双动全髋髋臼假体的优劣及其临床应用  

The advantages and drawbacks of dual mobility acetabular cups and its clinical application

作　　者：朱威[1] 冯宾[1] 周天钧 仉建国[1] 王雪晴 景秦江 翁习生[1] Zhu Wei;Feng Bin;Zhou Tianyun;Zhang Jianguo;Wang Xueqing;Jing Qinjiang;Weng Xisheng(Department of Orthopaedics,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院,北京协和医院,100730

出　　处：《中华骨科杂志》2021年第18期1367-1372,共6页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金青年项目(82102582);北京协和医院青年基金(201911847)。

摘　　要：全髋关节置换术在多种股骨髋骨疾病的终末期诊疗中起到关键作用,但是传统骨水泥假体带来的脱位风险一直是全髋关节置换术的关键制约因素之一。Bousquet在股骨头和髋臼之间增加了高分子内衬,使得内衬与髋臼之间活动分离,形成的双动全髋髋臼系统可以有效降低术后假体脱位的发生率。第一代双动全髋髋臼系统以聚乙烯作为内衬,随着现代材料医学技术的进步,逐步形成了光滑表面、仿生涂层和高交联聚乙烯衬垫的新型双动全髋髋臼系统,性能有所提高。双动全髋髋臼系统由于内衬的存在,股骨头与髋臼距离较大,能够容许更大的活动度,稳定性较高不易脱位,相同时间的假体磨损程度也较低。因此,双动全髋髋臼系统在临床应用中越发广泛,特别适用于具有高脱位风险的老年人群、翻修手术或神经肌肉功能障碍的患者。但是在另一方面,基于双动全髋关节假体的设计原理,多种因素造成的假体内脱位以及缺乏固定孔等缺点导致双动全髋系统在针对严重骨缺损等患者时容易引发髋臼松动,因此制约了其进一步使用。双动全髋系统可以针对不同的临床应用情况,如针对不同特点的人群,以及针对初次手术的不同方法,采用不同的应用策略,从而降低术后翻修的发生率。以双动全髋髋臼系统在全髋关节置换术中的应用为核心,系统的阐述双动全髋髋臼系统的原理,与传统骨材料相对比,介绍其优点及缺点,并揭示其在临床中的应用策略,为未来双动全髋髋臼系统的在骨科的应用做出展望。Total hip arthroplasty plays a key role in the end-stage diagnosis and treatment of a variety of femoral and hip diseases,but the risk of dislocation caused by traditional bone cement prosthesis has always been one of the key constraints of total hip arthroplasty.Bousquet added a polymer lining between the femoral head and acetabulum to separate the activities between the lining and acetabulum.The dual mobility acetabular cup system can effectively reduce the incidence of prosthesis dislocation.The first generation of the dual mobility acetabular cup system is lined with polyethylene.With the progress of modern material medicine technology,a new type of the dual mobility acetabular cup system with smooth surface,bionic coating and high cross-linked polyethylene liner has been gradually formed,and its performance has been improved.Because of the existence of the inner liner,the distance between the femoral head and acetabulum of the dual mobility acetabular cup system is larger,which can allow greater range of motion,has higher stability,is not easy to dislocate,and has lower wear degree of the prosthesis at the same time.Therefore,the dual mobility acetabular cup system is more and more widely used in clinical practice,especially for the elderly with high risk of dislocation,revision surgery or neuromuscular dysfunction.But on the other hand,based on the design principle of dual motion total hip prosthesis,the disadvantages such as intraprosthetic dislocation caused by multiple factors and the lack of fixation holes result in the dual motion total hip system easily triggering acetabular loosening when targeting patients such as severe bone defects,thus limiting its further use.The dual motion total hip system can be tailored to different clinical applications,such as for populations with different characteristics,and for different methods of primary surgery,with different application strategies,thereby reducing the incidence of postoperative revision.In this paper,we take the application of the dual motion total

关 键 词：全髋关节置换术 临床应用情况 髋臼 应用策略 脱位 光滑表面 骨缺损 股骨头 

分 类 号：R687.4[医药卫生—骨科学]