中国骨伤2025，Vol.38Issue(12)：1249-1255,7.DOI:10.12200/j.issn.1003-0034.20240374
强直性脊柱炎患者髋关节假体个性化安全区的计算与影响因素分析
Calculation of personalized safety zone of hip joint prosthesis in patients with ankylosing spondylitis and analysis of influencing factors
摘要
Abstract
Objective To explore safe zones for acetabular prosthesis implantation in patients with ankylosing spondylitis(AS)at different anterior pelvic plane tilts(APPt),and to determine the optimal implantation angle of the prosthesis through the safe zones with different ranges of motion.To explore the influencing factors of size and scope of the safe zone.Methods CT data of pelvis before total hip arthroplasty(THA)in a 54-year-old male patient with Tonnis stage Ⅳ left hip arthritis,and virtual THA simulated by computer prosthesis with a femoral head diameter of 32 mm,a head-to-neck ratio of 2.67,and a cer-vical-shaft angle of 132° was selected and assembled by tilting forward by 15°.After defining the target range of motion of hip joint that could meet functions such as standing,sitting,and squatting,acetabular prosthesis implantation safety zones corre-sponding to bony impact and prosthesis impact when the anterior pelvic plane inclination angles are-10°,-5°,0°,5°,10°,15°,20° and 25° respectively were calculated.A model to change the parameters of the femoral prosthesis was select and cal-culated the safety zone when different prostheses were implanted.Results When the range of motion of spine and pelvis disap-peared,the safe zone for implant placement could meet the requirements of standing,sitting and squatting was extremely small.When the pelvis was tilted forward by 10° to backward by 25°,the abduction angle of acetabular implant could meet the daily range of motion decreased from 55.7° to 45.8°,and the forward inclination angle decreased from 29.9° to 7.4°.The diameter of femoral head was positively correlated with the size of safe zone.Within the range of 24 to 32 mm,for every 0.17 mm increased in the diameter of femoral head,the safe range of acetabular anterior inclination angle and abduction angle increased for 4° to 6°.For the ball head of the same diameter,the safety zone showed a trend of first increasing and then decreased with the in-crease of cervical shaft angle or anterior inclination angle of femur.Conclusion When AS patients undergo THA,precise im-plantation techniques are required to obtain a safe range of motion that could meet the requirements of standing,sitting and squatting.For patients with obvious anterior or posterior pelvic tilt,personalized prosthesis implantation should be carried out to reduce prosthesis suspension and impact on the iliopsoas muscle.Large-diameter femoral head prostheses are more sensitive to changes in the cervical shaft angle and anterior inclination angle,and the area of the implanted combined safety zone is larger.关键词
强直性脊柱炎/全髋关节置换术/安全区/计算机模拟Key words
Ankylosing spondylitis/Total hip arthroplasty/Safe zone/Computer simulation分类
医药卫生引用本文复制引用
陈胤熹,刘更,付鹏鸽,王启中,王羽昕,李辉..强直性脊柱炎患者髋关节假体个性化安全区的计算与影响因素分析[J].中国骨伤,2025,38(12):1249-1255,7.基金项目
国家自然科学基金(编号:81601913) （编号:81601913）
陕西省自然科学基金(编号:2018JM7049)National Natural Science Foundation of China(No.81601913) （编号:2018JM7049）
