The Risk Area Of The Main Blood Vessels Around The Acetabulum In Total Hip Arthroplasty And Its Relationship With Gender: In Vivo Three-Dimensional Model Analysis

Objectives:For total hip arthroplasty,vascular injury caused by the placement of acetabular screws is undoubtedly the most serious complication,often resulting in fatal consequences.Therefore,the main purpose of this study is to explore the dangerous areas of the major blood vessels around the acetabulum and to compare whether they are related to gender.Methods:Retrospectively collecting CT data of 40 patients who underwent lower limb CT angiography(CTA),including 20 males and 20 females.A customized software was used to construct a three-dimensional(3D)model of the patient’s pelvic bone and blood vessels,into which a virtual cup was implanted.The cup was divided into polar and non-polar regions,with the non-polar region further divided into four areas:anterior superior,anterior inferior,posterior superior,and posterior inferior.The blood vessels were projected onto the cup,and we quantitatively measured the dangerous areas of these blood vessels on the cup,the shortest distance from the outer surface of the cup to the blood vessels(the safe distance of the blood vessels),and the maximum length of the hip socket screws that could be safely implanted.We compared these parameters between males and females.Results:For polar regions,both the closure artery and hip artery projections on the acetabulum originate or pass through this area.For non-polar region,the danger zone of the external iliac artery is mainly located in the anterior superior area.The minimum longitude value of the external iliac artery in female patients is-4.6±14.4°,which is lower than that of male patients(6.9±11.0°),with statistical significance(p<0.05).However,there is no significant difference between the two groups in terms of maximum longitude value.The danger zone angle of the external iliac artery in females is larger than that in males(67.6±15.0 vs.58.1±13.4),with statistical significance(p<0.05).The safe distance of the external iliac artery in males is larger than that in females(18.2±2.5mm vs.14.9±3.3mm),with statistical significance(p < 0.05).Regardless of gender,the danger zone of the closure artery is distributed in the anterior inferior region.The minimum and maximum longitude values of male and female patients differ significantly(98.2±12.5° vs.110.4±12.4°,and 127.7±10.6° vs.135.7±14.0°,respectively)with statistical significance(p<0.05).However,there are no significant differences between the two groups in terms of the angle and safe distance of the closure artery.The danger zone of the gluteal artery is mainly concentrated in the posterior superior area.The minimum and maximum longitude values of male and female patients differ significantly(244.8±13.9° vs.253.8±12.9° and 329.5±5.3° vs.334.5±5.7°,respectively)with statistical significance(p<0.05).However,there is no significant difference between the two groups in terms of the angle and safe distance of the gluteal artery.The longest safe screw length for male and female patients is 118.3±5.4mm and118.0±4.8mm,there is no significant statistical difference between the two groups(p>0.05).Conclusions:This study used computer-assisted three-dimensional reconstruction models to analyze the main vascular regions around the acetabulum in total hip replacement.For the external iliac artery,the danger zone is mainly concentrated in the anterior upper region,and compared to males,the danger zone range for females is wider and more likely to be damaged.For the obturator artery,the danger zone is mainly distributed in the anterior lower region,slightly higher in males,and the outer surface of the acetabulum is very close to the obturator artery in this area,making it more prone to injury from nail placement.For the superior gluteal artery,the danger line area is mainly distributed in the posterior upper region,but the safety distance of this vessel is longer.When the implanted screw length is less than 35 mm,this area is relatively safe.For clinical doctors,the quantitative values measured in our study can be used to help reduce the risk of pelvic vascular injury during total hip replacement.