人工髋关节假体周围股骨骨折的内固定治疗

人工髋关节置换术中或术后骨折是一种少见的特殊骨折。由于髓腔内金属假体的存在，使这类骨折处理较为困难。而人工关节置换的广泛开展及翻修手术的不断增加，又使此类骨折的发生明显增多。1999年8月～2004年8月间对8例人工髋关节假体周围股骨骨折患者采用切开复位、不锈钢钢丝环扎、金属带绑扎及记忆合金环抱器内固定治疗取得不同疗效。现报告如下。     

金属对金属髋关节假体专题学术讨论会议纪要

金属对金属髋关节假体主要指全髋关节表面置换假体、金属对金属大直径股骨头全髋关节假体以及金属对金属小直径股骨头全髋关节假体。金属对金属髋关节假体置换术在20世纪50年代首先开展,但在临床应用过程中由于磨损、松动、股骨颈骨折等并发症发生率较高而一度被束之高阁。随着材料学的改进、假体设计制造水平的提高、手术技术及器械的完善,其耐磨性能及术后假体生存率大大提高。     

人工髋关节金属对金属假体研究进展

随着社会经济的发展,人们生活水平的不断提高,对生质量的要求也相应的日益提高。目前,人工髋关节置换术成为治疗股骨头缺血坏死、髋关节骨关节炎、强直性脊柱、先天性髋关节脱位、髋部外伤(如股骨颈骨折)等主要的疗手段,其适应证范围广泛,术后效果也相当可观,使术后者的生活质量得到了明显的改善。     

人工髋关节假体材料及界面的选择

<正>人工髋关节作为一种替代病损关节的人造器官,自从1891年德国医生Gluck采用象牙股骨头与髋臼进行了首次髋关节置换术以来,全髋关节置换术(total hip arthroplasty,THA)已经成为治疗终末期股骨头坏死、髋关节炎、髋关节发育不良、强直性脊柱炎等疾病最为常见且最为有效的方法之一[1]。它能够显著缓解病人疼痛,恢复髋关节的活动和功能,从而提高病人的生活质量。据文献报道,目前约有0.83%的美国人接受了人工髋关节置换手术[2]     

金属对金属人工髋关节临床应用的现状

人工髋关节晚期失败的主要原因是金属对聚乙烯（metal—on—polyethylene,MOP）磨损颗粒引起骨溶解导致的假体松动。由于认识到上述问题,并且随着20世纪80年代末新一代金属对金属（metal—on—metal,MOM）人工髋关节假体的推出,使人们的兴趣再一次转移到MOM假体上来。磨损率的大大降低使得MOM假体在临床上被迅速认可和使用,并且得到了较为满意的早中期临床结果。近年来,随着大直径MOM假体的广泛应用以及对这些患者随访时间的延长,其安全性等问题被越来越多的提出和关注心。     

大直径金属对金属假体全髋关节置换术的近期疗效

目的 探讨大直径金属对金属(MOM)假体全髋关节置换术(THR)的近期临床疗效.方法 对33例施行大直径MOM假体THR,术前诊断:股骨颈骨折6例,髋臼骨折内固定术后创伤性关节炎3例,股骨头缺血性坏死12例,髋关节骨性关节炎和类风湿关节炎8例,强直性脊柱炎4例.结果 平均随访21.8个月.Harris评分由术前平均44...     

国产髋关节人工假体置换术后生存率的远期随访

目的：通过远期随访了解国产髋关节人工假体置换术后生存率。方法：对本组176例髋关节人工假体置换术后有回信和Harris评分的病例采用临床生存率进行统计。对X线资料完整的92例采用X线生存率进行统计。结果：本组176例的临床生存率：5年158例(90％)；10年130例(73％)；15年32例(18％)；20年12例(7％)。本组92例的X线生存率：5年57例(67％)；10年40例(44％)；15年10例(11％)；20年2例(1％)。在10～15年X线生存率50例中的年龄分布是50～60岁。这说明50～60岁是髋关节人工假体置换的较好适应证。另外，20年X线生存率和临床生存率的平均年龄是45岁。这也说明此年龄段的骨质和体质相对较好。在10年和15年X线生存率中男女比例无明显差异。但在5年和20年X线生存率中女性所占比例较大。可能与5年X线生存率的高龄女性骨质疏松和20年X线生存率中的女性活动量比男性相对较少有关。从20年临床生存率的12例中没有见到肥胖者，间接说明体重对假体磨损有一定影响。本组人工假体5年平均下沉4mm；10年平均下沉9mm；15年平均下沉13mm；20年平均下沉19mm；25年平均下沉22mm。平均每年下沉1mm。结论：从本组176例国产髋关节人工假体置换术后随访结果可以提示：80岁以上、合并其他疾病的高龄患者(特别是女性)国产髋关节人工假体置换术后生存率是5年左右；50～60岁而无其他疾病的患者国产髋关节人工假体置换术后生存率是10～15年左右；个别年龄相对较小(40～50岁)、体重较轻而无其他疾患、不从事重体力劳动而又经常体育锻炼的患者，其国产髋关节人工假体置换术后生存率可能达到20年。     

人工全髋关节置换术后假体位置及髋关节功能评定方法

人工全髋关节置换(total hip arthroplasty,THA)用于治疗多种髋部疾病引起髋关节破坏而导致的疼痛、畸形和功能障碍,可以减轻或解除疼痛、矫正畸形、改善髋关节功能.随着人工关节技术的不断发展,THA已成为一种可靠的临床治疗手段,并为越来越多的人们所接受[1].为了便于指导手术操作,也为临床提供评价标准,国内外学者针对人工全髋关节假体位置和术后髋关节功能的评定方法进行了系列研究.     

金属-金属髋关节假体应用现状

传统的金属-聚乙烯全髋关节置换术在运动量要求较高的年轻患者中有较高的早期失败率.金属-金属髋关节置换术具有较强的稳定性和低磨损性,成为治疗髋关节疾病的重要选择之一.近年随着金属-金属髋关节假体的广泛应用及随访时间的延长,临床假体磨损、金属离子释放、软组织炎性假瘤等特有问题突显,涉及多种远期并发症.该文就金属-金属髋关节假体临床应用现状作一综述.     

Rationale for metal-on-metal total hip replacement

Traditional metal-on-polyethylene total hip replacements are prone to wear with secondary osteolysis and aseptic loosening, especially in younger, more active patients. Metal-on-metal represents an alternative bearing surface that offers much lower wear rates with the aim of improving longevity and the use of larger femoral heads that confer increased inherent stability, resulting in fewer patient restrictions and improved patient satisfaction. This article discusses the science and clinical evidence in support of choosing metal-on-metal as a bearing as well as its limitations.     

Modern metal-on-metal hip implants

This Technology Overview was prepared using systematic review methodology and summarizes the findings of studies published as of July 15, 2011, on modern metal-on-metal hip implants. Analyses conducted on outcomes by two joint registries indicate that patients who receive metal-on-metal total hip arthroplasty (THA) and hip resurfacing are at greater risk for revision than are patients who receive THA using a different bearing surface combination. Data from these registries also indicate that larger femoral head components have higher revision rates and risk of revision and that older age is associated with increased revision risks of large-head metal-on-metal THA. Several studies noted a correlation between suboptimal hip implant positioning and higher wear rates, local metal debris release, and consequent local tissue reactions to metal debris. In addition, several studies reported elevated serum metal ion concentrations in patients with metal-on-metal hip articulations, although the clinical significance of these elevated ion concentrations remains unknown.     

Revision total hip arthroplasty for metal-on-metal failure

Metal-on-metal (MoM) arthroplasty systems became popular in the early-2000s due to presumed advantages of improved wear characteristics and superior stability. However, subsequent reports of abnormal soft-tissue reactions to MoM implants and national registry data reporting high failure rates raised concerns. Early outcomes of revision total hip arthroplasty (THA) for adverse reaction to metal debris (ARMD) were poor, leading to development of surveillance programs and a trend towards early revision surgery. Patients with MoM arthroplasties require surveillance, comprehensive history and physical examination, imaging with ultrasound or magnetic resonance imaging (MRI), and laboratory evaluation including metal ion levels. Operative strategies for revision THA vary from exchange of modular components to extensive debridement and reconstruction with revision components. Surgeons should be aware of the increased risks of dislocation and infection following revision THA for ARMD. However, there is growing evidence that early revision surgery prior to extensive soft tissue destruction results in improved outcomes and decreased re-operation rates. It is estimated that >1 million MoM articulations have been implanted, with a large proportion still in situ. It is imperative to understand the aetiology, presentation, and management strategies for these patients to optimise their clinical outcomes.     

Imaging of metal-on-metal hip resurfacing

Conventional radiography is the primary imaging modality to evaluate the condition of hip resurfacing implants and the preferred method of assessing implant stability over time. Radiographs assess the angle of inclination of the femoral and acetabular components, implant stability, and femoral neck narrowing. Ultrasonography detects solid or soft tissue masses adjacent to the implant. Magnetic resonance imaging (MRI) detects osteolysis and complications in the periprosthetic soft tissues such as wear-induced synovitis, periprosthetic collections, neurovascular compression, and quality of the muscle and tendons of the rotator cuff of the hip. For pain after hip resurfacing, early use of optimized MRI is recommended.     

金属对金属髋关节表面置换术治疗强直性脊柱炎的临床研究

目的探讨金属对金属(MOM)髋关节表面置换术治疗强直性脊柱炎(AS)的早期临床疗效。方法对18例AS累及髋关节患者(23髋)行MOM髋关节表面置换术,术后定期随访,比较手术前后Harris评分、UCLA活动评分和影像学变化。结果术后平均随访20个月(6～36个月),Harris评分由术前(44±7)分上升到术后(89±6)分,UCLA活动评分由术前(2.4±1.15)分上升到术后(6.5±0.5)分,无感染、关节脱位、深静脉血栓形成、神经损伤和假体周围骨折等并发症的发生,术后X线检查假体无松动和移位。结论 MOM髋关节表面置换术治疗AS能够明显缓解患者症状,改善关节功能。     

金属对金属髋关节假体置换术后的炎性假瘤

金属对金属髋关节假体置换因其低磨损、高稳定性及灵活性等优势受到髋部疾病患者尤其是年轻患者的青睐。但近年来越来越多的报道指出,部分患者在金属对金属髋关节假体置换术后于假体周围软组织出现金属碎屑不良反应(Adverse reactions to metal debris,ARMD),这一不良反应会诱发炎性假瘤的形成,最终导致较高的术后翻修率。这引发了医生和患者的广泛关注和担忧。因炎性假瘤导致的髋关节翻修术面临骨及周围软组织大量缺损、原有假体难以移除及翻修假体固定困难等巨大的失败风险,使金属对金属髋关节假体的应用受到了限制,临床医生的选择也更加谨慎。通过最新研究文献就金属对金属髋关节假体置换术后炎性假瘤形成的危险因素、诊断及治疗进行综述。髋关节假体周围炎性假瘤形成的危险因素主要包括金属离子浓度升高、假体植入位置及患者自身因素三个方面。其诊断主要依靠体格检查、影像学检查、实验室检查、关节镜检查及组织学检查等方法。针对临床有症状和无症状患者其治疗策略也不相同。通过对以上内容的详尽分析、评价及总结,旨在为临床髋关节置换假体的选择提供指导,同时为进一步探究ARMD引发炎性假瘤的机制奠定基础。     

Painful metal-on-metal total hip arthroplasty

Two patients were evaluated for the possibility of hypersensitivity to a Metasul articulation (Centerpulse, Austin, Tex) coupled with total hip arthroplasty. Serum was tested with a lymphocyte proliferation assay, and the capsular tissues from the hip were examined for perivascular lymphocytes. The diagnosis of hypersensitivity to Metasul could not be confirmed in these patients, and ultimately, the painful hip arthroplasties were felt to be caused by a combination of musculoskeletal problems.     

全髋关节置换术后的假体松动

半个多世纪以来,人工髋关节置换术取得了极大的成功与发展,良好的临床效果为广大患者解除病痛、改善功能、提高了生活质量。目前临床上所使用的不管是骨水泥固定假体,还是生物学固定假体,术后10年的优良率达到90％,甚至更高。然而随着时间推移,晚期并发症越来越受到人们的关注,尤其是晚期所发生的骨口及收、骨溶解、骨缺损,最终导致假体松动等,已成为关节外科最具挑战性的临床问题。本讲座主要讨论非感染性假体松动相关机理,临床症状及其对策。     

Current concepts of metal-on-metal hip resurfacing

The second-generation, metal-on-metal (MOM) bearing for total hip replacements was launched in the 1980s, and resurfacing followed in the mid-1990s. Remaining challenges include long-term bone remodeling of the femoral resurfacing and consideration of adverse MOM wear conditions. Precise understanding of manufacturing variables such as alloy types, bearing diameters, design tolerances, and surface finish is imperative in obtaining clinical consistency and safety in the patient. This review examines femoral fixation, bone remodeling, and wear studies of MOM implants and provides a brief overview of the latest outcome and retrieval data and how these data integrate with the in vitro wear studies.