relationship in regard to total hip arthroplasty has become a topic of increasing interest in recent years. Hip arthritis and a stiff lumbar spine create a situation where the spinopelvic junction has decreased mobility, which in turn increases the risk of instability after total hip arthroplasty as the femoral acetabular joint must undergo increased motion. Regardless of the approach, surgeons should be aware of the risk of instability in patients with a stiff spinopelvic junction and the necessary modifications to component positioning to avoid postoperative instability. As many direct anterior approach surgeons use fluoroscopy for intraoperative navigation, anterior approach surgeons must also understand how to best use this technology to improve component positioning.
In this article, we address the basic concepts surrounding spinopelvic stiffness, the intraoperative component adjustments necessary for optimizing stability, and how to appropriately use fluoroscopy for navigation in the direct anterior approach.
Appropriate use of intraoperative fluoroscopy includes understanding the impact of parallax and distortion, properly recreating the patient's standing functional pelvic plane intraoperatively and adjusting the cup's target position based on a preoperative understanding of the patient's spinopelvic motion.
近年来，全髋关节置换术中的骨盆脊柱关系已成为一个日益受到关注的话题。髋关节关节炎和僵硬的腰椎会导致脊柱骨盆连接处活动度降低，这反过来又会增加全髋关节置换术后不稳定的风险，因为股骨髋臼关节必须进行更大的运动。无论采用何种入路，外科医生都应该意识到僵硬的脊柱骨盆连接处患者存在不稳定的风险，以及为避免术后不稳定而对部件定位进行必要的修正。由于许多直接前路入路的外科医生在术中使用透视来进行导航，因此直接前路入路的外科医生还必须了解如何最好地使用这项技术来改善部件定位。
在本文中，我们将介绍与脊柱骨盆僵硬相关的基本概念、优化稳定性所需的术中部件调整以及在直接前路入路中如何正确使用透视进行导航。
术中透视的正确使用包括了解视差和失真的影响、在术中正确重现患者站立功能骨盆平面，并根据术前对患者脊柱骨盆运动的了解调整杯的目标位置。
