全髋关节假体安装参数的优化组合  

Optimum combination of orientation parameters of total hip prosthesis

作　　者：蔡春元[1] 张力成[1] 李永奖[1] 杨国敬[1] 林瑞新[1] 余斌峰[1] 陈文良[1] 赵章伟[1] 

机构地区：[1]温州医学院附属第三医院骨科,瑞安325200

出　　处：《中华创伤杂志》2012年第7期648-653,共6页Chinese Journal of Trauma

基　　金：浙江省科技计划基金资助项目（2009C33144）;温州市科技计划基金资助项目（Y20090274）;瑞安市科技计划基金资助项目（201102033）

摘　　要：目的研究满足日常生活活动范围条件下，全髋关节假体安装参数优化组合及髋臼安装角度安全范围。方法建立人工全髋关节三维可视化计算机模型，将髋关节屈曲≥110°、屈曲9°内旋≥3°、后伸≥3°、外旋≥4°定义为日常生活活动范围一般标准；将屈曲≥120°、屈曲90°内旋≥45。、后伸≥3°、外旋≥40°定义为严格标准，头颈直径比变化范围为2-2．92，假体颈前倾角变化范围为0-30°，髋臼假体外展角变化范围为10°-60°，髋臼前倾角变化范围为0-7°，计算满足上述两种活动标准，臼杯外展角每变化5°，相应的髋臼假体前倾角，颈干角设定为135°。髋臼前倾角和外展角组合的安全范围定义为满足上述活动范围而没有杯颈撞击的面积。应用SAS6．12统计软件对数据进行分析。结果髋臼角度安全范围随着头颈比增大而增大；严格标准下的安全范围比一般标准的小。颈干角135°、一般标准活动度，髋臼前倾角平均值与外展角的和加0．816倍颈前倾角等于84．76°；严格标准活动度，髋臼前倾角平均值与外展角的和加0．873倍颈前倾角等于92．04°。结论大的头颈直径比明显增大髋臼角安全范围的面积。髋关节活动范围要求越高，髋臼角安全范围就越小，但可以通过增大头颈比来纠正。一般标准和严格标准活动度，髋臼前倾角平均值与外展角的和（Y）与颈前倾角（X）的组合分别可通过公式进行估计：Y1=-0．816X1＋84．76（R2=0．993），Y2=-0．873X2＋92．04（R2=0．999）。Objective To study the optimum combination of orientation parameter of total hip prosthesis and acetabular safe zone on condition that the range of motion for activities of daily living （ADL） is fulfilled. Methods A three-dimensional generic parametric and visually kinematic simula- tion module of THA was developed. Range of motion （ROM） of hip flexion ≥ 110°, intemai-rotation ≥30° at 90° flexion, extension 230° and external rotation ≥40° were defined as the normal criteria for ADL. ROM of hip flexion ≥ 120°, internal-rotation ≥45° at 90° flexion, extension ≥30° and external rotations≥40° were as the severe criteria. The ranges of changes in general ratios （GRs） of head-neck, femoral neck anteversion （ FNA）, operative inclination （OI） and anteversion （OA） of acetabulur compo- nents were 2.0-2.92, 0°-30°, 10°-60°, and 00-70° respectively. Within the limits of the upper two ac- tivity criteria, the synchronous OA of acetabulur components was calculated with every 5 ° change in OI of the cup, and the collodiaphyseal angle （CDD） was set as 135°. The safe-zone of combination of acetabu- lur operative anteversion （OA） and inclination （OI） was defined as the area that fulfilled the two men- tioned criteria of ROM without cup-neck impingement. All parameters were analyzed by using SAS 6.12 software. Results The safe zone of acetabular angle rose with the increase of GRs of head-neck and the safe zone of severe criteria was smaller than that of normal criteria. When the CDD angle was 135°, the sum of average acetabular OA and acetabular OI plus 0.816 times of the FNA equaled to 84.76° innormal criteria; and tile sum of average aeetabular OA and acetahular Ol plus 0. 873 times of the FNA e- qualed to 92.04° in severe criteria. Conclusions A high GR of head-neck greatly increases the size of safe-zone of acetabular angle. The higher demand of ROM of hip joint requires the smaller safe zone of ace- tabular angle, as can be eorrected by increasing the GR of

关 键 词：关节成形术 置换 髋 髋假体 活动范围 关节 

分 类 号：R687.4[医药卫生—骨科学]