金属对聚乙烯全髋关节置换术后锥部腐蚀的研究进展  

Advance of head taper corrosion after metal on polyethylene total hip arthroplasty

作　　者：安帅[1] 李征[1] 曹光磊[1] 冯明利[1] 黄江[1] 沈惠良[1] An Shuai;Li Zheng;Cao Guanglei;Feng Mingli;Huang Jiang;Shen Huiliang(Department of Orthopaedics,Xuan Wu Hospital, Capital Medical University,Beijing100053,China)

机构地区：[1]首都医科大学宣武医院骨科,北京100053

出　　处：《中华骨科杂志》2019年第10期630-636,共7页Chinese Journal of Orthopaedics

基　　金：北京市优秀人才培养资助-青年骨干个人项目(2015000020124G116).

摘　　要：全髋关节置换术是目前治疗髋部疾病重要的手术方式,其头颈结合部的组配式设计为术中调整肢体长度和偏心距提供了便利,但组配界面的磨损、腐蚀、松动等并发症也是不可避免的老问题。近年来,随着假体设计的变化、患者年轻化活跃化的趋势、手术微创化的发展等原因,锥部腐蚀再次成为骨科需要解决的和不容忽视的问题,引起关节外科医生的关注。既往金属对金属假体组配界面术后金属离子浓度升高、锥部腐蚀和局部组织不良反应等相关并发症的研究较多,而金属对聚乙烯假体的研究较少,但后者也存在类似问题,其锥部腐蚀也会出现局部金属离子浓度升高和有症状的局部组织不良反应,进而可以出现松动、脱位、骨折等并发症。目前,国内对于金属对聚乙烯全髋关节置换术相关锥部腐蚀的认识和报道很少,其表现形式、发生机制等问题尚存在争议。本文通过文献回顾对上述问题进行归纳总结,从金属对聚乙烯假体锥部腐蚀的概念、研究历史、评估方法、发生率等方面进行阐述,并依次分析了材料组成、金属球头直径、颈长、偏心距、锥部形态学、手术因素、在体时间和患者因素等方面对锥部腐蚀的影响。总而言之,目前对于其发生的具体作用机制的研究尚有很多问题没有解决,因此对于锥部腐蚀的预防非常重要:选择同种材料或陶瓷材料、避免股骨头直径和偏心距过大、锥度不宜太小、术中注意敲击力量和锥部的清洁等是目前可行的选择。Total hip arthroplasty is currently an important surgical method for the treatment of hip diseases. The modular design of the head and neck taper facilitates the adjustment of limb length and femoral offset during surgery, however, complications such as wear, corrosion and looseness of the modular interface are also inevitable old problems. In recent years, with the changes in the design of prostheses, the trend that patients becomes younger and active, and the development of minimally invasive surgery, taper corrosion has again become a problem that needs to be solved and cannot be ignored, which is causing the attention of joint surgeons. There have been many studies on the complications associated with metal-on-metal prosthesis modular interfaces, such as increased metal ion level, taper corrosion and adverse local tissue reactions, while there are few studies on the complications of metal-on-polyethylene total hip arthroplasty, and metal-on-polyethylene prosthesis has similar problems such as increased local metal ion level and adverse tissue reactions caused by taper corrosion, which may also lead to complications such as prosthesis loosening, dislocation and fracture. Currently there are few reports about head and neck taper corrosion of metal-on-polyethylene prosthesis in China and there are still controversies about its manifestation and mechanism. In this paper, we summarized the above problems through literature reviewto expound the concept, research history, assessment methods, and incidence of metal-on-polyethylene prosthesistaper corrosion and the effect of material composition, diameter of the metal head, neck length, femoral offset, geometry of the taper, surgical factors, in vivo time, and patient factors on taper corrosion are analyzed. In summary, there are still many problems in the researches about the specific forming mechanism that have not been solved, thus it is very important for the prevention of taper corrosion: choosing the same material or ceramic material, avoiding overlarge diameter

关 键 词：髋关节置换术后 聚乙烯假体 金属假体 腐蚀 全髋关节置换术 相关并发症 手术方式 假体设计 

分 类 号：R687.4[医药卫生—骨科学]