背景：早期临床工作中应用非生物型材料(骨水泥)治疗髋关节，由于固定范围较大，时间较长，且骨水泥界面的老化、破裂而引起假体松动等并发症，效果欠佳，所以置换后髋关节活动度的恢复会受到一定的影响。 目的：探讨使用生物型与非生物型植入材料进行全髋关节置换的方法和进展，评价不同材料髋关节假体的特点及临床应用。 方法：由第一作者应用计算机检索PubMed数据及CNKI数据库，在标题和中以“不同植入材料，全髋关节置换，内固定材料”或“Carpal bone，fracture ununited”为检索词，纳入与生物材料及组织工程人工髋关节相关的文章。 结果与结论：生物型内固定材料具有良好的耐磨性、耐腐蚀性及生物相容性。目前髋关节置换临床应用最多的是金属关节头和超高分子量聚乙烯髋臼的组合，但金属的弹性模量与人体骨骼相差甚远，导致应力遮挡效应，容易引起假体的疏松和不稳定。生物惰性陶瓷在活体内具有很高的稳定性和很好的机械强度；生物活性陶瓷具有骨传导特点及与活骨整合的性能。复合材料假体因其可调的弹性模量和足够的力学强度，接近人体骨骼的力学性能而逐渐被重视。但目前还缺乏生物相容性好、生物力学相容性好的理想假体材料。因此应从改进人工髋关节设计和制造工艺，提高材料的耐磨性与力学性能，增强假体与宿主骨的结合性，减少应力遮挡等方面来提高植入物与宿主的生物相容性，更好地延长假体使用寿命。%BACKGROUND:Early clinical application of non-biological materials (bone cement) for treatment of hip joint is ineffective, due to the large fixed range, long fixation time, as wel as aging and rupture of bone cement interface causing complications such as prosthetic loosening. Thus, postoperative range of motion of the hip joint can be affected to some degree. OBJECTIVE:To investigate the methods and progress of biological and non-biological materials for total hip replacement and to assess the features and clinical application of different hip prostheses. METHODS:A computer-based search of PubMed and CNKI was performed by the first author to retrieve articles related to biological materials and tissue-engineered hip joint using the keywords of“carpal bone, fracture ununited”in the title and abstract. The keywords were limited to Chinese and English. RESULTS AND CONCLUSION:Biological materials for internal fixation have good wear resistance, corrosion resistance and biocompatibility. Currently, the combination of metal joint head and polyethylene acetabulum with ultrahigh molecular weight is the most commonly used in hip replacement. However, the metal joint head exhibits an elastic modulus far from the human skeleton, resulting in stress shielding effects which are easy to cause prosthetic loosening and instability. Bio-inert ceramics has high in vivo stability and good mechanical strength;and bioactive ceramics has bone conduction characteristics and performance of the living bone integration. Composite prosthesis, because of adjustable elastic modulus and sufficient mechanical strength, shows the mechanical properties close to the human bone and has been gradual y noticed. However, there is a lack of ideal prostheses with good biocompatibility and biomechanics. Therefore, hip design and manufacturing processes should be improved to elevate wear resistance and mechanical properties, to enhance the binding between prosthesis and the host bone, and to reduce stress shielding in order to improve the biocompatibility of the implant with the host, and extend the prosthetic life.
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