摘要
目的:人工髋关节研究一直是近年热点,自运用以来在临床方面取得了可喜的成果,但由于自身材料和技术问题使远期效果受到一定的限制。本文就人工髋关节未来十年的发展趋势和临床应用前景进行综述。资料来源:应用计算机检索PUBMED1990-01/2006-01期间的相关文章,检索词为“totalhipreplacements,surgicalrobot,tissueengineering,vir-tualendoscopy”,并限定文章语言种类为English。同时计算机检索万方数据库1990-01/2005-12期间的相关文章,检索词为“人工髋关节,材料,仿真内镜,手术机器人,组织工程学”,并限定文章语言种类为中文。资料选择:对资料进行初审,并查看每篇文献后的引文。纳入标准:文章所述内容应与人工髋关节研究相关。排除标准:重复研究或Meta分析类文章。资料提炼:共收集到39篇相关文献,22篇文献符合纳入标准,排除的17篇文献为内容陈旧或重复。符合纳入标准的22篇文献中,5篇涉及人工关节材料对假体松动和致癌性的影响,2篇涉及计算机辅助导航手术使人工关节手术微创化,1篇涉及机器人引入人工关节手术,3篇涉及定制和特制人工关节的发展,9篇涉及人工髋关节表面置换的可能性,2篇涉及组织工程技术与人工关节的结合。资料综合:现代人工髋关节研究探索新的耐磨损假体,减少骨溶解、骨吸收所致的假体松动。根据病情的需要利用计算机辅助设计/制造技术进行特殊设计和制作,解决假体周围骨折及肿瘤保肢手术的要求。计算机辅助导航手术使人工关节手术微创化,术后患者恢复快。通过开发具有中国本土化的手术机器人,提高人工髋关节手术的成功率。运用仿真关节镜,能够准确了解关节内软骨及软骨下骨破坏情况,并将其量化,可以选择最为合适可靠的假体,增加精确性。组织工程技术修复缺损能够提高假体骨性结合,使人工关节置换技术更加完美。结论:未来十年人工髋关节将向着求稳定、零危害、微创化、机械化、个体化、多样化发展,从而使人工髋关节置换技术更加规范、安全和高成功率。
OBJECTIVE： Researches on total hip replacements are always the hot spots in recent years. The replacements have obtained satisfactory, outcomes in clinic. However, the long-term effect is limited because of the material and technical problems. This paper is to summarize the developmental trend and the prospect of clinical application for total hip replacements in 10 years.
DATA SOURCES： A computer-based online search of Medline database was undertaken to identify relevant articles published in English from January 1996 to January 2006 by using the keywords of ＂total hip replacements, surgical robot, tissue engineering, virtual endoscopy＂. Meanwhile, Chinese relevant articles published from January 1990 to December 2005 were searched in Wanfang database, the keywords were ＂total hip replacements, material, virtual endoscopy, surgical robot, tissue engineering＂ in Chinese.
STUDY SELECTION： The articles were primarily checked, and the references in each literature were reviewed. Articles about the study on total hip replacements were involved; Meanwhile, the repetitive studies or Meta analysis were excluded.
DATA EXTRACTION： Totally 39 relevant articles were collected, and 22 of them accorded with the inclusive criteria, 17 old or repetitive ones were excluded. Of the 22 articles, 5 were about the influence of artificial joint material on prosthetic loosening and its carcinogenesis： 2 about the microinvasion of joint replacement induced by computer-aided surgery navigation; 1 about the introduction of surgical robot; 3 about the development of custom-made and specially made artificial joint; 9 about the possibility for the surface replacement of hip; and 2 about the combination of tissue engineering technique and artificial joint.
DATA SYNTHESIS： Modern researches on total hip replacements are exploring wearing tolerant prosthesis to reduce the prosthetic loosening caused by osteolysis and bone resorption. The computer-aided design/made technique is used for special design and manufacture according to the need of disease, so as to solve the fracture around prosthesis and meet the need of limb salvage surgery. The computer-aided surgery navigation realizes the microinvasion of joint replacement and the fast recovery after surgery. The successful rate of total hip replacements is improved by developing localized surgical robot in China. By using the virtual endoscopy, we can accurately know the damaged conditions of intraartieular cartilage and sub-cartilage bone, which are also able to be quantifized, so that more suitable and reliable prosthesis can be selected to increase the accuracy. The tissue engineering technique in repairing defect ean increase the synostosis of prosthesis, and perfect the technique of joint replacement.
CONCLUSION： In the coming 10 years, total hip replacements will develop towards stability, harmlessness, microinvasion, mechanization, individualization and diversification, so that the total hip replacements will be much stander and safer with higher successful rate.
出处
《中国临床康复》
CSCD
北大核心
2006年第41期225-227,228,共4页
Chinese Journal of Clinical Rehabilitation
