Wagner H
Clin Orthop Relat Res. 1978 Jul-Aug(134):102-30.
The principle of hip joint resurfacing is replacement of diseased joint surfaces and simultaneous restoration of the normal anatomy and biomechanical function to the maximal degree possible. This concept offers several theoretical advantages over conventional total hip joint replacement and the clinical results in this series of 426 cases appears to confirm the value of both the method and the concept. Successful joint resurfacing surgery with attention to detail. Most problems can be anticipated and handled appropriately. Complications are few. The operation should only be done in cases of severe hip disability, when the patient's level of suffering demands operative intervention and when the only reasonable alternatives are fusion, total joint replacement or head and neck resection. It is an operation designed and recommended as an "in-between" procedure to gain time against the progressive disease. Resurfacing should not be performed if conservative measures or classic hip osteotomies offer significant benefit. The principal advantages of this procedure relate directly to the prosthetic design. Only the joint surfaces are removed during surgery, most of the normal bone is preserved, the medullary canal is not opened, and the implants utilized are of small volume. As a result the risk of infection is low compared to other implant arthroplasty techniques and clinical statistics confirm this anticipated advantage. The operation is designed to interfere minimally with the normal joint mechanics so it is also anticipated that prosthesis longevity will be greater than when rigid stem prostheses are placed in elastic bone. As yet follow-up is too short to make valid judgments on this point. The technique is applicable to younger patients, however, because if it should, in time, fail and other surgical treatment becomes necessary the original alternatives of total hip replacement, arthrodesis, or head and neck resection remain available. Relief of pain is predictable and almost all patients have experienced significant improvement in function. The procedure has a broader indication in cases of prior bone or joint infection and is definitely a preferable procedure in young individuals with severe hip disability.
髋关节表面置换的原则是替换病变的关节面，并尽可能最大程度地同时恢复正常解剖结构和生物力学功能。这一理念相较于传统全髋关节置换具有若干理论优势，本系列426例患者的临床结果似乎证实了该方法及理念的价值。成功的关节表面置换手术需注重细节。多数问题可被预见并妥善处理。并发症较少。该手术仅适用于严重髋关节功能障碍的病例，即患者的痛苦程度需要手术干预，且唯一合理的替代方案为关节融合、全关节置换或头颈切除。这是一种被设计并推荐为“过渡性”的手术，用于争取时间对抗疾病进展。若保守措施或经典髋关节截骨术能带来显著益处，则不应进行表面置换。该手术的主要优势直接与假体设计相关。手术中仅去除关节面，大部分正常骨质得以保留，髓腔未被打开，且所使用的植入物体积较小。因此，与其他植入式关节成形术技术相比，感染风险较低，临床统计数据证实了这一预期优势。该手术旨在对正常关节力学的干扰降至最低，因此预计假体使用寿命将长于将刚性柄假体植入弹性骨质的情况。然而，目前随访时间过短，无法就此做出有效判断。不过，该技术适用于年轻患者，因为若日后出现失败且需要其他手术治疗，全髋关节置换、关节融合或头颈切除等原有替代方案仍然可行。疼痛缓解效果可预测，几乎所有患者的功能都有显著改善。该手术在既往有骨或关节感染的病例中有更广泛的适应证，对于严重髋关节功能障碍的年轻个体而言，无疑是更可取的手术。
