Boutin P, Christel P, Dorlot J M, Meunier A, de Roquancourt A, Blanquaert D, Herman S, Sedel L, Witvoet J
Clinique Marzet, Pau, France.
J Biomed Mater Res. 1988 Dec;22(12):1203-32. doi: 10.1002/jbm.820221210.
The purpose of this article was to review the laboratory and clinical performances since 1970 of a total hip prosthesis using alumina-alumina combination. The chemical and physical properties of dense alumina ceramic were studied in relation to biocompatibility, mechanical strength, and surface properties. Through the examination of 35 retrieved implants, it was found that the long-term success of alumina-alumina total hip replacement depends on both the ceramic microstructure (small grain size with uniform distribution, minimum porosity, absence of inclusions) and implant geometry (sphericity deviation +/- 1 micron, radius tolerance between components 7-10 microns). Alumina component wear and fractures have disappeared with the use of high-performance materials and severe manufacturing quality control. Examination of human biopsies from well-fixed prostheses showed that alumina particles deposits increase with time with only a low-grade macrophagic reaction. When loosening occurred, an inflammatory reaction appeared; this reaction was less striking than with loose metal-polyethylene prostheses, however. The long-term behavior of cementless alumina cup fixation depends upon initial positioning and stability; survivorship analysis of the cemented ceramic cups showed an 88% survival probability after 8 years with a 1.6% average annual probability of revision. The percentage of surviving was 100% after 8 years in patients who were less than 50 years old. Aseptic loosenings occurring at the cup-cement interface were assumed to be related to stress protection secondary to the high rigidity of the ceramic leading to a weakening of the spongious bone supporting the cement mantle. Good bone stock quality as well as high-quality ceramic appear to be the prerequisites for durable fixation of alumina sockets.
本文旨在回顾自1970年以来使用氧化铝-氧化铝组合的全髋关节假体的实验室和临床性能。研究了致密氧化铝陶瓷的化学和物理性能与生物相容性、机械强度及表面性能的关系。通过对35个回收植入物的检查发现，氧化铝-氧化铝全髋关节置换的长期成功取决于陶瓷微观结构（小晶粒尺寸且分布均匀、最小孔隙率、无夹杂物）和植入物几何形状（球度偏差±1微米，部件间半径公差7-10微米）。随着高性能材料的使用和严格的制造质量控制，氧化铝部件的磨损和骨折现象已消失。对固定良好的假体进行人体活检检查显示，氧化铝颗粒沉积物随时间增加，仅伴有低度巨噬细胞反应。当出现松动时，会出现炎症反应；然而，这种反应不如金属-聚乙烯松动假体明显。非骨水泥氧化铝杯固定的长期行为取决于初始定位和稳定性；骨水泥陶瓷杯的生存分析显示，8年后的生存概率为88%，平均每年翻修概率为1.6%。50岁以下患者8年后的生存率为100%。杯-骨水泥界面发生的无菌性松动被认为与陶瓷高刚性导致的应力保护有关，进而导致支撑骨水泥套的松质骨减弱。良好的骨量质量以及高质量的陶瓷似乎是氧化铝髋臼持久固定的先决条件。
