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研究生:戴念國
研究生(外文):Lien-Guo Dai
論文名稱:雙極式半人工髖關節之運動-自動離心復位機構之探討
論文名稱(外文):The Motion of Bipolar Hemiarthroplasty-Self Centering Mechanism
指導教授:鄭誠功鄭誠功引用關係高鴻展陳天雄陳天雄引用關係
指導教授(外文):Cheng-Kung ChengHuang-Chan KaoTain-Hsiung Chen
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:復健科技輔具研究所
學門:醫藥衛生學門
學類:復健醫學學類
論文種類:學術論文
論文出版年:2004
畢業學年度:92
語文別:英文
論文頁數:84
中文關鍵詞:雙極式半人工髖關節自動離心復位機構骨溶蝕
外文關鍵詞:Bipolar HemiarthroplastySelf CenteringOsteolysis
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雙極式半人工髖關節的離心復位機構,是利用髖臼外帽的球心與股小球的球心兩者在不同點,來防止發生髖臼外帽固定於髖臼中某角度卡住不動,而使股骨柄頸部固定磨損超高分子聚乙烯內襯之一邊緣,進而加速超高分子聚乙烯內襯之磨耗,造成骨溶蝕與人工髖關節的鬆脫。這機構設計已廣泛使用在雙極式半人工髖關節上,但其效果功能在文獻中仍少有探討。
三種不同設計之雙極式半人工髖關節各一組,廠牌分別是:全新U1 (United Orthopedic Corp, Taipei, Taiwan, R.O.C.),全新UHR (Osteonics, Allendale, NJ, U.S.A.),使用過之AML(Depuy, Warsaw, IN, U.S.A.),實驗時,由材料測試機控制雙極式半人工髖關節裝置垂直下壓至豬髖臼裝置上,由材料測試機以10 N/sec之速率(loading rate)給予雙極式半人工髖關節垂直下壓作用力,改變髖臼外帽起始角度位置。並且以數位攝影機紀錄雙極式半人工髖關節之自動離心復位現象。
只針對單一設計之雙極式半人工髖關節作討論,採用壹組聯合骨科雙極式半人工髖關節樣本。於U1雙極式半人工髖關節之金屬外帽上緣位置,以鑽石鑽頭鑽出壹直徑大約1 mm的小洞,穿過尼龍線,藉由此線可給予雙極式半人工髖關節側邊垂直上拉或水平側拉之力量。測試三種不同轉動方式:髖臼外帽屈曲-伸直(flexion - extension)方向轉動,髖臼外帽內旋-外旋(internal - external rotation)方向轉動,股骨柄內旋-外旋(internal - external rotation)方向轉動之摩擦力矩,以及股小球和超高分子聚乙烯內襯間(內軸承)的摩擦力矩及金屬外帽和髖臼骨之間(外軸承)摩擦力矩。
結果顯示全新U1 雙極式半人工髖關節裝置,有所謂自動離心復位之現象。全新UHR 雙極式半人工髖關節則無。不同下壓作用力下,不同轉動方式,所產生之轉動摩擦力矩,以及單獨測之內外軸承轉動摩擦力矩皆隨著下壓作用力之增加而增加。髖臼外帽屈曲-伸直方向轉動產生之轉動摩擦力矩大於內旋-外旋方向轉動產生之轉動摩擦力矩。內軸承(股小球和超高分子聚乙烯內襯間) 平均摩擦係數隨著下壓之作用力之增加而減少。雙極式半人工髖關節股骨柄於自由轉動時會選擇摩擦力矩較低之軸承作轉動。自動離心復位機構是有意義的,但很容易因摩擦力矩與關節作用力比值上升而失去作用。
The self-centering mechanism design of bipolar endoprosthesis has advocated the use of offset centers of rotation between the inner and outer joint bearing surfaces to generate a self-centering moment on loading to prevent impingement of polyethylene rim and stem neck or cup fixed at wrong place. The design was used popularly, but the function of self-centering mechanism was discussed in very few papers.
Three bipolar endoprosthesis were evaluated: UNIQHIP system (United Orthopedics), UHR system (Osteonics), and AML system (Depuy). The pig acetabulum and bipolar prostheses were fixed on a Bionix 858 material testing system axially by separate fixation tools. The increasing axial loading with 10 N/sec loading rate was applied on the specimen with different initial position of bipolar cup. The digital video taked the record of motion of cup.
One bipolar endoprosthesis (United Orthopedics) was evaluated for the fiction torque at different motion direction and condition. The traction force over the side of cup was applied to make the cup moving with different direction under joint loading force. The cup moving directions those were flexion-extension and internal-external rotation like in human activity. The friction torque was calculated by formula. Then the axial load of 100 N, 200 N, 500 N and 1000 N was applied on the specimen without other traction force. The axis was rotated form 0o to 30o at the speed 5o/s. All the tests paired with three acetabulums and whole procedure repeated three times. The friction torque of bipolar free rotation motion was recorded by the material testing system. The friction torque on inner bearing and outer bearing surface were also measured by the same procedure as was done for the bipolar free rotation motion.
The final results showed that the new United bipolar endoprosthesis has the appearance of self-centering mechanism. UHR bipolar has not the appearance. The friction torque increased when the loading force increased under different cup motion direction and condition. The friction torque of flexion-extension rotation was more than the friction torque of internal-external rotation motion. The friction coefficient of inner bearing surface decreased when loading force increased. Bipolar endoprosthesis motion friction torque would be the lower friction torque of bearing surface. We thought that the self-centering mechanism function is positive with the centering offset which must be larger than 2 times of friction torque per loading force.
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