吴毅东, 于康康, 张佳, 李中耀, 滕浩然, 肇刚, 安明扬, 王明新, 李春宝. 髋关节镜手术入路建立:髋臼眉弓中点标定法的应用[J]. 解放军医学院学报, 2023, 44(6): 594-599, 606. DOI: 10.3969/j.issn.2095-5227.2023.06.004
引用本文: 吴毅东, 于康康, 张佳, 李中耀, 滕浩然, 肇刚, 安明扬, 王明新, 李春宝. 髋关节镜手术入路建立:髋臼眉弓中点标定法的应用[J]. 解放军医学院学报, 2023, 44(6): 594-599, 606. DOI: 10.3969/j.issn.2095-5227.2023.06.004
WU Yidong, YU Kangkang, ZHANG Jia, LI Zhongyao, TENG Haoran, ZHAO Gang, AN Mingyang, WANG Mingxin, LI Chunbao. Establishment of hip arthroscopic portals: Application of acetabular sourcil midpoint calibration[J]. ACADEMIC JOURNAL OF CHINESE PLA MEDICAL SCHOOL, 2023, 44(6): 594-599, 606. DOI: 10.3969/j.issn.2095-5227.2023.06.004
Citation: WU Yidong, YU Kangkang, ZHANG Jia, LI Zhongyao, TENG Haoran, ZHAO Gang, AN Mingyang, WANG Mingxin, LI Chunbao. Establishment of hip arthroscopic portals: Application of acetabular sourcil midpoint calibration[J]. ACADEMIC JOURNAL OF CHINESE PLA MEDICAL SCHOOL, 2023, 44(6): 594-599, 606. DOI: 10.3969/j.issn.2095-5227.2023.06.004

髋关节镜手术入路建立:髋臼眉弓中点标定法的应用

Establishment of hip arthroscopic portals: Application of acetabular sourcil midpoint calibration

  • 摘要:
      背景  目前髋关节镜手术在建立入路时缺乏准确定位穿刺方向的方法。
      目的  提出一种在建立髋关节镜手术入路时辅助定位穿刺方向的方法,验证其在建立前外侧(anterolateral,AL)入路、改良前方(modified anterior,MA)入路时定位穿刺方向的可行性和准确性。
      方法  前瞻性招募2021年1月 - 2022年6月于我科接受髋关节镜手术的患者。术中在透视下采用实心钢珠定位髋臼眉弓中点体表标志点,以其尾侧5 mm处作为建立入路的穿刺定位点。建立AL、MA入路时按穿刺定位点方向穿刺,该方法称为髋臼眉弓中点标定法。计算此方法穿刺进入关节间隙的准确率。术中测量眉弓中点体表标志点与同侧髂前上棘最下缘之间的水平距离(X)和垂直距离(Y),分析X和Y的离散程度。用多元线性回归方法分析X、Y与患者一般资料、骨盆正位X线片影像学参数的相关性。
      结果  共招募53例髋关节镜手术病例,其中男34例,女19例;年龄(34.91 ± 12.26)岁;手术侧别左侧25例,右侧28例。髋臼眉弓中点标定法建立AL入路的穿刺准确率为94.3%;建立MA入路的穿刺准确率为90.6%。水平距离(X)为(2.94 ± 1.07) cm (95% CI:0.80 ~ 4.79 cm),服从正态分布;垂直距离(Y)为(1.64 ± 1.02) cm (95% CI:0 ~ 3.76 cm),服从正态分布。距离X和Y与患者一般资料、骨盆正位X线片影像学参数均不存在显著相关性(P>0.05)。
      结论  建立AL、MA入路时,髋臼眉弓中点标定法可准确定位穿刺方向。建立入路前可通过水平距离(X)、垂直距离(Y)的均值和95% CI初步确定眉弓中点体表标定点的位置,有助于快速定位标定点。

     

    Abstract:
      Background  Currently, there is a lack of methods to accurately determine the direction of puncture when establishing the hip arthroscopy portals.
      Objective   To propose a method for assisting in determination of the direction of puncture for anterolateral (AL) and modified anterior (MA) portals for hip arthroscopy, and verify its feasibility and accuracy.
      Methods  Patients who were proposed to undergo hip arthroscopy in our department from January 2021 to June 2022 were recruited prospectively. Intraoperatively, a solid steel ball was used under fluoroscopy to locate the acetabular sourcil midpoint body marker (SMBM), and a point 5 mm caudal to the SMBM was used as the puncture location point for establishing portals. When establishing the AL and MA portals, the puncture was performed in the direction of the puncture location point, and this method was called the acetabular sourcil midpoint calibration. The accuracy of the puncture into the joint space was calculated. The horizontal distance (X) and vertical distance (Y) between the SMBM and the inferior edge of the anterior superior iliac spine (ASIS) were measured intraoperatively, and the dispersion of these distances was analyzed. Multiple linear regression was used to analyze the correlation of the horizontal (X) and vertical (Y) distances in relation to the patient's general information and the imaging parameters of anteroposterior pelvis radiograph.
      Results  A total of 53 hip arthroscopy cases were recruited, including 34 males and 19 females, with average age of 34.91 ± 12.26 years. Twenty-five cases were on the left side and 28 cases were on the right side. The puncture accuracy rate was 94.3% for the establishment of the AL portal and 90.6% for the establishment of the MA portal. The horizontal distance (X) was 2.94 ± 1.07 cm (95% CI: 0.80-4.79 cm), following a normal distribution; the vertical distance (Y) was 1.64 ± 1.02 cm (95% CI: 0.00-3.76 cm), following a normal distribution. The horizontal (X) and vertical (Y) distances were not significantly correlated with the patients' general information and the imaging parameters of anteroposterior pelvis radiograph (P > 0.05).
      Conclusion  While establishing the AL and MA portals, the acetabular sourcil midpoint calibration can locate the exact puncture direction. The location of the SMBM can be initially determined by the mean and 95% confidence interval of the horizontal distance (X) and vertical distance (Y) before establishing portals.

     

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