Shuyang Han , Zackary Byrd , Sabir K. Ismaily , Luis E. Delgadillo , Adam M. Freedhand , David Rodriguze-Quintana , Philip C. Noble
{"title":"在通过直接前路进行的全髋关节置换术中，关节囊释放对股骨暴露的贡献。","authors":"Shuyang Han , Zackary Byrd , Sabir K. Ismaily , Luis E. Delgadillo , Adam M. Freedhand , David Rodriguze-Quintana , Philip C. Noble","doi":"10.1016/j.clinbiomech.2024.106303","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>In total hip arthroplasty via the direct anterior approach, appropriate exposure is critical to allow preparation of the femur. The objective of this study was to explore the optimal soft tissue releases needed to allow broaching of the femur through a combination of experimental tests and computer simulations.</p></div><div><h3>Methods</h3><p>Fourteen full-body cadaveric specimens were included in this study. Total hip arthroplasty was performed via the direct anterior approach with the femur at 20° adduction and 20°extension. Soft tissue releases were performed sequentially, namely, the transverse iliofemoral ligament, descending iliofemoral ligament, ischio-femoral ligament, conjoint tendon, and obturator externus. After each release, the femur mobility was assessed by applying a 6 Nm external rotation torque and a 120 N distraction force. Subsequently, using specimen-specific models and models of the broach and handle, the broach passage after each release was simulated, and the release that allowed broach passage was analyzed.</p></div><div><h3>Findings</h3><p>The average external rotation after releasing the transverse and descending iliofemoral ligaments increased by 14.1° ± 6.1° and 13.8° ± 5.3°. With subsequent soft tissue releases, the rotational mobility increased incrementally, though the impact decreased. Impingement between the broach passage and the pelvis was mainly at the anterior superior iliac spine and the anterior inferior iliac spine. The volume of impingement decreased from 4.8 ± 4.5 cm<sup>3</sup> after resection of the femoral head to 1.8 ± 1.6 cm<sup>3</sup> and 1.2 ± 1.9 cm<sup>3</sup> after release of the transverse and descending iliofemoral ligament, respectively.</p></div><div><h3>Interpretation</h3><p>With sequential soft-tissue releases, the femur mobility increased incrementally. However, the number of releases needed for each femur varied extensively between specimens. Most (10/14) femurs became accessible after the release of the ilio-femoral or ischio-femoral ligament.</p></div>","PeriodicalId":50992,"journal":{"name":"Clinical Biomechanics","volume":null,"pages":null},"PeriodicalIF":1.4000,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Contributions of capsular releases to femoral exposure in total hip arthroplasty via the direct anterior approach\",\"authors\":\"Shuyang Han , Zackary Byrd , Sabir K. Ismaily , Luis E. Delgadillo , Adam M. Freedhand , David Rodriguze-Quintana , Philip C. Noble\",\"doi\":\"10.1016/j.clinbiomech.2024.106303\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>In total hip arthroplasty via the direct anterior approach, appropriate exposure is critical to allow preparation of the femur. The objective of this study was to explore the optimal soft tissue releases needed to allow broaching of the femur through a combination of experimental tests and computer simulations.</p></div><div><h3>Methods</h3><p>Fourteen full-body cadaveric specimens were included in this study. Total hip arthroplasty was performed via the direct anterior approach with the femur at 20° adduction and 20°extension. Soft tissue releases were performed sequentially, namely, the transverse iliofemoral ligament, descending iliofemoral ligament, ischio-femoral ligament, conjoint tendon, and obturator externus. After each release, the femur mobility was assessed by applying a 6 Nm external rotation torque and a 120 N distraction force. Subsequently, using specimen-specific models and models of the broach and handle, the broach passage after each release was simulated, and the release that allowed broach passage was analyzed.</p></div><div><h3>Findings</h3><p>The average external rotation after releasing the transverse and descending iliofemoral ligaments increased by 14.1° ± 6.1° and 13.8° ± 5.3°. With subsequent soft tissue releases, the rotational mobility increased incrementally, though the impact decreased. Impingement between the broach passage and the pelvis was mainly at the anterior superior iliac spine and the anterior inferior iliac spine. The volume of impingement decreased from 4.8 ± 4.5 cm<sup>3</sup> after resection of the femoral head to 1.8 ± 1.6 cm<sup>3</sup> and 1.2 ± 1.9 cm<sup>3</sup> after release of the transverse and descending iliofemoral ligament, respectively.</p></div><div><h3>Interpretation</h3><p>With sequential soft-tissue releases, the femur mobility increased incrementally. 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Contributions of capsular releases to femoral exposure in total hip arthroplasty via the direct anterior approach
Background
In total hip arthroplasty via the direct anterior approach, appropriate exposure is critical to allow preparation of the femur. The objective of this study was to explore the optimal soft tissue releases needed to allow broaching of the femur through a combination of experimental tests and computer simulations.
Methods
Fourteen full-body cadaveric specimens were included in this study. Total hip arthroplasty was performed via the direct anterior approach with the femur at 20° adduction and 20°extension. Soft tissue releases were performed sequentially, namely, the transverse iliofemoral ligament, descending iliofemoral ligament, ischio-femoral ligament, conjoint tendon, and obturator externus. After each release, the femur mobility was assessed by applying a 6 Nm external rotation torque and a 120 N distraction force. Subsequently, using specimen-specific models and models of the broach and handle, the broach passage after each release was simulated, and the release that allowed broach passage was analyzed.
Findings
The average external rotation after releasing the transverse and descending iliofemoral ligaments increased by 14.1° ± 6.1° and 13.8° ± 5.3°. With subsequent soft tissue releases, the rotational mobility increased incrementally, though the impact decreased. Impingement between the broach passage and the pelvis was mainly at the anterior superior iliac spine and the anterior inferior iliac spine. The volume of impingement decreased from 4.8 ± 4.5 cm3 after resection of the femoral head to 1.8 ± 1.6 cm3 and 1.2 ± 1.9 cm3 after release of the transverse and descending iliofemoral ligament, respectively.
Interpretation
With sequential soft-tissue releases, the femur mobility increased incrementally. However, the number of releases needed for each femur varied extensively between specimens. Most (10/14) femurs became accessible after the release of the ilio-femoral or ischio-femoral ligament.
期刊介绍：
Clinical Biomechanics is an international multidisciplinary journal of biomechanics with a focus on medical and clinical applications of new knowledge in the field.
The science of biomechanics helps explain the causes of cell, tissue, organ and body system disorders, and supports clinicians in the diagnosis, prognosis and evaluation of treatment methods and technologies. Clinical Biomechanics aims to strengthen the links between laboratory and clinic by publishing cutting-edge biomechanics research which helps to explain the causes of injury and disease, and which provides evidence contributing to improved clinical management.
A rigorous peer review system is employed and every attempt is made to process and publish top-quality papers promptly.
Clinical Biomechanics explores all facets of body system, organ, tissue and cell biomechanics, with an emphasis on medical and clinical applications of the basic science aspects. The role of basic science is therefore recognized in a medical or clinical context. The readership of the journal closely reflects its multi-disciplinary contents, being a balance of scientists, engineers and clinicians.
The contents are in the form of research papers, brief reports, review papers and correspondence, whilst special interest issues and supplements are published from time to time.
Disciplines covered include biomechanics and mechanobiology at all scales, bioengineering and use of tissue engineering and biomaterials for clinical applications, biophysics, as well as biomechanical aspects of medical robotics, ergonomics, physical and occupational therapeutics and rehabilitation.
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