全髋关节置换术中金属柄与陶瓷内衬之间的撞击：发生撞击的部位不仅仅在颈部。
Impingement Between the Metal Stem and the Ceramic Liner in Total Hip Arthroplasty: The Neck Is Not the Only Place Where Impingement Occurs.
机构信息
Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea.
出版信息
J Bone Joint Surg Am. 2021 Jan 20;103(2):139-145. doi: 10.2106/JBJS.20.00354.
BACKGROUND
It is assumed that impingement between the ceramic liner and the stem increases the possibility of a liner fracture in total hip arthroplasty with a ceramic-on-ceramic bearing. The purpose of this study was to analyze the pattern of the impingement by evaluating the notches (U-shaped indented wear scars engraved on the stem) on radiographs to determine when and where impingement develops and to analyze the factors affecting its occurrence.
METHODS
Among the primary total hip arthroplasty cases using a ceramic-on-ceramic bearing performed from November 1997 to December 2003, 244 cases of 197 patients (123 male patients and 74 female patients) that had follow-up of ≥15 years were included. All of the radiographs were examined with special regard to the notches and the cup positions.
RESULTS
Notches were detected at 77 sites of 57 cases (23.4%) for the first time between 8 months and 14.8 years after the surgical procedure. They were located on the neck or the shoulder of the stem. Shoulder notches were detected only in the cases with a short-neck head. Shoulder notches were found in 29 cases (20.0% of short-neck cases). Cup inclination was lower (p = 0.01) and anteversion was higher (p = 0.01) in the group with notches than the group without notches. There were 5 cases of ceramic head fracture. One of them experienced another ceramic liner fracture, assumed to be caused by prosthetic shoulder impingement, after the revision surgical procedure.
CONCLUSIONS
The results of this study suggest that impingement between the stem and the ceramic liner occurs in a considerable proportion of patients who underwent total hip arthroplasty not only on the neck but also on the shoulder of the stem. Forceful and abrupt impingement on the stem shoulder can cause ceramic liner fracture. Impingement between the stem shoulder and the ceramic liner should be considered in designing a stem. It seems to be prudent to recommend that patients avoid squatting or sitting cross-legged on the floor as much as possible.
LEVEL OF EVIDENCE
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
背景
在全髋关节置换术中，陶瓷内衬与柄之间的撞击会增加陶瓷对陶瓷关节轴承内衬断裂的可能性。本研究的目的是通过评估射线照片上的凹陷（刻在柄上的 U 形凹陷磨损痕迹）来分析撞击的模式，以确定撞击何时何地发生，并分析影响撞击发生的因素。
方法
在 1997 年 11 月至 2003 年 12 月期间进行的全髋关节置换术的陶瓷对陶瓷关节轴承初次置换病例中，纳入了 197 名患者（123 名男性，74 名女性）中的 244 例，随访时间≥15 年。所有射线照片均特别关注凹陷和杯位置。
结果
在手术 8 个月至 14.8 年后，首次在 57 例（23.4%）中的 77 个部位发现了凹陷。它们位于柄的颈部或肩部。只有短颈头的病例才会出现肩部凹陷。在 29 例（短颈病例的 20.0%）中发现了肩部凹陷。有凹陷的组杯倾斜度较低（p = 0.01），前倾角较大（p = 0.01）。有 5 例陶瓷头骨折。其中 1 例在翻修手术后经历了另一次陶瓷衬里骨折，认为是由于假体肩部撞击所致。
结论
本研究结果表明，全髋关节置换术后，不仅在柄颈部，而且在柄肩部，相当一部分患者发生了柄与陶瓷衬里之间的撞击。对柄肩部的剧烈和突然撞击会导致陶瓷衬里骨折。在设计柄时应考虑柄肩部与陶瓷衬里之间的撞击。建议患者尽可能避免蹲坐或盘腿坐在地板上，这似乎是谨慎的做法。
证据水平
治疗水平 IV。有关证据水平的完整描述，请参阅作者说明。
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