Zhao Gongyin, Zhao Chenyu, Bao Hongwei, Liu Junting, Zhou Baojun, Wang Yuji
Department of Orthopedics, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou Medical Center, Nanjing Medical University, Changzhou, China.
Department of Orthopedic Biomechanics Research Laboratory, Mayo Clinic, Rochester, MN, USA.
Arthroplast Today. 2024 Oct 15;30:101487. doi: 10.1016/j.artd.2024.101487. eCollection 2024 Dec.
Hip dislocation represents a significant complication encountered following hip arthroplasty procedures. In this investigation, we conducted a comparative analysis of the biomechanical characteristics exhibited by the piriformis and the conjoined tendon after total hip arthroplasty (THA) via the direct anterior approach (DAA), utilizing cadaveric specimens. The objective is to ascertain the relative significance of the piriformis muscle and the conjoined tendon in mitigating hip dislocation.
A total of 16 hip joints from 8 freshly frozen cadavers were selected and stratified into 2 groups: the piriformis tendon (PT) group and the conjoined tendon (CT) group. Following THA via the DAA, measurements were taken to record the torque required to induce hip dislocation under various conditions. Torque readings were obtained with the tendon in its intact state (intact group) and after preservation or reconstruction of either the PT or the CT.
The torques of anterior and posterior dislocation in PT group were 22.24 ± 4.53 N.m and 30.7 ± 15.5 N.m following tendon severed, and 20.04 ± 2.67 N.m and 17.5 ± 6.7 N.m following reconstruction. There were no differences compared to the intact group. The torque decreased in the CT group after CT was severed with the torques dropping from 31.2 ± 7.6 N.m to 8.18 ± 2.6 N.m ( < .0001) for anterior dislocation, and from 34.9 ± 8.3 N.m to 9.8 ± 2.8 N.m ( < .0001) for posterior dislocation. Following reconstruction, the torque required for dislocation significantly increased ( < .0001).
This study underscores the preeminent role of the CT in ensuring hip stability following THA via DAA, highlighting the cruciality of its preservation and reconstruction during surgical interventions.
髋关节脱位是髋关节置换术后出现的一种严重并发症。在本研究中，我们利用尸体标本对经直接前方入路（DAA）行全髋关节置换术（THA）后梨状肌和联合肌腱的生物力学特性进行了对比分析。目的是确定梨状肌和联合肌腱在减轻髋关节脱位方面的相对重要性。
从8具新鲜冷冻尸体上选取16个髋关节，分为2组：梨状肌腱（PT）组和联合肌腱（CT）组。经DAA行THA后，测量并记录在各种情况下导致髋关节脱位所需的扭矩。在肌腱完整状态（完整组）以及PT或CT保存或重建后获取扭矩读数。
PT组肌腱切断后前脱位和后脱位的扭矩分别为22.24±4.53 N·m和30.7±15.5 N·m，重建后分别为20.04±2.67 N·m和17.5±6.7 N·m。与完整组相比无差异。CT组CT切断后扭矩降低，前脱位扭矩从31.2±7.6 N·m降至8.18±2.6 N·m（P<0.0001），后脱位扭矩从34.9±8.3 N·m降至9.8±2.8 N·m（P<0.0001）。重建后，脱位所需扭矩显著增加（P<0.0001）。
本研究强调了CT在经DAA行THA后确保髋关节稳定性方面的重要作用，突出了在手术干预期间保留和重建CT的关键性。
