人工髋关节无菌性松动失效的生物力学分析与诊断推理

Biomechanical analysis and reasoning on aseptic loosening failure after total hip arthroplasty

目的研究人工髋关节置换术后无菌性松动失效的力学机理以及引发松动的具体原因,提出对临床中发生无菌性松动事件进行失效诊断的具体方法。方法从骨水泥层强度、界面微动、应力遮挡、磨损与骨溶解等生物力学角度对无菌性松动的成因进行研究,分析无菌性松动失效与产品、临床和患者等因素的关系,并研究翻修术前检测松动的方法。结果提出无菌性松动失效原因推理路线图,成功利用荧光透视分析(fluoroscopic analysis,FSA)技术在翻修术前对无菌性松动进行了在体测定。结论无菌性松动失效分析推理路线图可以帮助展开失效事件的原因挖掘,应用FSA方法可以对松动进行在体测定与确认,辅助医生开展人工髋关节置换术后无菌性松动失效的诊治。

Objective To propose some detailed methods for diagnosis of aseptic loosening failure in clinic by studying the mechanical mechanism and the specific causes of aseptic loosening failure after the total hip arthro- plasty （THA）. Methods The causes of aseptic loosening were investigated from the view of biomechanics, such as strength of the bone cement layer, interface fretting, stress shielding, wear and osteolysis; the relationships between aseptic loosening failure and products, clinical and patient factors were analyzed; the method to detect loosening before the revision surgery was also studied. Results The reasoning route for aseptic loosening failure analysis after THA was proposed, and detection of aseptic loosening with fluoroscopic analysis （FSA） technique before the revision surgery was conducted successfully. Conclusions The reasoning route for aseptic loosening failure analysis can help to discover reasons of failure occurrence. Loosening can be detected and confirmed in vivo by FSA method, which can also assist the clinician for diagnosis and treatment of aseptic loosening after the THA.