人工髋关节置换技术发展人工髋关节置换技术发展 对康复提出的新挑战 对康复提出的新挑战 上海交通大学医学院 附属第九人民医院 骨科 朱振安 毛远青 人工髋关节 人工髋关节 人工（髋人工（髋）关节置换术 关节置换术 20世纪最重要的技术创新 SWEDISH HIP ARTHROPLASTY REGISTER 2010 5 Peter Herberts Professor Emeritus Johan Krrholm Professor Gran Garellick Associate Professor Reporting to the Registry Most departments report via the web application. Copies of medical records from re-operations are sent over the year with varying delay. Reviews of medical-record copies and systemized data collection centrally are necessary for Regis- ter analysis regarding reoperations and revisions. Re-reporting All publications, annual reports and scientific reports are presented on our website. The Hip Arthroplasty Registry in collaboration with the Swedish Knee Arthroplasty Reg- istry invites all departments to an annual user meeting at Arlanda. Local activity analysis and development The Registry has always intended that re-reporting should stimulate participating departments to carry out local anal- yses of their activity and that this should lead to measures for improvement. The purpose of open comparisons is that they should put increased pressure on this process. In the past few years we have, in each annual report, selected good examples of such work. This year we publish written re- ports from two departments about their analyses. How to stimulate all departments to carry out similar work is a cen- tral problem area for the Registrys work. This years production In 2010 the procedure frequency of total hip arthroplasties increased further to an all-time high (15,935, 170/100,000 inhabitants, adjusted for individuals aged over 40 years: 332/100,000) see bar diagram. The procedure frequency for hemi-arthroplasties during 2010 was unchanged at about 4,500. Private enterprise has for some years produced more opera- tions than the university hospitals and this is now further accentuated. These producers have in most cases no R Group 2: 34.6%) as well as revision arthroplasty (Group 1: 26.8%; Group 2: 0%) were associated with a higher incidenceof dislocations. There was no significant difference in mean head diameters and neck length between the patients with and without dislocation (p0.05). Mean acetabular cup inclination (conventional measurement) was 42 for Group 1 and 43 for Group 2. There was no significant difference between the two groups (p0.79). There was also no difference in acetabular cup torsion between Group 1 (mean: 14.5) and 2 (mean 15.0). Regarding inclination and torsion, the majority of cups in both groups (56% and 61%, p0.05) were positioned in the “safe zone” defined by Lewinnek et al.16Evaluation of component position revealed no significant differences between the two groups (Fig. 1, Table 3). The mean difference between the conventional and newly developed measurement methods concerning cup inclination and torsion was 3.0 and 6.5 for Group 1 and 2.8 and 6.4 for Group 2, respectively. Discussion Dislocation after THA remains an unsolved problem and agreement on the risk factors is limited.6,28-30失去功能失去功能 稳定性的维持 稳定性的维持 头臼对合 假体-骨界面固定 1960 Charnley 金属金属-塑料全髋塑料全髋 low-friction 骨水泥的深入研究与推广 骨水泥的深入研究与推广 John Charnley 22mm 金属金属-塑料全髋塑料全髋 骨水泥固定 骨水泥固定 中晚期中晚期 松动率高 松动率高 磨损快磨损快 脱位率脱位率7% 即刻稳定即刻稳定 早中期功能优异 早中期功能优异 界面固定 界面固定 骨水泥非骨水泥 表面处理 假体形状 （力学分布） 早期机械性稳定 中远期生物性稳定 对合稳定 对合稳定 金属-聚乙烯 陶瓷 金属-金属 磨损率大大降低，减少松动 股骨头直径 股骨头直径 was higher than both infection and aseptic loosening 10. In addition, the revision burden is expected to increase over the next 20 years from 10% presently to over 20% of all THAs by the year 2030 25. Dislocation causes are mul- tifactorial and are associated with femoral stem design 1, 48, acetabular component orientation 2, 7, 28, surgical approach 7, 31, 34, soft tissue laxity 40, femoral headsize 12, 21, 23, 34, and other patient-specific factors 7, 18, 34. Mechanisms described for the characterization of dis- location using these testing conditions include levering the femoralheadoutoftheacetabulumsecondaryto impingement 2, 33 as well as femoral head translation resulting from muscle weakness 6, 33 or soft tissue laxity 11. Regardless of the mechanism of dislocation, the femoral head must travel a certain distance, typically termed the jump distance, before it can be unseated from the acetabular component. Prior studies to quantify thesemeasurements did so by using simplified two-dimensional geometry (Fig. 1) to compare the effect of varying femoral head sizes on the jump distance required for dislocation. Additionally, these studies used a range of acetabular cup positions (varying through the extremes of 0! to 90! of abduction), which can generate results that might never be realized in an in vivo setting. However, the continued prevalence of dislocation after THA suggests that although jump distance may be a valid indicator for dislocation risk, the way this value is determined may require a more sophisticated approach and t