CAJ | 학술논문

背景：股骨颈保留型(Col um Femoris Preserving，C.F.P)假体为意大利骨科医生Pipino与德国LINK公司联合设计开发。该假体手术操作手册中推荐截骨平面是否适合国人股骨结构特点以及所采用截骨方式是否会引起假体以及股骨应力发生变化，目前尚未见研究报告。 　　目的：通过临床病例回顾和三维有限元模型分析股骨颈保留型人工全髋关节置换的临床疗效以及应力分布变化。 　　方法：①回顾分析36例股骨颈保留型全髋关节置换及36例普通生物型全髋关节置换患者临床资料，通过Harris评分、目测类比评分、置换前后偏心距变化、IDES-Engh放射学及并发症等指标评价疗效。②建立两种不同截骨平面股骨颈保留型全髋关节置换有限元分析模型，分析股骨转子间窝上1.5 cm及头颈交界处为截骨平面带来的偏心距差异、股骨以及假体应力分布变化。 　　结果与结论：①头颈交界处为截骨平面的股骨颈保留型全髋关节置换，短期随访临床疗效优良，与普通生物型无明显差别。②有限元分析显示：头颈交界为截骨平面与转子间窝上1.5 cm为截骨平面比较，偏心距增大，假体及股骨所受应力增大，但应力分布相同。
배경：고골경보류형(Col um Femoris Preserving，C.F.P)가체위의대리골과의생Pipino여덕국LINK공사연합설계개발。해가체수술조작수책중추천절골평면시부괄합국인고골결구특점이급소채용절골방식시부회인기가체이급고골응력발생변화，목전상미견연구보고。 　　목적：통과림상병례회고화삼유유한원모형분석고골경보류형인공전관관절치환적림상료효이급응력분포변화。 　　방법：①회고분석36례고골경보류형전관관절치환급36례보통생물형전관관절치환환자림상자료，통과Harris평분、목측류비평분、치환전후편심거변화、IDES-Engh방사학급병발증등지표평개료효。②건립량충불동절골평면고골경보류형전관관절치환유한원분석모형，분석고골전자간와상1.5 cm급두경교계처위절골평면대래적편심거차이、고골이급가체응력분포변화。 　　결과여결론：①두경교계처위절골평면적고골경보류형전관관절치환，단기수방림상료효우량，여보통생물형무명현차별。②유한원분석현시：두경교계위절골평면여전자간와상1.5 cm위절골평면비교，편심거증대，가체급고골소수응력증대，단응력분포상동。
BACKGROUND:Col um Femoris Preserving prosthesis is developed by Pipino, an Italian surgeon, and LINK (Germany). Whether the femoral osteotomy plane recommended in the surgical manual is suitable for Chinese people and whether the osteotomy method can cause stress changes of the prosthesis and femur has not been yet reported. OBJECTIVE:Based on clinical reviews and three-dimensional finite element model, to analyze the clinical efficacy of total hip arthroplasty with Col um Femoris Preserving prosthesis and relevant stress distribution. METHODS:We retrospectively analyzed 36 patients undergoing total hip arthroplasty with neck-retaining femoral prosthesis and 36 patients receiving total hip arthroplasty with biotype prosthesis in terms of Harris scores, visual analog scale scores, preoperative and postoperative measurements of eccentricity changes, IDES-Engh radiological evaluation and the incidence of complications. Two different osteotomy plane finite element analysis models were created to analyze the eccentricity difference and changes in the stress distribution of prosthesis and femur when the osteotomy plane was set 1.5 cm above the intertrochanteric fossa or at the junction of femoral head and neck. RESULTS AND CONCLUSION:Neck-retaining total hip arthroplasty with the osteotomy plane set at the junction between the head and neck achieved good short-term outcomes, showing no difference from total hip arthroplasty with normal biological prosthesis. The finite element analysis showed that the eccentricity increased and the stress on the prosthesis and femur also increased when the osteotomy plane was set at the junction of femoral head and neck compared with that set 1.5 cm above the intertrochanteric fossa. But there was no difference in stress distribution between two osteotomy planes.