术者如何实现准确地安放预期髋臼假体位置 / 开普饭

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来源：304关节学术

Surgeons' Accuracy in Achieving Their Desired Acetabular Component Orientation

Background: Wide variability in cup orientation has been reported. The aims of this study were to determine how accurate surgeons are at orientating the acetabular component and whether factors such as visual cues and the side of operating table improved accuracy.

Methods: A pelvic model was positioned in neutral alignment on an operating table and was prepared as in a posterior approach. Twenty-one surgeons (9 trainers and 12 trainees) were tasked with positioning an acetabular component in a series of target orientations. The orientation of the component was measured using stereophotogrammetry, and the difference between the achieved orientation and the target orientation was calculated. Tasks included stating the surgeon's preferred orientation and thereafter placing the cup in that orientation, reproducing visual cues (transverse acetabular ligament and alignment guide), altering orientation by 10°, and estimating orientation while on the assistant's side.

Results: The preferred inclination was 42° and the preferred anteversion was 21°. On average, surgeons decreased the inclination by 4° and increased the anteversion by 11° when tasked with replicating their desired orientation. The variability (defined as 2 standard deviations) in achieving a target orientation was 14°. The use of visual cues, such as the transverse acetabular ligament or the alignment guide, significantly improved accuracy to 1° for anteversion (p < 0.001) and -3° for inclination (p = 0.003). In addition, the use of an alignment guide reduced the variability by one-third. Trainees and trainers had similar accuracy and variability. There was greater variability in assessing cup inclination when standing on the assistant's side compared with the surgeon's side of the table, which has implications for training.

Conclusions: Surgeons overestimate operative inclination and underestimate anteversion, which is of benefit, as this, on average, helps to achieve the desired radiographic cup orientation. Although the use of visual cues helps, conventional techniques result in a large variability in acetabular component orientation. New and better guides and methods for training need to be developed.

术者如何实现准确地安放预期髋臼假体位置

译者：张峻

背景：文献报道髋臼杯安放角度变异很大。本研究的目的明确医生如何正确地安放髋臼假体，以及通过视觉线索和参考手术床是否可以提高髋臼假体安放的准确性。

方法：将骨盆模型沿身体中立位轴线摆放在手术台上，拟行后路手术。21个手术医生（9名教师和12名学员）目标是将髋臼假体放在预期角度范围内。通过立体摄影测量髋臼杯角度，并计算安放臼杯的预期角度和实际角度的差异。具体流程包括说明手术医生喜好的预期安放角度，通过复现视觉线索（髋臼横韧带和轴线引导），可以改变10°方向，并在助手一侧位置判断角度，以达到将臼杯安放在预期角度的目的。

结果：预期外展角42°，预期前倾角21°。平均而言，实际外展度减少了4°，前倾角增加了11°。实际角度变异（定义为2个标准差）为14°。使用视觉线索，如髋臼横韧带或轴线引导，可显著提高前倾角1°的准确度（p<0.001），外展角-3°的准确度（p=0.003）。此外，使用轴线引导将变异降低了三分之一。教师和学员有相似的准确性和变异性。当站在助手一侧时，与术者一侧相比，判断臼杯倾角度的变异性更大，这不利于学员学习。

结论：术者术中高估外展角，低估前倾角有一定好处。因为平均而言，这有助于实现预期的髋臼杯角度。虽然使用视觉线索对臼杯安放有所帮助，但传统的技术会对髋臼假体安放变异较大。需要找到新的更好的术中引导参考和方法。

文献出处：Grammatopoulos G, Alvand A, Monk AP, Mellon S, Pandit H, Rees J, Gill HS, Murray DW. Surgeons' Accuracy in Achieving Their Desired Acetabular Component Orientation. J Bone Joint Surg Am. 2016 Sep 7;98(17):e72. doi: 10.2106/JBJS.15.01080. PMID: 27605697.

术者如何实现准确地安放预期髋臼假体位置

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