国产羟基磷灰石球眶内置入整形术

目的提高眼球摘除术后的眼窝整形效果。方法将国产羟基磷灰石(Hydroxyapatite,HA)加工成符合眼球大小规格要求的填充球,包埋在巩膜壳内,置于眶内,将眼外肌按生理附着点缝于巩膜壳上,制成可转动义眼座连体。结果临床用于眼球摘除术后的眼窝整形患者102例,术后改善了眼窝塌陷外观,义眼活动自如。随访6～38个月,疗效稳定,效果满意。结论国产 HA 填充球是眼窝植入整形术中较理想材料之一。     

Geschichte der Exoprothetik an der unteren Extremität

Following the development of prosthetics for the lower limb since the middle of the 18th century one will find very interesting similarities to modern prostheses. This becomes evident when looking at former knee and ankle joint mechanisms or socket designs. Also, the materials used for the prostheses underwent very interesting variations. In our paper we will describe the development of socket designs and several materials from the beginning of the 19th century. Several still obtainable books dealing with 200 years of prosthetics development, were reviewed. Charles White describes in the year 1761 a supramalleolar amputation using the flap technique and the specially built BK prostheses the socket. V. Brünninghausen describes in 1809 a socket made of tin sheet. It was built oval, as the normal transverse section of the thigh is. Stump adhesion was obtained when a shortly trimmed dog fur--panelling the socket and covering the stump--was attached like brushes end on end. A similar fitting was described by Heine in 1811, v. Dornblüth in 1831, and Mrs. Eichler in 1836. Hermann first mentioned the need of a perpendicular construction of prostheses. Parmelee developed in 1868 the first suction socket. The first tuber-enclosing socketdesign was made by Riedel in 1911. We will show documents from this time and will also show, that muscle-physiological aspects had a very important influence on socket designs.     

Socket considerations for the patient with a transtibial amputation

This paper reviews the theory of transtibial prosthetic socket designs from a historic perspective to the present. The patella tendon bearing socket originated in 1959, and is the standard from which the new alternative socket designs have evolved. Although the patella tendon bearing socket is still the most commonly prescribed socket for a transtibial prosthesis, the total surface bearing and hydrostatic sockets are becoming increasingly accepted. The total surface bearing socket still may incorporate the weightbearing characteristics of the patella tendon bearing socket, but often will be accompanied by a shock absorbing gel liner. The hydrostatic socket does not incorporate the standard patella tendon bearing design characteristics, but instead depends on a method of pressure casting that in theory produces a socket with equally distributed pressure over all of the residual limb soft tissue. These three designs are reviewed as current options for the socket portion of the transtibial prosthesis.     

Socket/stump interface dynamic pressure distributions recorded during the prosthetic stance phase of gait of a trans-tibial amputee wearing a hydrocast socket.

Force sensing resistors (FSR) have been used to measure dynamic stump/socket interface pressures during the gait of a trans-tibial amputee. A total of 350 pressure sensors were attached to the inner wall of a hydrocast socket. Data were sampled at 150 Hz during approximately 0.8 seconds of prosthetic stance of gait. The dynamic pressure distributions within a hand cast socket reported by Convery and Buis (1998) are compared with those monitored within a hydrocast socket for the same amputee. The pressure gradients within the hydrocast socket are less than that of the hand cast Patellar-Tendon-Bearing (PTB) socket. The proximal "ring" of high pressure in the hand cast PTB socket is replaced with a more distal pressure in the hydrocast socket.     

A newly developed socket design for a knee disarticulation amputee who is an active athlete

This case report describes a newly developed socket design for a world class knee disarticulation athlete. To meet the demands concerning especially the suspension of the prosthesis a new type of socket was developed. The socket is made from carbon fibres and polyaramid fibres and is designed with a slit in the socket creating a flexible flap. This allows the amputee to both increase and decrease the inner circumference of the socket, thereby allowing the amputee to adjust the socket to stump variations. According to the amputee the new design offers an excellent fit and enables him to concentrate fully on the technical aspects of the different disciplines.     

Cemented versus uncemented socket in hip arthroplasty: A radiostereometric study of 60 randomized hips followed for 2 years

60 patients with arthrosis who received a Charnley total hip replacement were randomly assigned to either an uncemented porous Harris-Galante type I socket or a cemented all-polyethylene Charnley socket. Socket migration and rotation were studied by radiostereometry (RSA) for 2 years. After 2 years, all sockets were still in situ. There was no difference in migration or rotation between the 2 socket designs, nor was there any difference in pain or function.

We conclude that the initial fixation of the Harris-Galante socket resembles that of the Charnley socket.     

Polymer-on-Metal or Metal-on-Polymer Total Disc Arthroplasty: Does It Make a Difference?

STUDY DESIGN.: Mechanical testing of total disc arthroplasty (TDA). OBJECTIVE.: To compare the friction between a polymer socket-on-metal ball and metal socket-on-polymer ball TDA. SUMMARY OF BACKGROUND DATA.: A degenerate intervertebral disc can be replaced by TDA. The most common designs have a ball and socket articulation; the contact between the surfaces leads to friction. Friction needs to be minimized to prevent loosening and wear. One of the common material combinations in disc arthroplasty devices is the articulation of a metal socket on polymer ball. However, the combination of a polymer socket on metal ball (which is used in hip arthroplasty) has not been investigated for TDA. METHODS.: TDA models with either a polymer socket/metal ball or a metal socket/polymer ball were manufactured with ball radii of 10 and 14 mm, each with a radial clearance of 0.35 mm. Samples were tested using a spine simulator with a lubricant of diluted newborn calf serum. Each sample was subjected to an axial load of 1200 N; motions of flexion-extension, lateral bending, and axial rotation were then applied at frequencies of 0.25 to 2 Hz. Frictional torque was measured to compare the performance of the TDAs. RESULTS.: The frictional torque was found to be significantly higher for a disc with a metal socket/polymer ball than for a disc with a polymer socket/metal ball for both 10 and 14 mm radii in axial rotation, lateral bend, and extension. The frictional torque in flexion (0°-6°) was not found to be significantly different between the 2 different material combinations. However, when the flexion motion was reduced to 0° to 2°, frictional torque in the metal socket/polymer ball was found to be significantly higher than the polymer socket/metal ball. CONCLUSION.: TDA with a combination of a polymer socket/metal ball has lower friction than the conventional TDA with metal socket/polymer ball. This conclusion has implications in the design of TDA.     

Results of the pilot phase of a clinical evaluation of computer aided design of trans-tibial prosthesis sockets

This study served as a pilot to develop the methodology for a larger number of clinical trials. Ten trans-tibial amputees compared sockets made by conventional methods with sockets made using computer aided socket design (CASD). Prosthetists, paired for experience, fitted each subject with one prosthesis using each method. A preferred socket was selected by the subject on the basis of comfort without knowledge of the method by which the socket was designed. Prosthetists also evaluated the sockets. Three subjects preferred sockets built using CASD and one subject preferred the conventional socket only slightly more than the CASD socket. Six subjects clearly preferred the conventional fitting.     

Clinical experience with ceramics in total hip replacement

As part of a search for better articulation in total hip prostheses, the decrease in the thickness of the socket in different total hip prostheses was measured in vivo. The wear rates of (1) RCH 1000 (molecular weight, 10(6)) socket gamma-irradiated with 100 Mrad articulating with a crude COP (stainless steel containing 20% cobalt and 0.01% phosphorous) metal femoral head; (2) RCH 1000 socket nonirradiated articulating with a crude COP femoral head; (3) RCH 1000 socket irradiated with 100 Mrad articulating with an alumina femoral head; (4) ultra high molecular weight polyethylene (molecular weight, 5-6 x 10(6)) socket articulating with an alumina femoral head; and (5) ultrahigh molecular weight polyethylene socket articulating with a stainless steel femoral head (T-28) were 0.06, 0.30, 0.06, 0.1 and 0.25 mm/year, respectively, in the authors' clinical cases. Alumina femoral heads were effective in decreasing wear of the polyethylene socket. However, the wear rates of gamma-irradiated sockets articulating with alumina and with metal femoral heads wear very low and were not different from each other. Regarding the relationship between wear rate and the thickness of the ultra high molecular weight polyethylene socket articulating with a 28 mm alumina femoral head, on radiographs, average wear rates of socket thicknesses of 7, 8, 9, 10 and 11 mm were 0.14, 0.15, 0.12, 0.06, and 0.08 mm/year, respectively. On measuring retrieved prostheses, average wear rates of 7, 8, 9 and 11 mm thickness sockets were 0.2, 0.19, 0.14, and 0.1 mm/year, respectively. The wear of sockets has been proven to be minimal in alumina femoral heads articulating with ultrahigh molecular weight polyethylene sockets thicker than 10 mm.     

Failed Christiansen total hip arthroplasty. A radiographic and histologic study

Twenty-two consecutive cases of the Christiansen total hip arthroplasty revised because of aseptic loosening were analyzed with regard to radiographic changes and operative and histopathologic findings. This prosthesis was designed with a socket and a trunnion sleeve made of polyoxymethylene or Delrin. In 18 cases there was isolated socket loosening, in all cases there was obvious bone resorption beneath the collar of the stem, and in 20 cases the socket had migrated. The radiographic socket wear rate averaged 0.4 mm/year. In 18 cases a significant amount of debris material was found in the joint cavity. Light microscopy revealed a severe foreign body reaction with numerous plastic particles, most often engulfed by macrophages. Taken together, these findings indicate that socket wear leading to a foreign body reaction with bone resorption is the main cause of the poor results noted with this particular total hip prosthesis.     

A photoelastic clinical study of the static load distribution at the stump/socket interface of PTB sockets

It is recognized that the assessment of prosthetic socket fit is based largely on the subjective clinical judgement of the prosthetist. This study assesses a novel technique, photoelasticity, for use as a tool for the qualitative and quantitative assessment of socket fit. Photoelasticity is a visual technique that produces contours of principal stress or strain differences. The colour and/or distance between the contours can be qualitatively or quantitatively assessed, using a polariscope, to give a full-field analysis of the stresses on the sockets's surface. This paper presents qualitative photoelastic socket surface contour data gathered during several prosthesis fitting sessions for two male trans-tibial amputees. Results are compared with the actual known contact regions at the stump/socket interface to determine if a relationship exists. This comparison of results has then been used to conclude the suitability of photoelasticity as a tool for the assessment of socket fit and recommendations are made as to the future developments of the technique. A direct relationship between the stump/socket contact regions and the qualitative photoelastic contours was demonstrated. Given further development this photoelastic technique may therefore be suitable for qualitative analysis of the interactions between the stump and prosthetic socket.     

Fifteen year-experience with the angle bore socket in patients with an increased risk of dislocation following total hip replacement

The angle bore socket was designed by surgeons at the Charnley Institute in Wrightington and introduced clinically in 1983. The socket was designed to provide increased coverage to the prosthetic femoral head during flexion, adduction and internal rotation, in an effort to decrease the rate of dislocation. It achieves this by using a chamfer, which is angled at 45° to the bore of the socket and is discontinuous anteriorly, preventing impingement between the socket and prosthetic femoral neck during flexion, adduction and internal rotation. We report the 15-year experience of the senior author with the angle bore socket in patients with an increased dislocation risk, secondary to increased age with general poor mobility and muscle function, decreased cognitive ability, recurrent dislocation and decreased muscle function secondary to co-morbid illness. Between 1990 and 2005, 54 patients underwent a total hip replacement using an angle bore socket. Of these patients, only one suffered a recurrent episode of dislocation post-operatively, requiring further surgery. The dislocation rate of 1.85% seen in this study suggests that this prosthesis can decrease the incidence of dislocation in vulnerable patients. In these patients, with a low activity level and/or short life expectancy, the benefit of the increased stability provided by the angle bore socket outweighs the limitations imposed by increased constraint.     

游离皮瓣眶窝充填再造眼窝手术方法探讨

目的 探讨游离皮瓣修复眶窝空旷及眼窝闭锁畸形的效果。方法 2001年10月至2005年1月，我们为21例眶窝空旷及眼窝闭锁患者采用游离皮瓣移植，其中19例采用前臂游离皮瓣，2例采用肩胛游离皮瓣。利用显微外科血管吻合技术将游离皮瓣移植于眶窝内，以填充空旷和再造眼窝，同时根据移植后眶窝空旷程度选择性同期眶内充填羟基磷灰石材料，一期重建眼窝。结果 所有眶窝内移植的皮瓣均成活良好，术后随访4～42个月，外观佳，义眼配戴满意。结论 游离皮瓣移植修复重度的眶窝空旷畸形和再造眼窝是一种可取的方法。     

Instability and wear of total hip prostheses determined with roentgen stereophotogrammetry

Summary A roentgen stereophotogrammetric analysis of hip prostheses was made in four patients with rheumatoid arthritis during a postoperative period of 2 years.Implanted tantalum balls, prosthetic femoral head, and ends of the wire in the acetabular socket were used as measurement points.The migration of the prosthetic head and the acetabular socket in relation to the pelvic bone was determined. The difference between the cranial migration of the head and the socket is a measure of the postoperative instability of the hip joint and deformation of the prosthetic components. This deformation occurs in the plastic acetabular socket and is mainly due to wear.The roentgen stereophotogrammetric method can be applied to standard hip prostheses with a metal femoral head and a plastic or a metal acetabular socket to study migration or loosening of the prosthesis in relation to the supporting bone, prosthesis instability, and deformation of the prosthetic components.     

Socket design and manufacturing technique for through-knee stumps

This paper describes a socket design and manufacturing technique for through-knee stumps, based on 14 years experience with 290 prostheses. The bulbous shape of the stump and its full end-bearing quality requires a socket which has very little resemblance to above-knee sockets. The requirements of the through-knee socket are listed and the manufacturing technique is described and illustrated in detail. Emphasis is put on the quality of the negative plaster mould. The socket is manufactured according to the double wall technique commonly used in below-knee sockets. It provides a maximum of comfort and cosmesis without extra costs.     

Instability and wear of total hip prostheses determined with roentgen stereophotogrammetry

A roentgen stereophotogrammetric analysis of hip prostheses was made in four patients with rheumatoid arthritis during a postoperative period of 2 years. Implanted tantalum balls, prosthetic femoral head, and ends of the wire in the acetabular socket were used as measurement points. The migration of the prosthetic head and the acetabular socket in relation to the pelvic bone was determined. The difference between the cranial migration of the head and the socket is a measure of the postoperative instability of the hip joint and deformation of the prosthetic components. This deformation occurs in the plastic acetabular socket and is mainly due to wear. The roentgen stereophotogrammetric method can be applied to standard hip orostheses with a metal femoral head and a plastic or metal acetabular socket to study migration or loosening of the prosthesis in relation to the supporting bone, prosthesis instability, and deformation of the prosthetic components.     

A new method of socket wear measurement in Charnley total hip replacement

A new technique of wear measurement of the Charnley type socket is developed and introduced with an evaluation of its advantages and reliability. The principle in this technique is as follows: the X-ray projection angle of the radiograph taken before wear is corrected by some calculations on the basis of the second radiograph taken after wear has occurred. Then, on the identical X-Y coordinate axes made on these films, the shift of the femoral head's center (that is the wear vector) reveals the amount and direction of socket wear. When experimental wear of a socket was measured with this technique, the amount of wear was found accurate independent of varying socket fixating angle or irradiating direction. This technique has certain problems including technical complexity and the need for a new radiograph. However, it is useful clinically, because two-dimensional evaluation of socket wear both in amount and direction is possible.     

Total surface bearing self suspending above-knee sockets

A new type of above-knee socket has been designed to provide total surface support and to dispense with ischial bearing as the primary weight bearing area. The socket is based upon the hypothesis that if the soft tissues of an above-knee stump are adequately supported in a suitably shaped container they will behave under load as an elastic solid with low stiffness. A method has been devised for taking the cast for the new type socket using an elastic sleeve as a "compliant socket". The grip of the elastic sleeve and the use of traction weights deform the stump tissues to the required shape while the cast is setting. The results of laboratory measurements of the transinterface pressures in these sockets under axial loading conditions have correlated well with the figures forecast by calculation. The new socket is now available to patients at a number of Centres in England.     

Can Post-Cam Function Be Replaced by Addition of a Third Condyle in PS TKA?

The purpose of the study was to analyze the effectiveness of an additional ball and socket articulation in implanted knees and whether it can replicate post-cam function. Fifteen knees implanted with a cruciate substituting (CS) polyethylene without a post and ten knees implanted with a posterior stabilized (PS) polyethylene with a post were analyzed using 3D model fitting approach. Two types of designs showed similar posterior translation and similar axial rotation. Most of the contact points at the ball and socket joint stayed within the socket height for the PS group. This study indicates that the ball and socket joint is able to function as a replacement of the post-cam mechanism, which might serve as a new way to achieve posterior stability.