基于杠杆重建平衡理论对保留股骨颈型髋关节置换的回顾与展望  

Review and prospect of total hip arthroplasty with collum femoris preserving prosthesis based on lever reconstruction balance theory

作　　者：张殿英[1] Zhang Dianying(Department of Orthopaedics and Traumatology,National Center for Trauma Medicine,Key Laboratory of Ministry of Education for Trauma Treatment and Nerve Regeneration,Peking University People's Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院创伤骨科,国家创伤医学中心,"创伤救治与神经再生"教育部重点实验室,北京100044

出　　处：《中华骨科杂志》2022年第18期1191-1196,共6页Chinese Journal of Orthopaedics

基　　金：教育部创新团队项目(IRT_16R01);北京大学医学部学院建设项目(2020)-国家创伤医学中心(BMU2020XY005-01);北京大学医学部学院建设项目(2020)-创伤救治与神经再生教育部重点实验室(BMU2020XY005-03);北京大学人民医院建设项目(2021)-国家创伤医学中心(BMU2021XY008-01);北京大学人民医院建设项目(2021)-创伤救治与神经再生教育部重点实验室(BMU2021XY008-03)。

摘　　要：保留股骨颈型(collum femoris preserving,CFP)髋关节置换是一种强调骨保留的手术方式,可提高股骨近端皮质的应力分布,尤其适用于年轻或高活动量患者。虽然传统CFP假体的短中期临床结果良好,且骨保留效果优于传统全髋关节置换假体,但并未展现出更高的远期假体生存率,限制了传统CFP假体的广泛应用。与传统全髋关节假体柄相比,传统CFP假体虽然通过保留股骨颈使重建支点内移,改善了压应力的传递机制,但忽视了张应力传递的力学重建。基于杠杆重建平衡理论设计的CFP仿生髋关节假体在保留股骨颈和股骨近端骨质的基础上实现了股骨近端重建支点内移,并通过张力螺钉重建张应力传导机制,降低了应力遮挡效应,改善了股骨近端的应力分布,在增强假体初始稳定性的同时实现假体的仿生固定。传统全髋关节假体和CFP假体有无菌性松动和假体周围骨折等远期并发症,而CFP仿生髋关节假体的设计有望为解决髋关节假体寿命问题打开新局面。Collum femoris preserving (CFP) is a surgical approach that emphasizes bone preservation, which can improve the stress distribution of the proximal femur, especially for young and active patients. Although the conventional CFP prosthesis has excellent short-term and medium-term clinical outcomes, and bone stock preservation is better than traditional total hip arthroplasty, it has not shown a higher prosthetic survival rate, which limits the broad application of CFP prosthesis. Compared with the conventional total hip prosthesis stem, the conventional CFP prosthesis improved the compressive stress transfer mechanism by retaining the femoral neck and moving the reconstruction fulcrum inward, neglecting the mechanical reconstruction of tensile stress transfer. Based on the theory of lever reconstruction balance, the bionic collum femoris preserving (BCFP) stem achieves the medial migration of the fulcrum based on preserving the femoral neck and proximal femoral bone and reconstructs the tension stress transmission mechanism through tension screws to reduce the stress shielding effect and improve the stress distribution. In addition to enhancing the initial stability of the prosthesis, the bionic fixation of the prosthesis is realized. Traditional total hip prosthesis and CFP prosthesis are plagued by long-term complications such as aseptic loosening and periprosthetic fractures. The innovative design of the BCFP prosthesis is expected to break new ground in addressing the longevity of the hip prosthesis.

关 键 词：髋关节置换 保留股骨颈 髋关节假体 股骨近端 假体周围骨折 传递机制 内移 活动量 

分 类 号：R687.4[医药卫生—骨科学]