首页> 中文期刊> 《骨科动态》 >哪些因素决定大直径金属对金属全髋置换术后磨损率?对276个关节假体的多因素分析

哪些因素决定大直径金属对金属全髋置换术后磨损率?对276个关节假体的多因素分析

         

摘要

背景:明确临床因素与回收髋关节假体的工程分析结果之间联系可以帮助我们理解假体失败的机制.因为金对金髋关节置换绝大多数失败原因仍无法解释,这一研究对于金对金髋关节置换尤为重要.我们试图了解在大宗回收金对金髋关节假体中磨损率变化规律.方法:我们前瞻性地记录了术前、术中和术后数据以研究以下变量对于股骨头和髋臼杯磨损率的影响:患者性别、失败原因、制造厂商类别、表面置换或组配式设计、血中钴和铬浓度、边缘负载(edge-loading)、股骨头尺寸、和髋臼杯俯倾角度.我们分析了从失败的金对金髋关节置换术后分析了回收的276个组件(138对股骨头和髋臼杯组合).结果:我们发现边缘负载占有很高比例(64%),而138髋中仅有43髋(31%)存在臼杯俯倾角>55°的情况.多因素分析结果显示,决定磨损率变化最重要的因素是边缘负荷的存在与否,甚至调整髋臼杯俯倾角度后仍出现边缘负荷.髋臼杯和股骨头之间的磨损率与血清钴和铬的浓度存在明显的相关性.结论:对9个因素的多因素分析发现边缘负载是磨损率最重要的预测因素,发生在2/3失败的金对金髋关节置换术中.大多数失败病例并没有臼杯俯倾角过大,68%的髋关节俯倾角≤55°.这一发现以及我们研究中发现的相对低的中期磨损率,提示臼杯俯倾角和/或磨损率可能不是仅有的与金对金髋关节置换失败相关因素.

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    《骨科动态》 |2013年第3期|169-177|共9页
  • 作者单位

    Investigation performed at the London Implant Retrieval Centre, a Collaboration Between Imperial College London, London, and the Royal National Orthopaedic Hospital NHS Trust, Middlesex, United Kingdom;

    Investigation performed at the London Implant Retrieval Centre, a Collaboration Between Imperial College London, London, and the Royal National Orthopaedic Hospital NHS Trust, Middlesex, United Kingdom;

    Investigation performed at the London Implant Retrieval Centre, a Collaboration Between Imperial College London, London, and the Royal National Orthopaedic Hospital NHS Trust, Middlesex, United Kingdom;

    Investigation performed at the London Implant Retrieval Centre, a Collaboration Between Imperial College London, London, and the Royal National Orthopaedic Hospital NHS Trust, Middlesex, United Kingdom;

    Investigation performed at the London Implant Retrieval Centre, a Collaboration Between Imperial College London, London, and the Royal National Orthopaedic Hospital NHS Trust, Middlesex, United Kingdom;

    Investigation performed at the London Implant Retrieval Centre, a Collaboration Between Imperial College London, London, and the Royal National Orthopaedic Hospital NHS Trust, Middlesex, United Kingdom;

    Investigation performed at the London Implant Retrieval Centre, a Collaboration Between Imperial College London, London, and the Royal National Orthopaedic Hospital NHS Trust, Middlesex, United Kingdom;

    Investigation performed at the London Implant Retrieval Centre, a Collaboration Between Imperial College London, London, and the Royal National Orthopaedic Hospital NHS Trust, Middlesex, United Kingdom;

    Investigation performed at the London Implant Retrieval Centre, a Collaboration Between Imperial College London, London, and the Royal National Orthopaedic Hospital NHS Trust, Middlesex, United Kingdom;

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