髋臼内衬背侧磨损的研究进展

RESEARCH PROGRESS OF BACKSIDE WEAR IN ACETABULAR LINERS

目的总结采用组配式髋臼假体行人工全髋关节置换术后髋臼内衬背侧磨损发生机制、磨损程度评估方法、磨损与髋臼侧骨溶解关系以及减少磨损的方法。方法广泛查阅国内外有关髋臼内衬背侧磨损的文献,并进行总结分析。结果髋臼内衬背侧磨损的发生主要与髋臼内衬与臼杯之间微动、髋臼内衬与臼杯接触界面粗糙、髋臼内衬厚度以及股骨颈假体撞击有关,目前磨损程度评估方法只适用于翻修术取出的髋臼内衬。髋臼内衬背侧磨损可产生聚乙烯磨损颗粒,这些磨损颗粒能通过金属臼杯钉孔进入髋臼侧骨质,与髋臼侧骨溶解进程可能有一定关系。针对导致髋臼内衬背侧磨损的因素,可以采取完善锁定机制、使用高抛光接触界面、髋臼内衬与臼杯良好的形合度、提高聚乙烯髋臼内衬质量、减少撞击等措施减少磨损的发生。结论目前尚无评估在体髋臼内衬背侧磨损的方法,背侧磨损与髋臼侧骨溶解以及髋臼侧假体无菌性松动的关系均有待进一步研究。

Objective To summarize the occurrence mechanism of backside wear, the method of evaluating backside surface damage, the relationship between backside wear and osteolysis in acetabulum, and the approach to reduce backside wear in total hip arthroplasty with modular acetabulum prosthesis. Methods The recent articles about the backside wear in acetabular liners were extensively reviewed. Results Backside wear in acetabular liners is connected with micromotion between the liner and the shell, rough interface, thickness of the liner, and impingement. The methods to evaluate backside wear damage are only proceeded in revised acetabular liners. Backside wear can generate polyethylene particles that is likely related to the process of osteolysis in acetabulum through the screw holes of metallic shell. To reduce backside wear between the liner and the shell, measures such as improved locking mechanisms, smooth inner metallic shell, maximized shell liner conformity, improving the quality of polyethylene, and reducing impingement can be taken. Condusion There is no method of evaluating the backside wear in vivo. The relationship between backside wear and osteolysis in acetabulum as well as aseptic loosening of acetabulum prosthesis is controversial.