Bizot P, Nizard R, Hamadouche M, Hannouche D, Sedel L
Service de Chirurgie Orthopédique et Traumatologique, Hĵpital Lariboisière, Paris, France.
Clin Orthop Relat Res. 2001 Dec(393):85-93. doi: 10.1097/00003086-200112000-00010.
Alumina-on-alumina bearings in total hip replacement have been used for 30 years. Excellent tribologic properties and extra low debris generation could, in theory, provide an answer to osteolysis. A review of the authors' experience with alumina-on-alumina bearings showed that, except in a few bearings that had been loose for a long time, osteolysis was not a problem. Although the cemented titanium stem and the alumina-on-alumina couple were not a problem, fixation of the socket had to be improved. To improve the socket fixation system and to avoid the use of a cemented titanium stem that may have created problems in the long-term, a new design was introduced in 1997. The current authors present the preliminary results of the first 96 hips with cementless fully-coated hydroxyapatite titanium alloy stems and sockets, 32-mm alumina femoral head, and alumina liner, both held with a Morse taper. Ninety-six consecutive hips in 89 patients (57 males, 32 females) with a median age of 46 years (range, 14-72 years) were analyzed. One socket was revised at 4 months because of poor primary stability in a patient with a severe acetabular fracture. One patient experienced a traumatic fracture of the implanted femur 3 weeks after surgery. The mean followup was 16 months (range, 4-38 months). One patient died from rupture of an aneurysm. Ninety-three hips in 86 patients were assessed regarding the clinical and radiologic ratings. Two patients (two hips) were interviewed by telephone. The Merle d'Aubigné rating system was 18 in 65 hips (59 patients), 17 in 25 hips (25 patients), and 16 in three hips (three patients) mainly related to a previous disability including limp, sciatic palsy, or stiffness. Examination of 93 available radiographs revealed no ostelolysis, no radiolucent lines at the last examination, and no subsidence. The level of excellent results, even in this young population, and lack of osteolysis and wear are encouraging, even if the followup is too short to allow any conclusions to be made.
全髋关节置换中的氧化铝对氧化铝轴承已使用30年。理论上，其优异的摩擦学性能和极低的碎屑产生量可为骨溶解问题提供解决方案。回顾作者使用氧化铝对氧化铝轴承的经验发现，除了少数长期松动的轴承外，骨溶解并非问题。虽然骨水泥固定的钛柄和氧化铝对氧化铝组合没有问题，但髋臼的固定仍需改进。为改进髋臼固定系统并避免使用可能在长期使用中产生问题的骨水泥固定钛柄，1997年引入了一种新设计。本文作者展示了首批96例采用无骨水泥全涂层羟基磷灰石钛合金柄和髋臼、32毫米氧化铝股骨头以及氧化铝内衬（均采用莫氏锥度固定）的髋关节置换的初步结果。分析了89例患者（57例男性，32例女性）的96例连续髋关节置换病例，患者中位年龄46岁（范围14 - 72岁）。1例髋臼严重骨折患者因初次稳定性差，在4个月时对1个髋臼进行了翻修。1例患者在术后3周发生植入股骨的创伤性骨折。平均随访时间为16个月（范围4 - 38个月）。1例患者死于动脉瘤破裂。对86例患者的93个髋关节进行了临床和影像学评估。通过电话对2例患者（2个髋关节）进行了访谈。Merle d'Aubigné评分系统中，65个髋关节（59例患者）评分为18分，25个髋关节（25例患者）评分为17分，3个髋关节（3例患者）评分为16分，主要与既往残疾包括跛行、坐骨神经麻痹或僵硬有关。对93份可用的X线片检查显示，末次检查时无骨溶解、无透亮线且无下沉。即使在这个年轻人群中，优异的结果水平以及无骨溶解和磨损的情况令人鼓舞，尽管随访时间过短无法得出任何结论。
