基于杠杆重建平衡理论对髋关节表面置换术的回顾与展望  

Retrospect and prospect of hip resurfacing arthroplasty based on lever reconstruction balance theory

作　　者：丁镇涛 王艳华[1] 郁凯[2] 张晓萌[1] 张立佳 陈小锋 熊晨 姬云 张殿英[1] DING Zhentao;WANG Yanhua;YU Kai;ZHANG Xiaomeng;ZHANG Lijia;CHEN Xiaofeng;XIONG Chen;JI Yun;ZHANG Dianying(Department of Orthopaedics and Trauma,People's Hospital,Peking University,Key Laboratory of Ministry of Education for Trauma Treatment and Nerve Regeneration,National Center for Trauma Medicine,Beijing 100044;Department of Orthopaedics,Tianjin Fifth Central Hospital,Tianjin 300450;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]北京大学人民医院创伤骨科“创伤救治与神经再生”教育部重点实验室国家创伤医学中心,北京100044 [2]天津市第五中心医院骨科,天津300450 [3]中国医学科学院北京协和医学院北京协和医院骨科,北京100730

出　　处：《中华骨与关节外科杂志》2022年第2期137-142,共6页Chinese Journal of Bone and Joint Surgery

摘　　要：髋关节表面置换术是一种适合年轻且运动量较大患者的手术方式,保留股骨近端骨量并维持自然的生物力学特性,作为全髋关节置换术的替代手术方案获得广泛关注。回顾髋关节表面置换术的发展历程和临床现状,发现其在特定患者中能获得良好的长期假体生存率和术后关节功能,但手术适应证窄、技术难度高、学习曲线长、金属对金属界面的潜在并发症等问题使其难以推广。本文从杠杆重建平衡理论的角度出发,分析股骨近端的生物力学特点和髋关节表面置换术后的应力改变,发现传统髋关节表面置换假体主要关注髋关节病变表面的修复,却忽视了股骨近端杠杆和支点的生物力学重建。基于该理论设计的新型髋关节表面置换假体,有望通过仿生重建的方式解决当前的困境,使髋关节表面置换术成为骨科医师在临床中的常备技术方案。Hip resurfacing arthroplasty(HRA) is a surgical solution for young and active patients. HRA can preserve the bone mass of proximal femur and maintain the natural biomechanical properties. Therefore, it has received widespread attention as an alternative option for total hip arthroplasty. By reviewing the history and clinical status of HRA, we found that HRA could achieve excellent longterm survival and joint function in specific subgroups. However, issues like limited indications, high technical difficulties, long learning curve and potential concerns of metal-on-metal bearings make it difficult for HRA to be marketed in practice. From the perspective of lever reconstruction balance theory, we analyzed the biomechanical characteristics of proximal femur and the stress distribution after resurfacing. Previous resurfacing prostheses focus on the rebuilt of diseased surface of hip, while ignoring the biomechanical reconstruction of the lever and fulcrum of proximal femur. The new resurfacing prostheses designed based on this theory are expected to solve the current dilemma through bionic reconstruction, making HRA a regular technical solution for orthopedic surgeons.

关 键 词：髋关节表面置换 杠杆重建平衡理论 应力遮挡 生物力学 

分 类 号：R684.3[医药卫生—骨科学]