人工髋关节头颈部磨损的影响因素及临床表现

人工髋关节置换术是目前治疗股骨头坏死、发育性髋关节发育不良等髋关节疾病的主要术式,在减轻病变关节疼痛、改善关节功能方面具有良好的效果。组配式髋关节假体便于调整偏心距和肢体长度,但假体界面间的磨损可导致炎性假瘤、骨溶解等不良反应。探讨髋关节假体界面间的磨损因素有利于改进产品的设计制造理念、提高产品性能,同时可以帮助手术医生优化手术技术、减小人为因素对假体磨损的影响。既往有大量文献探讨了假体头-臼界面间磨损的机制,此界面间磨损的机制已被阐述得相对明确。除头-臼界面外,头-颈界面间的磨损被认为是导致髋关节置换术后关节周围不明原因疼痛、假体松动翻修的另一个主要因素。影响头颈部磨损的因素众多,假体的设计(如假体材料、假体锥度)、手术技术(如击打力度、假体错配)和患者因素(如年龄、性别、活动量)等都对头颈部磨损产生重要影响。头颈部磨损所导致的不良反应也受到了广泛关注。但对头颈部磨损尚无很好的解决方法,因此应通过优化假体设计、提高手术技术、指导患者康复等方法进行预防。通过文献回顾围绕头-颈界面磨损的影响因素及头颈部磨损所导致的临床表现进行分析,旨在提高关节外科医生的认识。

Risk factors and clinical manifestations of head-neck wear in artificial hip joints

At present,total hip arthroplasty(THA)is the primary treatment for hip diseases such as femoral head necrosis and developmental dysplasia of the hip.It has good effects in reducing pain and improving joint function.The appearance of modular hip prosthesis facilitates adjustment of limb length and femoral offset.However,the wear between the interface of hip prosthesis can lead to inflammatory pseudotumor,osteolysis and other adverse reactions.To explore the risk factors of wear between hip prosthesis interface is helpful to improve the design and manufacturing concept of the product,improve the product performance,help surgeons optimize the operation technology and reduce the impact of human factors on the wear of the prosthesis.Many literatures have reported the mechanism of wear between the head-acetabula interface of prosthesis.The mechanism of wear between the interfaces has been described relatively clearly.In addition to the head-acetabula interface,the wear between the head-neck interface is another major cause of unexplained pain around the joint and prosthesis loosening after hip replacement.Many factors affect head-neck wear.The design of prosthesis(such as prosthesis material and prosthesis taper),surgical technology(such as impact strength and prosthesis mismatch)and patient factors(such as age,gender and activity)have important impact on head-neck wear.Adverse reactions caused by head-neck wear have also been widely concerned.However,there is no considerable solution for wear prevention.Thus,we should optimize the design of prosthesis,improve the surgical technology,and guide the rehabilitation of patients to prevent wear.In order to improve the attention of joint surgeons,the present paper reviews the literatures and analyzes the risk factors of head-neck interface wear and the clinical manifestations caused by head-neck wear.