陶瓷对陶瓷人工髋关节置换手术技巧及相关研究

Surgery technique of ceramic-on-ceramic total hip replacement and related research

[目的]介绍陶瓷对陶瓷髋关节置换的手术方法,分析2种陶瓷髋假体的特点。[方法]自2001年11月～2006年6月间行101例123髋初次全髋置换手术,分别使用Osteonics ABC(型和Option(陶瓷对陶瓷人工髋关节系统。术中严格控制假体位置,并遵循安放陶瓷假体的特殊技巧。取2款陶瓷髋假体进行体外实验:测量理论最大活动范围,测量不同的臼杯位置对发生撞击的影响。[结果]临床和影像学结果令人满意。无骨溶解,无陶瓷碎裂和感染等严重并发症。1例陶瓷部件术中发生边缘崩裂现象,2例出现一过性髂腰肌刺激症状。实验结果:髋臼假体位置直接影响关节活动度。超半径设计对髋关节活动范围影响明显,理论活动范围和臼杯安放位置允许区间均较小。[结论]人工全髋置换术使用陶瓷对陶瓷型假体,需要掌握特殊的手术技巧,超半径设计假体安放要求适当增加髋臼假体前倾角。

[Objective] To introduce the surgical technique of ceramic-on-ceramic total hip replacement and discuss the difference between two implant design. [ Method] From November 2001 to June 2006,123 hip in 101 patients were treated by total hip arthroplasty with Osteonics ABC and Option Hip System. The prosthesis was fixed in strict position following some special technique for ceramic components. The theoretic range of motion of two hip systems were measured from experiment in vitro. The different cup positions which impingement happened were record for each prosthesises. [ Result ] The clinical score and the radiographic position of implants was good without evidence of wear,loosening, osteolysis and ceramic fracture. One chipping of ceramic insert happened during operation, and two patients had temporary irritation of iliopsoas. No other sever complication were found so far such as dislocation and infection. Experiment result ： The deepened cup design obviously decreased the hip range of motion and ＂safe zone＂ was narrow than the flat cup design. [ Conclusion] Ceramic-on-ceramic hip implant highly demands for surgical technique especially accurate cdp position. The deepened cup design cup should be posited with large anteversion.