骨盆体位性角度变化三维监测对髋关节置换的临床意义

目的对正常人骨盆体位变动下相应髋臼角度的三维监测观察，为临床上髋关节假体置入的角度判定提供解剖学参考依据。方法对60名受试者于不同体位下进行骨盆侧位X线摄片并进行前倾角监测。摄片体位包括自然站立位、自然仰卧位及屈髋抱膝仰卧位。结果在自然站立位、自然仰卧位及屈髋抱膝仰卧位的前倾角分别为——青年组：64．2°±3．33°，60．6°±3．53°，45．4°±5．69°；老年组：68．0°±3．33°，67．0°±3．92°，55．0°±3．34°。站立位较自然卧位骨盆前倾角差值均数为3．56°（青年组）和3．60°（老年组）。站立位较屈髋抱膝仰卧位骨盆前倾角均数差值为18．8°（青年组），12．1°（老年组）。结论屈髋抱膝仰卧位较站立位时骨盆前倾角变化显著，使得髋臼窝开口与躯干水平面及矢状面间角度改变较大．会影响关节置换术臼杯置入角度的准确性，因此在临床上应予以重视。

Clinical value of three-dimensional monitoring in the change of pelvic postural angle for total hip replacement

Objective To observe the motion range of the human pelvis in different position and evaluate the change of acetabular orientation during total hip replacement. Methods The X-ray photographs of lateral-position of pelvis in different positions were taken and the anteversion angles of pelvis were measured on the X-ray photograph. The positions included standing position, dorsal position and hip-flexion dorsal position. Results The anteversion angle of pelvis on the X-ray photograph of standing position, dorsal position and hip-flexion dorsal position were respectively 64.2°±3.33°, 60.6°±3.53°, 45.4°±5.69° （young group） and 68.0°±3.33°, 67.0°±3.92°, 55.0°±3.34° （elder group）. Differential value mean of anteversion angle between standing position and dorsal position were 3.56°±1.41° in young group and 3.60°±1.34° in elder group. The mean differential value of standing position and hip-flexion dorsal position were 18.8°±4.74° in young group and 12.1°±2.48° in elder group. Conclusion The change of the anteversion angle of pelvis is very significant between standing position and hip-flexion dorsal position. It would lead to significantly change of the acetabular orientation. Therefore, it must be abended during total hip replacement.