髋臼卵圆窝三维定位法在全髋关节置换术髋臼假体定位中的临床应用

doi:10.3969/j.issn.1006-5725.2025.20.013

摘要/Abstract

摘要：

目的探讨髋臼卵圆窝三维定位法辅助全髋关节置换术（total hip arthroplasty，THA）中髋臼假体定位的可行性和应用价值。方法将60例行初次THA的股骨颈骨折患者随机分为两组（各30例）。观察组应用髋臼卵圆窝三维定位法：术前基于CT数据测量髋臼角度、重建骨盆模型并规划，术中依据髋臼卵圆窝、横切迹、横韧带等解剖标志按规划置入假体。对照组采用传统徒手目测法。比较两组手术指标（时间、透视次数、出血量）、术后髋臼假体角度（外展角、前倾角）偏差、髋关节Harris评分（HHS）、疼痛视觉模拟评分（VAS）及脱位率。结果两组年龄、性别等基线资料可比。观察组出血量高于对照组（P < 0.001），手术时间、透视次数差异无统计学意义。术后影像学测量显示，观察组的髋臼假体外展角和前倾角偏差均显著小于对照组（P < 0.001）。术后1个月，观察组HHS评分明显更高、VAS评分明显更低（P < 0.05）；术后3、6个月两组功能与疼痛评分差异无统计学意义。观察组无脱位，对照组脱位1例。结论髋臼卵圆窝三维定位法结合解剖标志与个体化术前规划，能量化髋臼假体置入角度并显著提高髋臼假体置入的精准性，利于患者术后早期功能恢复，临床疗效满意，具有应用价值。

关键词: 髋臼卵圆窝, 三维定位, 术前规划, 全髋关节置换术（THA）, 髋臼假体, 精准置入

Abstract:

Objective To evaluate the feasibility and clinical significance of the three-dimensional acetabular oval fossa-guided positioning technique in acetabular prosthesis placement during total hip arthroplasty （THA）. Methods Sixty patients with femoral neck fractures who underwent primary THA were randomly divided into two groups （n = 30 per group）. The observation group received acetabular component placement guided by a three-dimensional positioning technique based on preoperative acetabular angle measurements and pelvic model reconstruction using CT data. During surgery， placement was performed according to the preoperative plan， using anatomical landmarks including the acetabular fossa， transverse acetabular incision， and transverse acetabular ligament. The control group underwent conventional freehand acetabular component placement. The two groups were compared in terms of surgical parameters （operation time， intraoperative fluoroscopy frequency， blood loss）， postoperative deviations in acetabular component angles （abduction and anteversion angles）， Harris hip score （HHS）， visual analog scale （VAS） for pain， and dislocation rate. Results Baseline characteristics were comparable between groups. The observation group exhibited a slightly longer operation time and significantly greater blood loss compared to the control group， with no significant difference in fluoroscopy frequency. Postoperative radiographic measurements showed that deviations in both the abduction and anteversion angles of the acetabular component were significantly smaller in the observation group than in the control group. At one month postoperatively， the HHS was significantly higher and the VAS score was significantly lower in the observation group. However， no significant differences in functional or pain scores were found between the two groups at three and six months postoperatively. No dislocations were observed in the observation group， whereas one dislocation occurred in the control group. Conclusions The three-dimensional acetabulum oval fossa-guided positioning technique， which integrates anatomical landmarks with individualized preoperative planning， enables precise quantitative measurement and significantly enhances the accuracy of acetabular component placement angles in THA. This improvement contributes to faster postoperative functional recovery and leads to favorable clinical outcomes， demonstrating strong practical application value.

Key words: acetabulum oval fossa, three-dimensional positioning, preoperative planning, total hip arthroplasty （THA）, acetabular prosthesis, precision placement

中图分类号:

R684

李策,袁伶俐,唐昊旭,梁英杰,丁鹏霖,钱闵龙. 髋臼卵圆窝三维定位法在全髋关节置换术髋臼假体定位中的临床应用[J]. 实用医学杂志, 2025, 41(20): 3235-3242.

Ce LI,Lingli YUAN,Haoxu TANG,Yingjie LIANG,Minlong. QIAN. Clinical application of three‑dimensional acetabulum oval fossa‑guided positioning technique in acetabular prosthesis placement during total hip arthroplasty[J]. The Journal of Practical Medicine, 2025, 41(20): 3235-3242.

图/表 13

表1

一般资料比较 (例)"

组别	性别		年龄（ $x ˉ$ ± s）/岁	BMI （ $x ˉ$ ± s）/（kg/m2）	Garden分型		患肢
组别	男	女	年龄（ $x ˉ$ ± s）/岁	BMI （ $x ˉ$ ± s）/（kg/m2）	Ⅲ	Ⅳ	左	右
观察组	10	20	65.07 ± 7.12	25.85 ± 5.03	19	11	15	15
对照组	16	14	64.13 ± 7.87	26.15 ± 5.46	16	14	13	17
t/χ²值	2.443		0.482	-0.219	0.617		0.268
P值	0.118		0.632	0.828	0.432		0.605

表1

图1

图2

图3

图4

图5

图6

表2

表3

表4

表5

图7

图8

参考文献 22

[1]	MIN K， BEOM J， KIM B R， et al. Clinical Practice Guideline for Postoperative Rehabilitation in Older Patients With Hip Fractures［J］. Ann Rehabil Med， 2021，45（3）： 225-259. doi:10.5535/arm.21110 doi: 10.5535/arm.21110
[2]	CHANG H， LUAN C， LI C. Effect of Comprehensive Rehabilitation Training Based on Balance Function on Postoperative Recovery and Function of Hip Fracture in the Elderly： A Systematic Review and Meta-Analysis［J］. Geriatr Orthop Surg Rehabil， 2024，15： 21514593241261506. doi:10.1177/21514593241261506 doi: 10.1177/21514593241261506
[3]	GOMEZ ALCARAZ J， PARDO GARCIA J M， SEVILLA FERNANDEZ J， et al. Primary total hip arthroplasty in elderly patients over 85 years old： Risks， complications and medium-long term results［J］. Rev Esp Cir Ortop Traumatol （Engl Ed）， 2021，65（1）： 13-23. doi:10.1016/j.recote.2020.12.006 doi: 10.1016/j.recote.2020.12.006
[4]	TURNBULL G， BLACKLOCK C， AKHTAR A， et al. Experience of an anatomic femoral stem in a UK orthopaedic centre beyond 20 years of follow-up［J］. Eur J Orthop Surg Traumatol， 2024，34（4）： 2155-2162. doi:10.1007/s00590-024-03901-1 doi: 10.1007/s00590-024-03901-1
[5]	PINTO D， ALSHAHRANI M， CHAPURLAT R， et al. The Global Approach to Rehabilitation Following an Osteoporotic Fragility Fracture： A Review of the Rehabilitation Working Group of the International Osteoporosis Foundation （IOF） Committee of Scientific Advisors［J］. Osteoporos Int， 2022， 33： 527-540. doi:10.1007/s00198-021-06240-7 doi: 10.1007/s00198-021-06240-7
[6]	REGIS D， CASON M， MAGNAN B. Dislocation of Primary Total Hip Arthroplasty： Analysis of Risk Factors and Preventive Options［J］. World J Orthop， 2024，15（6）： 501-511. doi:10.5312/wjo.v15.i6.501 doi: 10.5312/wjo.v15.i6.501
[7]	陈检文，董立明，蒋科，等. 髋臼假体安装位置与无菌性松动的相关分析［J］. 中国矫形外科杂志， 2022， 30（1）： 28-32.
[8]	MEERMANS G， GRAMMATOPOULOS G， INNMANN M， et al. Cup Placement in Primary Total Hip Arthroplasty： How to Get It Right Without Navigation or Robotics［J］. EFORT Open Rev， 2022，7（6）： 365-374. doi:10.1530/eor-22-0025 doi: 10.1530/eor-22-0025
[9]	BOSKER B H， VERHEYEN C C P M， HORSTMANN W G， et al. Poor accuracy of freehand cup positioning during total hip arthroplasty［J］. Arch Orthop Trauma Surg， 2007，127（5）： 375-379. doi:10.1007/s00402-007-0294-y doi: 10.1007/s00402-007-0294-y
[10]	LEARMONTH I D， YOUNG C， RORABECK C. The operation of the century： Total hip replacement［J］. Lancet， 2007， 370（9597）： 1508-1519. doi:10.1016/s0140-6736(07)60457-7 doi: 10.1016/s0140-6736(07)60457-7
[11]	BEVERLAND D E， O'NEILL C K J， RUTHERFORD M， et al. Placement of the acetabular component［J］. Bone Joint J， 2016， 98-B（1 ）： 37-43. doi:10.1302/0301-620x.98b1.36343 doi: 10.1302/0301-620x.98b1.36343
[12]	ABDEL M P， von ROTH P， JENNINGS M T， et al. What Safe Zone？ The Vast Majority of Dislocated THAs Are Within the Lewinnek Safe Zone for Acetabular Component Position［J］. Clin Orthop Relat Res， 2016， 474（2）： 386-391. doi:10.1007/s11999-015-4432-5 doi: 10.1007/s11999-015-4432-5
[13]	崔晓荣，兰丽华，李向阳，等. 基于MSCT三维扫描加重建对成人髋关节发育不良全髋关节置换术中髋臼假体的选择及截骨的准确性预测价值［J］. 实用医学杂志， 2024， 40（9）： 1309-1313.
[14]	GRAMMATOPOULOS G， INNMANN M， PHAN P， et al. Spinopelvic challenges in primary total hip arthroplasty［J］. EFORT Open Rev， 2023，8（5）： 298-312. doi:10.1530/eor-23-0049 doi: 10.1530/eor-23-0049
[15]	VAN DUREN B H， ROYECA J M， CUNNINGHAM C M， et al. Can the use of an inclinometer improve acetabular cup inclination in total hip arthroplasty？ A review of the literature［J］. Hip Int， 2021，31（5）： 609-617. doi:10.1177/1120700020946716 doi: 10.1177/1120700020946716
[16]	DARRITH B， BELL J A， CULVERN C， et al. Can the use of an inclinometer improve the positioning of the acetabular component in total hip arthroplasty？［J］. Bone Joint J， 2018， 100-B（7）： 862-866. doi:10.1302/0301-620x.100b7.bjj-2017-1607.r1 doi: 10.1302/0301-620x.100b7.bjj-2017-1607.r1
[17]	BRUCE-BRAND R， MAGILL P， O'NEILL C， et al. Mechanical and Anatomical Alignment Guide Techniques Are Superior to Freehand in Achieving Target Orientation of an Acetabular Component［J］. Arthroplast Today， 2021， 11： 222-228. doi:10.1016/j.artd.2021.08.016 doi: 10.1016/j.artd.2021.08.016
[18]	GOLDSTEIN K， TYNDALL W， NICKOL M E， et al. Inclinometer use in primary total hip arthroplasty does not improve acetabular component positioning： A non-randomized control trial［J］. Arthroplasty， 2024，6（1）： 41. doi:10.1186/s42836-024-00258-y doi: 10.1186/s42836-024-00258-y
[19]	周建生，凌遵龙，王志岩，等. Harris窝及髋臼切迹与髋臼中心点的应用解剖和相关性研究［J］. 解剖与临床， 2010， 15（4）： 231-234.
[20]	ZHANG H， ZHOU J， LING X， et al. Determining the Orientation of Acetabular Prosthesis in Total Hip Arthroplasty by Refering to the Anatomical Landmarker of Acetabular Notches［J］. Sci Rep， 2023， 13（1）：6185. doi:10.1038/s41598-023-33501-8 doi: 10.1038/s41598-023-33501-8
[21]	ARCHBOLD H A P， SLOMCZYKOWSKI M， CRONE M， et al. The Relationship of the Orientation of the Transverse Acetabular Ligament and Acetabular Labrum to the Suggested Safe Zones of Cup Positioning in Total Hip Arthroplasty［J］. Hip Int， 2008，18（1）： 1-6. doi:10.5301/hip.2008.1755 doi: 10.5301/hip.2008.1755
[22]	PORTINARO N M， MATTHEWS S J， BENSON M K. The acetabular notch in hip dysplasia［J］. J Bone Joint Surg Br， 1994，76（2）： 271-273. doi:10.1302/0301-620x.76b2.8113290 doi: 10.1302/0301-620x.76b2.8113290

组别	手术时间/min	术中透视次数/次	出血量/mL
观察组	123.55 ± 10.10	3.03 ± 1.21	197.04 ± 28.54
对照组	119.40 ± 5.54	3.20 ± 1.27	132.96 ± 28.28
t值	1.973	-0.619	8.734
P值	0.053	0.538	< 0.001

组别	术前 HHS评分	术后1月 HHS评分	术后3月 HHS评分	术后6月 HHS评分
观察组	29.80 ± 8.58	57.33 ± 8.95^*	75.67 ± 8.61^*	87.13 ± 6.816^*
对照组	31.40 ± 7.30	50.40 ± 10.87^*	76.07 ± 9.70^*	89.70 ± 6.137^*
t值	-0.778	2.698	-0.169	-1.533
P值	0.440	0.009	0.866	0.131

组别	术前 VAS评分	术后1月 VAS评分	术后3月 VAS评分	术后6月 VAS评分
观察组	87.03 ± 7.24	52.03 ± 10.52^*	24.10 ± 11.22^*	9.17 ± 6.37^*
对照组	89.07 ± 6.22	58.10 ± 10.55^*	27.67 ± 12.86^*	11.80 ± 8.11^*
t值	-1.167	-2.231	-1.145	-1.398
P值	0.248	0.030	0.257	0.167

组别	髋臼外展角偏差值	髋臼前倾角偏差值	术后脱位/例
观察组	3.91 ± 0.68	3.76 ± 0.87	0/30
对照组	7.47 ± 2.96	5.98 ± 2.34	1/30
t值	-6.415	-4.878	-
P值	< 0.001	< 0.001	1.000