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中华关节外科杂志(电子版) ›› 2020, Vol. 14 ›› Issue (04) : 447 -453. doi: 10.3877/cma.j.issn.1674-134X.2020.04.010

所属专题: 文献

基础论著

人工全髋关节置换髋臼假体稳定性的实验研究
卢士学1,(), 李俊1, 刘飞2, 江德胜3, 李成龙4, 丁磊1, 沙玉山1   
  1. 1. 237008 六安,皖西卫生职业学院附属医院骨科,兼骨科生物力学实验室
    2. 230000 合肥市第一人民医院关节外科
    3. 237000 六安市立医院影像中心
    4. 237008 六安,皖西卫生职业学院解剖教研室
  • 收稿日期:2019-06-08 出版日期:2020-08-01
  • 通信作者: 卢士学
  • 基金资助:
    安徽省教育厅自然科学一般项目(KJ2018B02); 安徽省高校优秀人才支持项目(qxyqZD2020062); 安徽省教育厅自然科学重点项目(KJ2017A909)

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

Shixue Lu1,(), Jun Li1, Fei Liu2, Desheng Jiang3, Chenglong Li4, Lei Ding1, Yushan Sha1   

  1. 1. Department of Orthopaedics and Orthopaedic Biomechanics Laboratory, the Affiliated Hospital of West Anhui Health Vocational College, Liu’an 237008, China
    2. Department of Joint Surgery of the First People's Hospital of He Fei, Hefei 230000, China
    3. Department of Image Center of Liu’an City Hospital, Liu’an 237000, China
    4. The Section of Anatomy Reaching and Research, West Anhui Health Vocational College, Liu’an 237008, China
  • Received:2019-06-08 Published:2020-08-01
  • Corresponding author: Shixue Lu
  • About author:
    Corresponding author: Lu Shixue, Email:
引用本文:

卢士学, 李俊, 刘飞, 江德胜, 李成龙, 丁磊, 沙玉山. 人工全髋关节置换髋臼假体稳定性的实验研究[J/OL]. 中华关节外科杂志(电子版), 2020, 14(04): 447-453.

Shixue Lu, Jun Li, Fei Liu, Desheng Jiang, Chenglong Li, Lei Ding, Yushan Sha. Experimental research on stability of acetabulum prosthesis of artificial total hip replacement[J/OL]. Chinese Journal of Joint Surgery(Electronic Edition), 2020, 14(04): 447-453.

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.

图1 实验用主要器械。图A为定位型髋臼锉;图B为实验用静态扭矩仪;图C为实验用拉压力仪
图2 同心圆形顺序锉臼髋臼重建过程。图A骨盆呈右侧卧位固定;图B~C通过定位型髋臼锉锉磨髋臼;D锉至软骨下骨时髋臼窝
图3 髋臼假体试模安装后效果图。图A右侧髋臼假体试模植入后效果;图B右侧髋臼假体试模植入后效果
图4 非同心圆形顺序锉臼髋臼重建过程。图A骨盆呈左侧卧位固定;图B~C通过普通型髋臼锉锉磨髋臼,通过主动故意变化髋臼锉角度,实现非同心圆锉磨;图D锉至软骨下骨时髋臼窝
图5 髋臼假体试模安装后假体试模力学测量情况。图A为扭矩测定情况;图B为抗拔出力测定情况
图6 髋臼假体试模植入骨盆标本的实物图和透视图。图A为双侧髋臼窝植入假体试模实物图;图B透视情况下观察的髋臼假体试模情况
表1 髋臼假体试模力学测量情况(±s)
图7 不同锉臼方式重建髋臼压配假体示意图(蓝色表示待成形的髋臼,黑色表示半球型髋臼假体,红色和橙色表示不同方向的普通型髋臼锉)。图A表示同心圆成形髋臼,假体植入后匹配和稳定性均强;图B和图C表示非同心圆锉臼后出现的不规则形髋臼,假体植入方向与最后锉的方向不一致时,会出现深度不足,髋臼环过大;图D表示非顺序扩臼重建后髋臼及假体植入时情况,使得髋臼假体边缘固定于髋臼上,匹配可能不良,但初始稳定性更强
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