人工全髋关节置换髋臼假体稳定性的实验研究

Experimental research on stability of acetabulum prosthesis of artificial total hip replacement

目的采用不同锉臼方法重建髋臼,比较髋臼假体试模植入后的稳定性,得出何种方法重建后植入的髋臼假体试模更稳定,为临床应用提供参考。方法采集皖西卫生职业学院解剖教研室完整防腐骨盆标本10具。使用同心圆形顺序和非顺序锉臼、非同心圆形顺序和非顺序锉臼,4种锉臼方式。同一骨盆的两侧髋臼设置成一区组。一侧使用同心圆形锉臼重建髋臼,两种方式先顺序锉臼,压配假体试模、测量;在此基础上非顺序锉臼重建髋臼再次测量;另一侧使用非同心圆形锉臼重建髋臼,使用相同方式顺序和非顺序锉臼,压配假体试模。测量髋臼假体试模的抗旋转扭矩和抗拔出力。4种处理手段分别为4个处理组,数据比较采用方差分析;组间两两比较行SNK-q检验。结果同心圆形顺序锉臼重建后髋臼假体试模的抗拔出力(83.8±3.3)N,抗旋转扭矩(26.5±2.6)Nm;与同心圆形非顺序锉臼重建抗拔出力(93.6±2.2)N,抗旋转扭矩(34.8±2.2)Nm。非同心圆形顺序锉臼重建抗拔出力(69.2±2.9)N,抗旋转扭矩(12.1±2.6)Nm,与非同心圆形非顺序锉臼重建抗拔出力(75.3±2.2)N,抗旋转扭矩(16.8±1.9)Nm。经过统计学分析,在抗旋转扭矩实验中,各处理组间扭矩有差异(F=443.8,P<0.05),每区组间扭矩有差异(F=6.2,P<0.05)。为进一步了解处理组间均数两两比较情况,SNK-q检验显示各处理组间抗旋转扭矩均值完全不相等。在轴向抗拔出力实验中,各处理组间抗拔出力有差异(F=187.2,P<0.05),每区组间抗拔出力无差异(F=1.9,P>0.05)。组间均数两两比较显示各处理组间抗拔出力均值完全不相等。抗拔出力和抗旋转扭矩呈现出同心圆形非顺序锉臼>同心圆形顺序锉臼>非同心圆形非顺序锉臼>非同心圆形顺序锉臼的结果。结论在尸体骨盆标本实验中得出同心圆形重建髋臼后半球形髋臼假体试模更稳定;在非顺序锉臼重建的髋臼窝中,假体试模植入后稳定性更强。同心圆形和非顺序两种锉臼重建方式重建髋臼操作简单、可行。

Objective To compare the stability of the acetabulum prosthesis after using different methods of filing acetabulum to reconstruct acetabulum,find out more stable methods and provide reference for clinical application.Methods Complete 10 antiseptic pelvic specimens from the Anatomy Teaching and Research Section of West Anhui Health Vocational College were collected.The concentric circular sequence filing(CCSF),the concentric circular non-sequence filing(CCNSF),the non-concentric circular sequence filing(NCCSF)and the concentric circular non-sequence filing(NCCNSF)were used to file the acetabulum.Both sides of the pelvic acetabulums were sat on one block.On one side the acetabulum was filed using concentric circles to reconstruct acetabulum by two ways:the acetabulum was sequence filed,the prosthesis was pressed for trial and measured.Based on the sequence filing,the acetabulum was then non-sequence filed and measured again.On the other side the non-concentric circles filing was applied to reconstruct acetabulum,by which the acetabulum was sequence and non-sequence filed,and the prosthesis was pressed for trial again.Rotary torque resistance and pull-out capacity of the acetabulum prosthesis were measured.Four kinds of acetabulum filing methods were designed to be four different groups.Data were compared by variance analysis and SNK-q test.Results In CCSF group,the pull-out capacity of the acetabulum prosthesis was(83.8±3.3)N,rotating torque resistance was(26.5±2.6)Nm In CCNSF group,the pull-out capacity was(93.6±2.2)N,rotating torque resistance was(34.8±2.2)Nm.In NCCSF group,the pull-out capacity was(69.2±2.9)N,rotating torque resistance was(12.1±2.6)Nm,while in NCCNSF group,the pull-out capacity was(75.3±2.2)N,and rotating torque resistance was(16.8±1.9)Nm.The differences in rotary torque resistance among the groups and the different blocks were statistically significant(F=443.8,6.2,both P<0.05).SNK-q test showed the rotating torque resistance was non-equal between the four groups.The differences in axial pull-out capacity among the groups were statistically significant(F=187.2,P<0.05),while there was no-difference among the different blocks(F=1.9,P>0.05).SNK-q test showed the pull-out capacity complete no-equal.Pull-out capacity and rotary torque resistance presented as CCNSF>CCSF>NCCNSF>NCCSF.Conclusions In the pelvic specimen experiments,posterior hemispherical cup prosthesis is more stable in concentric circular reconstruction of acetabulum,the stability of prosthesis in the acetabulum fossa reconstructed by non-sequence filing is stronger.The concentric circular and non-sequence filing can increase prosthesis stability.