Safe zone for transacetabular screw fixation in prosthetic acetabular reconstruction of high developmental dysplasia of the hip.
Background: Prosthetic reconstruction of hips with Crowe type-IV developmental dysplasia (a high complete dislocation) is technically demanding. Insufficient osseous coverage and osteopenic bone stock frequently necessitate transacetabular screw fixation to augment primary stability of the metal ace...
| Publicado en: | Journal of Bone & Joint Surgery, American Volume Vol. 91; no. 12; pp. 2880 - 2886 |
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| Autores principales: | , , , , , , , , , , , |
| Formato: | Journal Article |
| Publicado: |
Lippincott Williams & Wilkins
Dec2009
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105257386&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 105257386 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00219355 1H2 jtl: Journal of Bone & Joint Surgery, American Volume issn: 00219355 maglogo: N pubinfo: dt: Dec2009 vid: 91 iid: 12 pid: 433 pub: Lippincott Williams & Wilkins place: Baltimore, Maryland artinfo: ui: 105257386 NLM19952251 2010495254 10.2106/JBJS.H.01752 NLM19952251 105257386 ppf: 2880 ppct: 6 formats: tig: atl: Safe zone for transacetabular screw fixation in prosthetic acetabular reconstruction of high developmental dysplasia of the hip. aug: au: Liu Q Zhou YX Xu HJ Tang J Guo SJ Tang QH Liu, Q Zhou, Y X Xu, H J Tang, J Guo, S J Tang, Q H affil: Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China sug: subj: Acetabulum Surgery Arthroplasty, Replacement, Hip Methods Orthopedic Fixation Devices Hip Dislocation, Congenital Surgery Joint Prosthesis Adult Female Diagnostic Imaging Male Middle Age Therapy, Computer Assisted Adult: 19-44 years Middle Aged: 45-64 years Female Male ab: Background: Prosthetic reconstruction of hips with Crowe type-IV developmental dysplasia (a high complete dislocation) is technically demanding. Insufficient osseous coverage and osteopenic bone stock frequently necessitate transacetabular screw fixation to augment primary stability of the metal acetabular shell. We sought to determine whether a previously reported quadrant system for screw fixation of the acetabular cup can be applied in patients with high dislocation of the hip and to define a specialized safe zone for screw fixation in these hips, if needed.Methods: Using volumetric computed tomographic data and image-processing software, we made three-dimensional reconstructions of the osseous and vascular structures in eighteen hips in twelve patients. We virtually reconstructed a cup in the true acetabulum and dynamically simulated transacetabular screw fixation. We mapped the hemispheric cup into several areas and, for each, measured the distance between the virtual screw and the external iliac (femoral) and obturator blood vessels. In the six patients with unilateral high dislocation of the hip and a relatively normal, contralateral hip, the six relatively normal hips served as controls.Results: Reconstruction of the cup at the level of the true acetabulum shifted the center of rotation anteroinferiorly in the hips with a high, complete dislocation. Screws guided by the quadrant system frequently injured the obturator blood vessels in the hips with a high dislocation. In these patients, the safe zone shifted as a result of moving the prosthetic cup.Conclusions: The quadrant system, although helpful in determining screw placement in hips with a normal center of rotation, can be misleading and of less value in guiding screw insertion to augment acetabular shells for hips with a high dislocation. We believe that a safe zone specific to hips with a high dislocation should be used to guide transacetabular screw fixation. pubtype: Academic Journal doctype: Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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