Proposed Referential Index to Resect Femoroacetabular Cam-Type Impingement During Arthroscopy Using a Cadaveric Hip Model
Proposed Referential Index to Resect Femoroacetabular Cam-Type Impingement During Arthroscopy Using a Cadaveric Hip Model
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DOI：
10.1016/j.arthro.2014.12.024
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发表时间：
2015-06-01
影响因子：
4.7
通讯作者：
Nakamura, Hiroaki
中科院分区：
文献类型：
--
作者：
Yamasaki, Shinya;Hashimoto, Yusuke;Nakamura, Hiroaki
目的：建立一个参考指标，用于关节镜下凸轮型撞击最佳切除点的简单确定。研究方法：检查了12例中心-边缘角为20 °至40 °的左侧尸体髋关节，无骨关节炎（平均年龄85 ± 10.1岁）。固定骨盆，使骨盆前平面和股骨平行于手术台。撞击的截骨线首先定义在髋臼唇远端5 mm的股骨头表面上，从9点钟（前部）到12点钟（上级）位置。接下来，我们测量了头颈交界处到达切除线所需的髋关节屈曲角度。在股骨头表面沿着从股骨头9- 12点区域的切除线定位导丝后，我们使用蛙腿45/45/30视图在髋关节屈曲0度、15度、30度、45度和60度的X线片上测量目标α角（屈曲45度，外展45度，外旋30度）和Dunn 45视图（屈曲45度，外展20度，中性旋转）。结果：头颈交界处达到切除线时的平均髋关节屈曲角为31 ° ± 4.6 °。对于0 °、15 °、30 °、45 °和60 °髋关节屈曲，平均目标α角分别为75.5 ° ± 5.5 °、65.3 ° ± 5.6 °、56.3 ° ± 5.8 °、49.0 ° ± 6.6 °和42.6 ° ± 5.8 °，使用蛙腿45/45/30视图分别为75.0度+/-6.0度、65.8度+/-6.2度、57.2度+/-7.3度、50.7度+/-6.9度和44.2度+/-5.8度。两种影像学技术之间无显著差异（分别为P = 0.82、P = 0.84、P = 0.76、P = 0.57和P = 0.52）。结论：当使用盂唇作为截骨参考时，对凸轮截骨期间髋关节屈曲度的描述可能会影响最终α角。
Purpose: To establish a reference index for the simple identification of the optimum resection point for cam-type impingement on arthroscopy. Methods: Twelve cadaveric left hips with a 20 degrees to 40 degrees center-edge angle, without osteoarthritis, were examined (mean age, 85 +/- 10.1 years). The pelvis was fixed such that the anterior pelvic plane and femur were parallel to the table. The resection line for impingement was first defined on the femoral head surface 5 mm distal to the acetabular labrum, from the 9-o'clock (anterior) to 12-o'clock (superior) position. Next, we measured the hip flexion angle necessary for the head-neck junction to reach the resection line. After positioning the wire on the femoral head surface along the resection line from the 9- to 12-o'clock area of the femoral head, we measured the target alpha angle on radiographs at 0 degrees, 15 degrees, 30 degrees, 45 degrees, and 60 degrees of hip flexion using the frog-leg 45/45/30 view (45 degrees of flexion, 45 degrees of abduction, and 30 degrees of external rotation) and Dunn 45 view (45 degrees of flexion, 20 degrees of abduction, and neutral rotation). Results: The mean hip flexion angle at which the head-neck junction reached the resection line was 31 degrees +/- 4.6 degrees. For 0 degrees, 15 degrees, 30 degrees, 45 degrees, and 60 degrees of hip flexion, the mean target alpha angle was 75.5 degrees +/- 5.5 degrees, 65.3 degrees +/- 5.6 degrees, 56.3 degrees +/- 5.8 degrees, 49.0 degrees +/- 6.6 degrees, and 42.6 degrees +/- 5.8 degrees, respectively, using the frog-leg 45/45/30 view and 75.0 degrees +/- 6.0 degrees, 65.8 degrees +/- 6.2 degrees, 57.2 degrees +/- 7.3 degrees, 50.7 degrees +/- 6.9 degrees, and 44.2 degrees +/- 5.8 degrees, respectively, using the Dunn 45 view. There were no significant differences between the 2 radiographic techniques (P = .82, P = .84, P = .76, P = .57, and P = .52, respectively). Conclusions: A description of the degree of hip flexion during cam resection can affect the final alpha angle when using the labrum as a reference for resection.