摘要
目的 探讨自行设计的伞状记忆合金股骨头支撑器（以下简称伞状支撑器）治疗成人股骨头缺血性坏死的可行性及近期疗效。方法 采用Ni-Ti合金板制备伞状支撑器,采用pro/mechanica软件进行三维有限元分析其力学特征。2009年10月-2012年12月,收治10例（18髋）成人股骨头缺血性坏死患者。男7例（12髋）,女3例（6髋）;年龄21～53岁,平均40.6岁。病程1～5年,平均3.3年。Ficat分期：Ⅱ期10髋,Ⅲ期6髋,Ⅳ期2髋。应用微创方法刮除股骨头坏死组织,将伞状支撑器植入坏死塌陷的股骨头内,并植入自体髂骨和人工骨,顶起已塌陷的股骨头。结果 三维有限元分析显示,伞状支撑器最大应力为1 500 MPa,最大位移为1.75 mm。临床应用中1例（1髋）因减压通道位置偏向外侧,支撑器放置于股骨头外,术后6个月行人工全髋关节置换术;余10例（17髋）均顺利完成手术;均获随访15～26个月,平均19.7个月。末次随访时,按照百分评价法评定疗效,获优5髋,良9髋,可2髋,差1髋;优良率为82.35%。与术前相比,末次随访时Ficat分期无改变。结论 伞状支撑器治疗成人股骨头缺血性坏死能彻底清除死骨减压,增加股骨头负重区软骨下骨的机械支撑,降低局部应力,利于股骨头坏死的修复及重建,可获得较好近期疗效,但远期疗效有待进一步观察明确。
Objective To investigate the technique and short-term effectiveness of the umbrella-shaped memory alloy femoral head support device （umbrella-shaped support device for short） for the treatment of avascular necrosis of femoral head （ANFH）. Methods The umbrella-shaped support device was fabricated with Ni-Ti alloy, and its biomechanics characteristics were tested by three-dimensional finite element analysis with pro/mechanica software. Between October 2009 and December 2012, 10 patients （18 hips） with ANFH were treated. There were 7 males （12 hips） and 3 females （6 hips）, aged 21-53 years （mean, 40.6 years）. The disease duration was 1-5 years （mean, 3.3 years）. According to Ficat staged criteria, 10 hips were rated as stage II, 6 hips as stage III, and 2 hips as stage IV. Microtrauma methods were used to erase the necrotic tissue of the femoral head, and the umbrella-shaped support device, autogenous iliac bone graft, and artificial bone were implanted to support the collapsed femoral head. Results Three-dimensional finite element analysis showed that the largest stress of umbrella-shaped support device was 1500 MPa and the largest displacement was 1.75 mm. Operation was successfully completed in the other 10 patients （ 17 hips） except 1 failure hip （total hip arthroplasty was performed after 6 months）. The average follow-up period was 19.7 months （range, 15-26 months）. At last follow-up, the results were excellent in 5 hips, good in 9 hips, fair in 2 hips, and poor in 1 hip; the excellent and good rate was 82.35%. The Ficat stage had no change when compared with preoperative stages. Conclusion The advantages of the umbrella-shaped support device for the treatment of ANFH are to thoroughly remove the sequestrum, to rebuild blood circulation of the femoral head, to increase the machinery supporting of subchondral bone in weight-bearing area of femoral head, and to decrease the localized stress, and it has good short-term effectiveness, but long-term effectiveness needs further observation.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2014年第4期423-427,共5页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
股骨头缺血性坏死
伞状记忆合金股骨头支撑器
微创治疗
Avascular necrosis of femoral head Umbrella-shaped memory alloy femoral head support device Minimally invasive treatment
