| 不同假体设计与安装参数对全髋术后关节活动度的影响 |
| 投稿时间：2011-05-22 修订日期：2011-06-13 点此下载全文 |
| 引用本文：李永奖,林瑞新,张力成,杨国敬,蔡春元,周德彪,吴立军.不同假体设计与安装参数对全髋术后关节活动度的影响[J].医学研究杂志,2012,41(4):79-83 |
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| 基金项目:浙江省科技计划基金资助项目（2009C33144）;温州市科技计划基金资助项目（Y20090274） |
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| 中文摘要:目的研究全髋关节假体安装参数、不同头颈直径比和颈干角对假体撞击和髋关节活动范围的影响，分析髋臼杯位相安全范围及杯颈前倾角优化组合。方法建立人工全髋关节三维可视化计算机模型，将同时满足髋关节屈曲≥110°、屈曲90°内旋≥30°、后伸≥30°、外旋≥40°定义为日常生活活动范围普通标准，而将屈曲≥120°、屈曲90°内旋≥45°、后伸≥30°、外旋≥40°定义为严格标准，头颈比变化范围为2.00～2.92，股骨假体前倾角变化范围为0°～30°，髋臼假体外展角变化范围为10°～60°，髋臼前倾角变化范围为0°～70°，颈干角设定为130°和135°；计算满足上述两种活动范围，臼杯外展角每变化5°，相应的髋臼假体前倾角安装参数，并对数据进行分析。结果头颈比>2.37时，安全范围面积增大明显；严格标准条件下的安全范围比普通标准的小。颈干角130°，普通标准和严格标准活动度下，髋臼杯前倾角（Y）与股骨假体前倾角（X）的关系分别为Y1=-08164X1+41.914，Y2=-0.8028X2+47.094；允许的最小髋臼外展角（IAmin）和头颈比（HNR）的关系分别为IAmin′1=16813HNR-2.5041，IAmin′2=213.79HNR-2.272 2；当颈干角从135°移向130°，杯安全范围移向杯前倾角较小的区域，面积也有所减小。结论髋臼杯位相安全范围随着头颈比增大而增大；头颈比>2.37是比较合适的。髋关节活动范围要求越高，臼杯位相安全范围就越小，但可以通过增大头颈比来纠正。允许的最小髋臼外展角随着头颈比增大而变小；杯前倾角与股骨前倾角呈负相关。颈前倾角的增大和颈干角的变小均使得杯安全范围移向杯前倾角较小的区域，杯外展角随着颈干角增大而变小。 |
| 中文关键词:关节成形术 置换 髋 髋假体 活动范围 计算机 模拟 手术学定义 |
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| Effect of Different Prosthesis Design and Installation Parameters on The Range of Motion of The Hip in Total Hip Replacement |
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| Abstract:ObjectiveTo study the effect of the orientation of total hip components, different head/neck ratios and collodiaphyseal angles on the impingement and the range of hip, and abtain the cup safe-zone and the optimum combination of cup and neck anteversions. MethodsA three-dimensional generic parametric and kinematic simulation module of THA was developed. Range of motion(ROM) of flexion ≥110°, internal-rotation ≥30° at 90° flexion, extension ≥30° and external rotation ≥40° were defined as the normal criteria for desired ROM for activities of daily living, and ROM of flexion ≥120°, internal-rotation ≥45° at 90° flexion, extension ≥30° and external rotation ≥40° as the severe criteria. The range of the changes in the general head-neck ratios, the femoral neck anteversion(FA), the anteversion of acetabular,(AA) the inclination of the acetabular(IA) were 2.0-2.92, 0°-30°, 10°-60°, 0°-70° respectively. For two collodiaphyseal angle of 130° and 135°, the corresponding anteversion of acetabular related to the inclination of the acetabular which every 5° was calculated. All data was analyzed. ResultsIt is recommended that HNR be more than 2.37 as it further increases the size of safe-zone. The size of cup safe-zone of the severe criteria was smaller than that of the normal criteria. When the collodiaphyseal angle was 130°, the optimum relationship between AA and FA of the normal criteria and the severe criteria can be estimated by the formula: AA1=-0.8164FA1+41.914（r2=0.9988）and AA2=-0.8028FA2+47.094（r2=0.9998）respectively, and the minimum allowable inclination (IAmin) should be more than 168.13HNR-2.5041（r2 = 0.9985）and 213.79HNR-2.2722（r2 = 0.996）respectively. When the collodiaphyseal changed from 135° to 130°, the cup safe-zone moved to the area of smaller AA values, and its size got slightly smaller. ConclusionLarge HNR greatly increases the size of safe-zone and it is recommended that HNR be more than 237. The more severer of the hip motion, the more smaller size of the cup safe-zone, but can retrieve by increase the HNR. The IAmin was largely reduced with an increasing HNR. The AA was negative with FA. The increase of the FA and the change of collodiaphyseal angle from 135° to 130° moved the cup safe-zone toward a smaller AA, and the IA was decreased followed the increasing of the collodiaphyseal angle. |
| keywords:Arthroplasty Replacement Hip Hip prosthesis Range of motion Computers Analog Operative orientations |
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