Noble P C, Alexander J W, Lindahl L J, Yew D T, Granberry W M, Tullos H S
Division of Orthopedic Surgery, Baylor College of Medicine, Houston, Texas.
Clin Orthop Relat Res. 1988 Oct(235):148-65.
The shape of the femoral canal is variable, much more variable, in fact, than most contemporary designs of femoral components would suggest or can accommodate. In the face of this variability, line-to-line or surface-to-surface contact is not expected between cementless implants and much of the endosteal surface. It also is apparent that changes in implant design are still needed if the normal biomechanics of the hip joint are to be restored in each patient and if component fixation is to be optimized. Most cementless components aim to achieve proximal load transfer to the femoral canal. However, increasing clinical evidence suggests that distal filling of the femur also is necessary to minimize the incidence of postoperative symptoms, particularly in revision procedures. If this is indeed the case, more accommodating designs of femoral components are needed that will enable proximal and distal fitting at the femoral canal so that stable fixation may be achieved regardless of variations in bone geometry.
股骨髓腔的形状是可变的，实际上，其变化程度比大多数当代股骨假体的设计所显示的或所能适应的要大得多。面对这种变异性，非骨水泥型植入物与大部分骨内膜表面之间无法实现线对线或面与面的接触。同样明显的是，如果要在每个患者身上恢复髋关节的正常生物力学，并且要优化假体固定，仍需要对植入物设计进行改进。大多数非骨水泥型假体旨在实现向股骨髓腔的近端负荷传递。然而，越来越多的临床证据表明，股骨的远端填充对于将术后症状的发生率降至最低也是必要的，尤其是在翻修手术中。如果确实如此，就需要更具适应性的股骨假体设计，以便在股骨髓腔实现近端和远端的适配，从而无论骨几何形状如何变化都能实现稳定固定。
