CAJ | 학술논문

目的：通过对全髋置换术后髋臼和股骨假体联合前倾角进行CT 测量，对联合前倾角的临床现状进行总结，并与Dorr等的安全范围比较，评估使用传统手术方法安放联合前倾角的准确性。方法在该院进行全髋置换的206例（髋）进行了前瞻性研究，所有手术均采用侧卧位后外侧入路和传统手术方法，没有借助任何定向器等辅助器械，手术由12名医生完成。术后1周内进行了CT测量，使用三维CT方法测量了髋臼假体的放射学前倾角和股骨假体前倾角。对髋臼假体前倾角、股骨假体前倾角和联合前倾角分别进行了统计分析。结果在206例髋关节中，髋臼假体前倾角平均为16．23°±8．27°，在Lewinneck 5°～25°安全范围内的占76．21％。股骨假体前倾角平均为23．79°±10．70°。联合前倾角平均为40．02°±13．50°，在Dorr等建议的25°～50°范围内的有134例（65．05％）。高级职称医师和主治医师在髋臼假体前倾角、股骨假体前倾角和联合前倾角等方面比较差异均无统计学意义，P值分别为0．726、0．143和0．061。结论使用传统的手术方法安放联合前角是不准确的，仅有65．05％的联合前倾角在25°～50°的安全范围内；医师手术经验的增加并不能提高这一准确性。
목적：통과대전관치환술후관구화고골가체연합전경각진행CT 측량，대연합전경각적림상현상진행총결，병여Dorr등적안전범위비교，평고사용전통수술방법안방연합전경각적준학성。방법재해원진행전관치환적206례（관）진행료전첨성연구，소유수술균채용측와위후외측입로화전통수술방법，몰유차조임하정향기등보조기계，수술유12명의생완성。술후1주내진행료CT측량，사용삼유CT방법측량료관구가체적방사학전경각화고골가체전경각。대관구가체전경각、고골가체전경각화연합전경각분별진행료통계분석。결과재206례관관절중，관구가체전경각평균위16．23°±8．27°，재Lewinneck 5°～25°안전범위내적점76．21％。고골가체전경각평균위23．79°±10．70°。연합전경각평균위40．02°±13．50°，재Dorr등건의적25°～50°범위내적유134례（65．05％）。고급직칭의사화주치의사재관구가체전경각、고골가체전경각화연합전경각등방면비교차이균무통계학의의，P치분별위0．726、0．143화0．061。결론사용전통적수술방법안방연합전각시불준학적，부유65．05％적연합전경각재25°～50°적안전범위내；의사수술경험적증가병불능제고저일준학성。
Objective Our goal was to summarize the clinical data of the combined anteversion of both stem and cup measured by CT method after total hip arthroplasty and to evaluate the accuracy of conventional freehand technique for positioning the combined anteversion by comparing the results to the Dorr′s “safe zone” .Methods We prospectively studied 206 primary total hip arthro-plasties .For all the arthroplasties ,we used posterior lateral approach and conventional freehand technique without any alignment guides .12 surgeons performed all the 206 arthroplasties .Postoperatively all the patients were examined by CT scan within one week .We measured radiographic anteversion of acetabular components using a 3D CT method and measured femoral components anteversion using CT scans .Acetabular anteversion ,femotal component anteversion and combined anteversion were statistically ana-lyzed .Results In all the 206 hips ,the mean acetabular components anteversion was 16 .23° ± 8 .27° ,76 .21% of cases was in Lewin-neck′s safe range of 5°-25° .The mean femoral components anteversion was 23 .79° ± 10 .70° .The mean combined anteversion was 40 .02°± 13 .50° ,65 .05% was in safe range of 25°-50°recommended by Dorr .The acetabular components anteversion ,femoral com-ponents anteversion and combined anteversion placed by senior surgeons was no significantly different from those placed by junior orthopedic surgeons(P>0 .05 ,0 .726 ,0 .143 ,0 .061 ,respectively) .Conclusion The conventional freehand technique is an inaccurate method for positioning the cup anteversion or the combined anteversion .The experience of surgeons can not significantly improve this accuracy .