Objective： To study the stress distribution of the femoral hip prosthesis after the hip joint replacement. Methods： After the hip joint replacement, when the fenmr and prosthesis are considered as concentric cylinde...Objective： To study the stress distribution of the femoral hip prosthesis after the hip joint replacement. Methods： After the hip joint replacement, when the fenmr and prosthesis are considered as concentric cylinders with perfectly banded interface, a relatively perfect theoretical model of simulating the interracial stress transfer is established. Results： The maximum interfaeial shear stress oeeured at Z=O. At the cross-section of the femoral neck, interfacial shear stress decreased exponentially with the increases of the Z. Shear stress became very small at Z〉0. 1 m, which meant that the shear stress at the far end of the femoral hip prosthesis was very small. In order to avoid the stress concentration and femoral hip prosthesis sinking, interracial stress must remain constant and balanced with the pressure load at Z=O. The radius of the femoral hip prosthesis changed with interfacial shear stress. The maximum value of the radius occured at Z=O, then it decreased at m. Specially, a=18.2 mm at Z=10 ram, a=5.36 mm at Z=98 ram, these are ideal radius. Conclusion： A theoretical model of simulating the interfacial stress is established when the femur and prosthesis are considered as concentric cylinders. The distributions of the interfacial shear and radial stresses with the axial positions are obtained. A theoretical reference for the design of the prosthesis is provided.展开更多
The hip joint femoral head prosthesis was prepared using the Al2O3 material, which was synthesized by high purity alumina micro-powder and Mg- Zr- Y composite addhitives , the cold manufacturing techniques of lathe t...The hip joint femoral head prosthesis was prepared using the Al2O3 material, which was synthesized by high purity alumina micro-powder and Mg- Zr- Y composite addhitives , the cold manufacturing techniques of lathe turning, grade polishing and the matching size correction of the sintered femoral head were studied. The results showed, after being pressed under 200 MPa cold isostatic pressure and being pre-sintered at 1150℃ , the biscuit＇ s strength can meet the demands of lathe turning ; After being grade polished by SiC micro-powder and diamond abrading agent and being size corrected by special instrument, the femoral head prosthesis of Al2O3 ceramic has good surface degree of finish and articulates tightly with femoral handle.展开更多
The total hip replacement rationale, since 1960 when it was introduced by Sir Charnley, has been modified and evolved until nowadays thanks to laboratory research and clinical trials. This evolution followed a guideli...The total hip replacement rationale, since 1960 when it was introduced by Sir Charnley, has been modified and evolved until nowadays thanks to laboratory research and clinical trials. This evolution followed a guideline whose milestones are: 1) the surgical approach and implantation technique (ex: detachment of the greater trochanter);2) to use or not to use cement;3) the evolution of materials (titanium, ceramic, x-linked polyethylene);4) the identification of the debris-disease rather than the cement-disease;5) studies focused on bone-prosthesis interaction and biological phenomena related. Between those studies, the authors consider crucial the introduction of tissue sparing surgery and femoral neck preserving rationale, concepts to which they have devoted their scientific research and clinical experience for over the last 30 years, from 1980 to nowadays.展开更多
BACKGROUND The uncemented ArcosTM Modular Femoral Revision System(ARCOS)is a new comprehensive,press-fit revision design.The modular design offers a wide range of possible combinations to accommodate different variati...BACKGROUND The uncemented ArcosTM Modular Femoral Revision System(ARCOS)is a new comprehensive,press-fit revision design.The modular design offers a wide range of possible combinations to accommodate different variations of anatomy and bone stock.The ARCOS is made by a proximal body and a distal stem.As probably the only ones worldwide we predominantly use a combination of body and stem which supports proximal fixation and load,since this mimics the concept of the primary total hip arthroplasty with proximal weight-bearing,leading to bone stock preservation and no stress shielding or thigh pain.AIM To evaluate the early results after femoral revision in a consecutive series of patients undergoing surgery over 3 years.METHODS We included 116 patients in the study.They were operated in the period August 2011 to December 2014 and we got a clinical mean observation time of 4(0.5-6)years.Clinical and radiographical follow-up included present function of the hip assessed by Harris Hip Score,Oxford Hip Score,and EQ5D(measure of health outcome).Of the 116 patients,17 died in the interim and were consequently included only in the implant survivorship analysis;46 patients attended the follow-up control.RESULTS In total 6(5%)hips were re-revised due to infection(n=3),fracture(n=2)or subsidence(n=1).No patient was re-revised due to aseptic loosening.The 1-,2-and 5-year probability of implant survival(95%CI)were 97%(93%-100%),97%(93%-100%)and 96%(92%-99%),respectively.In this cohort 95 patients received a combination of a proximal broach and a distal curved and slotted stem(BS),aiming for proximal fixation and load bearing;21 patients received a different combination.When comparing these two groups the BS-group had a 5-year implant survival probability(95%CI)of 97%(93%-100%)compared with the group of other combinations with a 5-year implant survival probability(95%CI)of 90%(78%-100%)(P=0.3).Our regression analysis showed that periprosthetic fracture as an indication for the ARCOS operation was the only significant negative outcome predictor.The mean Harris Hip Score result(100 points being best)was 83(range 5-98).The mean Oxford Hip Score result(48 points being best)was 40(range 19-48).CONCLUSION The early results of the ARCOS are promising compared with similar studies.We encourage the use of the BS combination whenever the bone stock proximally is adequate.展开更多
目的探讨分析老年股骨颈骨折应用骨水泥型人工髋关节和生物型人工髋关节置换治疗的临床疗效以及应用价值。方法回顾性选取2020年1月—2023年1月龙口市人民医院收治的100例老年骨质疏松性股骨颈骨折行人工髋关节置换术治疗的患者的临床资...目的探讨分析老年股骨颈骨折应用骨水泥型人工髋关节和生物型人工髋关节置换治疗的临床疗效以及应用价值。方法回顾性选取2020年1月—2023年1月龙口市人民医院收治的100例老年骨质疏松性股骨颈骨折行人工髋关节置换术治疗的患者的临床资料,根据假体类型的不同分为研究组(n=50)和参照组(n=50)。对实施不同的假体置换后,比较两组患者的手术时间、术中出血量、术后引流量、异位骨化程度、术后假体稳定性、髋关节功能评分量表(Harris Hip Joint Function Scale,Harris)以及术后并发症发生情况。结果术后6个月,两组患者均开展X线检查,研究组假体稳定率明显高于参照组,差异有统计学意义(P<0.05)。研究组并发症发生率低于参照组(0 vs 4.00%),差异无统计学意义(χ^(2)=0.510,P>0.05)。结论相对于骨水泥型假体,使用生物型假体进行人工髋关节置换髋关节功能恢复效果更好,能够有效降低并发症的发生率,加快术后恢复,应用价值高。展开更多
The purpose of the letter is to introduce a madreporic porous artificial hip prosthesis with bone-ingrowth self-locking fixation. Co—Cr—Mo alloy steel femoral head replacement was performed on 16 adult dogs divided ...The purpose of the letter is to introduce a madreporic porous artificial hip prosthesis with bone-ingrowth self-locking fixation. Co—Cr—Mo alloy steel femoral head replacement was performed on 16 adult dogs divided into four groups (according to survey period of 5, 10, 15 and 20 weeks after operation), four in each group. After surgery, the function recovery of the operated limbs was recorded strictly. Roentgenograms of double hips were展开更多
目的:探讨微创股骨头置换术与股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)内固定术治疗高龄粉碎性股骨转子间骨折患者的临床疗效。方法:2020年4月至2020年10月治疗高龄粉碎性股骨转子间骨折患者76例,分别采用微创股...目的:探讨微创股骨头置换术与股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)内固定术治疗高龄粉碎性股骨转子间骨折患者的临床疗效。方法:2020年4月至2020年10月治疗高龄粉碎性股骨转子间骨折患者76例,分别采用微创股骨头置换术(假体组)与PFNA内固定术。假体组35例,女24例,男11例,年龄(86.2±6.1)岁;PFNA组41例,女28例,男13例,年龄(84.6±5.3)岁。观察比较两组手术时间、术中出血量、术后下地活动时间、住院时间及并发症发生情况,术后1、6、12个月行髋关节功能Harris评分。结果:患者均获得随访,时间13~17(14.3±1.4)个月。假体组手术时间长于PFNA组(P<0.05);PFNA组出血量少于假体组(P<0.05);术后下地活动时间假体组明显早于PFNA组(P<0.05);术后1、6个月假体组的Harris评分高于PFNA组(P<0.05),术后12个月两组Harris评分比较,差异无统计学意义(P>0.05)。假体组并发症少于PFNA组(P<0.05)。结论:高龄粉碎性股骨转子间骨折患者,采用微创股骨头置换术治疗是一种良好选择,有利于术后早期康复,减少并发症,提高生活质量,减轻家属及社会负担。展开更多
背景:人工膝关节置换作为治疗膝关节骨性关节炎、类风湿性关节炎等各类终末期关节疾患最有效的方法,广泛应用于关节外科领域。有限元分析是随着计算机技术不断进步而逐渐发展而来的一种生物力学研究方法,具有强大的建模功能和三维仿真...背景:人工膝关节置换作为治疗膝关节骨性关节炎、类风湿性关节炎等各类终末期关节疾患最有效的方法,广泛应用于关节外科领域。有限元分析是随着计算机技术不断进步而逐渐发展而来的一种生物力学研究方法,具有强大的建模功能和三维仿真特点。目前,有限元分析已广泛应用于骨科生物力学研究。目的:综述有限元分析技术在各类人工膝关节置换术中的应用现状与进展。方法:使用计算机检索PubMed、CNKI、万方数据库发表的关于有限元分析与人工膝关节置换的相关文献,文献发表时间为从各数据库建库至2022年8月,英文检索词:finite element analysis,TKA,UKA,revision total knee arthroplasty,knee osteoarthritis,knee joint,femoral component,tibia component;中文检索词:有限元分析,全膝关节置换术,单髁置换术,膝关节翻修术,膝关节,股骨假体,胫骨假体,最终共纳入53篇文献进行综述。结果与结论:①在全膝关节置换过程中,活动平台较固定平台降低了胫股关节接触面应力,从而减少了聚乙烯垫片的磨损;相对于机械对线,采用运动对线的全膝关节置换人工关节的股骨假体与聚乙烯垫片的最大应力与最大应变值均减小,产生的应力更低,从而减少关节接触面的磨损,延长假体寿命;②在单髁置换过程中,活动平台股骨和胫骨假体形合性较好,能够减少假体磨损;而固定平台假体单髁置换应避免过度形合引起局部应力集中而导致加速假体磨损;③在人工膝关节翻修术中,延长杆的设计长度应在保留骨质和植入后减少假体周围应力之间保持最佳平衡;与骨水泥延长杆相比,压配式延长杆显示出更高的微动;④相对于传统的力学研究而言,有限元分析可以进行相对较为准确的模拟,弥补了传统力学在膝关节研究上的不足,因此在医学领域具有较高的应用价值。展开更多
文摘Objective： To study the stress distribution of the femoral hip prosthesis after the hip joint replacement. Methods： After the hip joint replacement, when the fenmr and prosthesis are considered as concentric cylinders with perfectly banded interface, a relatively perfect theoretical model of simulating the interracial stress transfer is established. Results： The maximum interfaeial shear stress oeeured at Z=O. At the cross-section of the femoral neck, interfacial shear stress decreased exponentially with the increases of the Z. Shear stress became very small at Z〉0. 1 m, which meant that the shear stress at the far end of the femoral hip prosthesis was very small. In order to avoid the stress concentration and femoral hip prosthesis sinking, interracial stress must remain constant and balanced with the pressure load at Z=O. The radius of the femoral hip prosthesis changed with interfacial shear stress. The maximum value of the radius occured at Z=O, then it decreased at m. Specially, a=18.2 mm at Z=10 ram, a=5.36 mm at Z=98 ram, these are ideal radius. Conclusion： A theoretical model of simulating the interfacial stress is established when the femur and prosthesis are considered as concentric cylinders. The distributions of the interfacial shear and radial stresses with the axial positions are obtained. A theoretical reference for the design of the prosthesis is provided.
文摘The hip joint femoral head prosthesis was prepared using the Al2O3 material, which was synthesized by high purity alumina micro-powder and Mg- Zr- Y composite addhitives , the cold manufacturing techniques of lathe turning, grade polishing and the matching size correction of the sintered femoral head were studied. The results showed, after being pressed under 200 MPa cold isostatic pressure and being pre-sintered at 1150℃ , the biscuit＇ s strength can meet the demands of lathe turning ; After being grade polished by SiC micro-powder and diamond abrading agent and being size corrected by special instrument, the femoral head prosthesis of Al2O3 ceramic has good surface degree of finish and articulates tightly with femoral handle.
文摘The total hip replacement rationale, since 1960 when it was introduced by Sir Charnley, has been modified and evolved until nowadays thanks to laboratory research and clinical trials. This evolution followed a guideline whose milestones are: 1) the surgical approach and implantation technique (ex: detachment of the greater trochanter);2) to use or not to use cement;3) the evolution of materials (titanium, ceramic, x-linked polyethylene);4) the identification of the debris-disease rather than the cement-disease;5) studies focused on bone-prosthesis interaction and biological phenomena related. Between those studies, the authors consider crucial the introduction of tissue sparing surgery and femoral neck preserving rationale, concepts to which they have devoted their scientific research and clinical experience for over the last 30 years, from 1980 to nowadays.
文摘BACKGROUND The uncemented ArcosTM Modular Femoral Revision System(ARCOS)is a new comprehensive,press-fit revision design.The modular design offers a wide range of possible combinations to accommodate different variations of anatomy and bone stock.The ARCOS is made by a proximal body and a distal stem.As probably the only ones worldwide we predominantly use a combination of body and stem which supports proximal fixation and load,since this mimics the concept of the primary total hip arthroplasty with proximal weight-bearing,leading to bone stock preservation and no stress shielding or thigh pain.AIM To evaluate the early results after femoral revision in a consecutive series of patients undergoing surgery over 3 years.METHODS We included 116 patients in the study.They were operated in the period August 2011 to December 2014 and we got a clinical mean observation time of 4(0.5-6)years.Clinical and radiographical follow-up included present function of the hip assessed by Harris Hip Score,Oxford Hip Score,and EQ5D(measure of health outcome).Of the 116 patients,17 died in the interim and were consequently included only in the implant survivorship analysis;46 patients attended the follow-up control.RESULTS In total 6(5%)hips were re-revised due to infection(n=3),fracture(n=2)or subsidence(n=1).No patient was re-revised due to aseptic loosening.The 1-,2-and 5-year probability of implant survival(95%CI)were 97%(93%-100%),97%(93%-100%)and 96%(92%-99%),respectively.In this cohort 95 patients received a combination of a proximal broach and a distal curved and slotted stem(BS),aiming for proximal fixation and load bearing;21 patients received a different combination.When comparing these two groups the BS-group had a 5-year implant survival probability(95%CI)of 97%(93%-100%)compared with the group of other combinations with a 5-year implant survival probability(95%CI)of 90%(78%-100%)(P=0.3).Our regression analysis showed that periprosthetic fracture as an indication for the ARCOS operation was the only significant negative outcome predictor.The mean Harris Hip Score result(100 points being best)was 83(range 5-98).The mean Oxford Hip Score result(48 points being best)was 40(range 19-48).CONCLUSION The early results of the ARCOS are promising compared with similar studies.We encourage the use of the BS combination whenever the bone stock proximally is adequate.
文摘目的探讨分析老年股骨颈骨折应用骨水泥型人工髋关节和生物型人工髋关节置换治疗的临床疗效以及应用价值。方法回顾性选取2020年1月—2023年1月龙口市人民医院收治的100例老年骨质疏松性股骨颈骨折行人工髋关节置换术治疗的患者的临床资料,根据假体类型的不同分为研究组(n=50)和参照组(n=50)。对实施不同的假体置换后,比较两组患者的手术时间、术中出血量、术后引流量、异位骨化程度、术后假体稳定性、髋关节功能评分量表(Harris Hip Joint Function Scale,Harris)以及术后并发症发生情况。结果术后6个月,两组患者均开展X线检查,研究组假体稳定率明显高于参照组,差异有统计学意义(P<0.05)。研究组并发症发生率低于参照组(0 vs 4.00%),差异无统计学意义(χ^(2)=0.510,P>0.05)。结论相对于骨水泥型假体,使用生物型假体进行人工髋关节置换髋关节功能恢复效果更好,能够有效降低并发症的发生率,加快术后恢复,应用价值高。
文摘The purpose of the letter is to introduce a madreporic porous artificial hip prosthesis with bone-ingrowth self-locking fixation. Co—Cr—Mo alloy steel femoral head replacement was performed on 16 adult dogs divided into four groups (according to survey period of 5, 10, 15 and 20 weeks after operation), four in each group. After surgery, the function recovery of the operated limbs was recorded strictly. Roentgenograms of double hips were
文摘目的:探讨微创股骨头置换术与股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)内固定术治疗高龄粉碎性股骨转子间骨折患者的临床疗效。方法:2020年4月至2020年10月治疗高龄粉碎性股骨转子间骨折患者76例,分别采用微创股骨头置换术(假体组)与PFNA内固定术。假体组35例,女24例,男11例,年龄(86.2±6.1)岁;PFNA组41例,女28例,男13例,年龄(84.6±5.3)岁。观察比较两组手术时间、术中出血量、术后下地活动时间、住院时间及并发症发生情况,术后1、6、12个月行髋关节功能Harris评分。结果:患者均获得随访,时间13~17(14.3±1.4)个月。假体组手术时间长于PFNA组(P<0.05);PFNA组出血量少于假体组(P<0.05);术后下地活动时间假体组明显早于PFNA组(P<0.05);术后1、6个月假体组的Harris评分高于PFNA组(P<0.05),术后12个月两组Harris评分比较,差异无统计学意义(P>0.05)。假体组并发症少于PFNA组(P<0.05)。结论:高龄粉碎性股骨转子间骨折患者,采用微创股骨头置换术治疗是一种良好选择,有利于术后早期康复,减少并发症,提高生活质量,减轻家属及社会负担。
文摘背景:人工膝关节置换作为治疗膝关节骨性关节炎、类风湿性关节炎等各类终末期关节疾患最有效的方法,广泛应用于关节外科领域。有限元分析是随着计算机技术不断进步而逐渐发展而来的一种生物力学研究方法,具有强大的建模功能和三维仿真特点。目前,有限元分析已广泛应用于骨科生物力学研究。目的:综述有限元分析技术在各类人工膝关节置换术中的应用现状与进展。方法:使用计算机检索PubMed、CNKI、万方数据库发表的关于有限元分析与人工膝关节置换的相关文献,文献发表时间为从各数据库建库至2022年8月,英文检索词:finite element analysis,TKA,UKA,revision total knee arthroplasty,knee osteoarthritis,knee joint,femoral component,tibia component;中文检索词:有限元分析,全膝关节置换术,单髁置换术,膝关节翻修术,膝关节,股骨假体,胫骨假体,最终共纳入53篇文献进行综述。结果与结论:①在全膝关节置换过程中,活动平台较固定平台降低了胫股关节接触面应力,从而减少了聚乙烯垫片的磨损;相对于机械对线,采用运动对线的全膝关节置换人工关节的股骨假体与聚乙烯垫片的最大应力与最大应变值均减小,产生的应力更低,从而减少关节接触面的磨损,延长假体寿命;②在单髁置换过程中,活动平台股骨和胫骨假体形合性较好,能够减少假体磨损;而固定平台假体单髁置换应避免过度形合引起局部应力集中而导致加速假体磨损;③在人工膝关节翻修术中,延长杆的设计长度应在保留骨质和植入后减少假体周围应力之间保持最佳平衡;与骨水泥延长杆相比,压配式延长杆显示出更高的微动;④相对于传统的力学研究而言,有限元分析可以进行相对较为准确的模拟,弥补了传统力学在膝关节研究上的不足,因此在医学领域具有较高的应用价值。
