Mazek Jacek, Helmy Nader, Salas Antonio Porthos, Skowronek Pawel, Madej Arkadiusz, O Donnell John M, Dimitriou Dimitris
Clinic of Orthopaedic and Traumatology, Regional Hospital and Kochanowski Medical University, Grunwaldzka 45, Kielce 25-736, Poland.
Department of Orthopaedics and Traumatology, Bürgerspital Solothurn, Schöngrünstrasse 42, Solothurn 4500, Switzerland.
J Hip Preserv Surg. 2023 Aug 28;10(3-4):192-196. doi: 10.1093/jhps/hnad020. eCollection 2023 Aug-Dec.
The aim of the present study was to report the thickness of the cotyloid fossa at the acetabular ligamentum teres (LT) attachment and investigate the clearance of the obturator neurovascular bundle. Fifty-five consecutive patients undergoing a total hip arthroplasty for hip osteoarthritis were included. The thickness of the cotyloid fossa was measured at the acetabular LT attachment using a standard depth gauge. The minimal distance (clearance) of the obturator neurovascular bundle to the center of the acetabular LT attachment was measured in 7 patients (14 hips) who also underwent a computed tomography angiography. The average thickness of the cotyloid fossa at the acetabular LT attachment was 4.1 ± 2.3 (range: 1-10) mm. The obturator vein was closest to the acetabular LT attachment, but the clearance was more than the defined safe zone of 15 mm in all cases. Based on the current findings, it can be assumed that bone anchors might not be suitable for fixation of the graft in LT reconstruction (LTR) and an alternative implant such as a cortical button should be considered. Acetabular fixation of the graft with a 12-mm cortical button is relatively safe concerning injury to obturator neurovascular structures. The results of the present study provide a better understanding of the cotyloid fossa anatomy and might be relevant for surgeons who perform arthroscopic LTR.
本研究的目的是报告髋臼圆韧带（LT）附着处髋臼盂缘窝的厚度，并研究闭孔神经血管束的间隙。纳入了55例因髋关节骨关节炎接受全髋关节置换术的连续患者。使用标准深度测量仪在髋臼LT附着处测量髋臼盂缘窝的厚度。在7例（14髋）同时接受计算机断层血管造影的患者中，测量闭孔神经血管束到髋臼LT附着中心的最小距离（间隙）。髋臼LT附着处髋臼盂缘窝的平均厚度为4.1±2.3（范围：1 - 10）mm。闭孔静脉最靠近髋臼LT附着处，但在所有病例中间隙均超过规定的15 mm安全区。基于目前的研究结果，可以推测骨锚可能不适用于LT重建（LTR）中移植物的固定，应考虑使用皮质纽扣等替代植入物。使用12 mm皮质纽扣对移植物进行髋臼固定，在损伤闭孔神经血管结构方面相对安全。本研究结果有助于更好地了解髋臼盂缘窝的解剖结构，可能对进行关节镜下LTR的外科医生有参考价值。
