臺灣博碩士論文加值系統

摘要
已知許多風險因子會影響全人工髖關節髖臼杯的超高分子量聚乙烯襯墊（簡稱PE襯墊）的磨耗。從植入物材料產生的微粒磨屑和隨之而來的骨溶蝕現象，已經被認為是造成全人工髖關節置換長期失敗的主因。本論文進行一個回溯性研究，決定風險因子對PE襯墊的磨耗位置與在X光片上植入物周圍骨溶蝕標準分區的影響，進一步為亞洲人提供臨床手術及全人工髖關節設計的參考建議。從臺北馬偕紀念醫院546個人工髖關節篩選出88個全人工髖關節，使用游標卡尺測量PE襯墊磨耗位置及評分，使用前後向雙側髖部X光片判斷骨溶蝕型態包含Charnley區與Gruen區，並收集患者及取出物基本資料，最後使用SPSS進行統計分析。結果顯示影響骨溶蝕型態於Charnley區的風險因子有金屬背襯元件是否鎖螺釘在骨盆以及性別，於Gruen區的風險因子有髖臼杯的前傾角。全人工髖關節髖臼杯元件傾斜角40至50度，金屬背襯元件無螺孔，以及在PE襯墊厚度大於6公釐條件下金屬球頭直徑28公釐以上，其植入時間較長，癒後較佳。

Abstract
Several studies have shown many risk factors of wear of UHMWPE (ultrahigh molecular weight polyethylene) liner in THA (total hip arthroplasty) in the west. The osteolysis caused by the particulate wear debris from implant has been recognized as the major cause of long-term failure in THA. A retrospective study was used to determine the influence of the risk factors on different wear positions in THA and the standard zones of periprosthetic radiolucencies (osteolysis pattern). The results could have the implication for longer in vivo time of THA for Asian.

This stuty’s criteria for 546 hip retrieval prostheses in Mackay memorial hospital (Taipei, Taiwan) were bilateral hip supine anteroposterior radiograph, total hip arthroplasty, and follow-up at least 5 years (60 months). 88 chosen hip retrieval prostheses was studied for the wear position of UHMWPE liners including general wear zone and severe wear zone. Osteolysis pattern on X-ray was classified using standard zones of periprosthetic radiolucencies including 3 acetabular zones (Charnley zones) and 7 femoral stem zones (Gruen zones). Information of 88 THA patients was recorded including gender, revision age, in vivo time, tab of liner, screws of metal cup, femoral head diameter, stem pattern, the brand of implant, affected side, inclination of cup, anteversion of cup, stem angle, liner wear score, osteolysis acetabular score, and osteolysis stem score. Data was analyzed by SPSS statistical software, and the results were considered to be significant when P < 0.05.

In conclusion, screws of cup and gender had significant difference in Charnley zone, and anteversion had significant difference in Gruen zone. The results showed THA that composed of cup without holes for screws, cup inclination 40°-50°, thickness of liner > 6 mm, femoral head diameter > 28 mm would have longer in vivo time comparing with other combination.

目錄
中文摘要….......................................................................................……………….….I
英文摘要..................................................................................……………………….II
目錄…................................................................................…………………………..III
圖目錄…....................................................................…………………………….…..V
表目錄..............................................................................…………………….…….VII

第一章 前言................................................................................……………………..1
1-1人工髖關節簡介......................................................................................................2
1-1-1髖關節的解剖構造...........................................................................................2
1-1-2髖關節的生物力學….......................................................................................6
1-1-3人工髖關節置換術…..............................................................………..……8
1-1-4全人工髖關節再置換的原因…...............................................................…..10
1-2影響超高分子量聚乙烯襯墊磨耗的危險因子....................................................12
1-2-1性別、年齡和體重...........................................................................................12
1-2-2傾斜角與前傾角.............................................................................................12
1-2-3金屬球頭直徑與PE襯墊厚度.......................................................................13
1-2-4設計與植入時間.............................................................................................15
1-2-5包裝時間.........................................................................................................16
1-3文獻回顧................................................................................................................17
1-3-1髖臼杯元件傾斜角與前傾角的測量.............................................................17
1-3-2股骨元件的角度.............................................................................................19
1-3-3 PE襯墊的磨耗分區與評分...........................................................................20
1-3-4 X光片骨溶蝕分區與評分.............................................................................23
1-4研究動機與目的....................................................................................................26
第二章 材料與方法....................................................................................................27
2-1研究材料................................................................................................................27
2-2研究方法................................................................................................................32
2-2-1病患及取出物基本資料收集.........................................................................34
2-2-2髖臼杯元件傾斜角度量測.............................................................................35
2-2-3髖臼杯元件前傾角度量測.............................................................................36
2-2-4股骨柄角度量測.............................................................................................37
2-2-5 PE襯墊磨耗分區與評分...............................................................................38
2-2-6髖臼骨溶蝕分區與評分.................................................................................41
2-2-7股骨骨溶蝕分區與評分.................................................................................43
2-3統計分析................................................................................................................45
第三章 結果................................................................................................................48
3-1患者及取出物基本資料........................................................................................48
3-2危險因子於PE襯墊磨耗位置以及骨溶蝕型態的差異性................................. 50
3-2-1連續性的變數.................................................................................................50
3-2-2非連續性的變數.............................................................................................55
3-3植入時間於非連續性變數的差異性....................................................................60
3-4亞洲人理想的傾斜角度及前傾角度....................................................................64
第四章 討論................................................................................................................66
4-1髖臼骨溶蝕型態....................................................................................................68
4-1-1髖臼杯金屬背襯元件是否鎖螺釘在骨盆.....................................................68
4-1-2性別.................................................................................................................70
4-2股骨骨溶蝕型態....................................................................................................71
4-2-1前傾角.............................................................................................................71
4-3植入時間於危險因子的差異性............................................................................73
4-3-1傾斜角.............................................................................................................73
4-3-2金屬球頭直徑.................................................................................................74
4-3-3品牌型號.........................................................................................................75
4-4亞洲人理想的傾斜角度及前傾角度....................................................................77
4-5實驗限制................................................................................................................78
4-5-1髖臼杯傾斜角及前傾角的拍攝日期.............................................................78
4-5-2金屬股骨柄型態.............................................................................................78
4-5-3骨溶蝕範圍.....................................................................................................78
4-5-4 PE襯墊於人體的真實方位...........................................................................78
第五章 結論................................................................................................................79
參考文獻......................................................................................................................80














圖目錄
圖1-1骨盆的解剖構造…..............................................................................................2
圖1-2骨盆在性別上的差異..........................................................................................3
圖1-3髖骨的解剖構造..................................................................................................3
圖1-4股骨的解剖構造..................................................................................................5
圖1-5人體解剖平面......................................................................................................6
圖1-6髖關節的關節活動..............................................................................................7
圖1-7全人工髖關節元件..............................................................................................9
圖1-8骨盆雙側解剖特徵淚滴結構最下端連線........................................................17
圖1-9髖臼杯元件上緣端點及下緣端點連線............................................................18
圖1-10前傾角公式......................................................................................................18
圖1-11 PE襯墊的磨耗分區........................................................................................22
圖1-12 Charnley分區示意圖......................................................................................25
圖1-13 Gruen分區示意圖...........................................................................................25
圖2-1 Osteonics公司的Omnifit系列的髖臼杯元件.................................................30
圖2-2 Depuy公司的AMLRPlus系列的髖臼杯元件.................................................30
圖2-3 Zimmer公司的HG I系列的髖臼杯元件.........................................................30
圖2-4 Mecron公司的Mecring系列的髖臼杯元件....................................................31
圖2-5實驗流程圖........................................................................................................33
圖2-6髖臼杯元件傾斜角度量測…........... ................................................................35
圖2-7髖臼杯元件前傾角度量測................................................................................36
圖2-8股骨柄角度量測................................................................................................37
圖2-9 PE襯墊磨耗分區與評分範例..........................................................................39
圖2-10髖臼骨溶蝕分區與評分範例..........................................................................41
圖2-11股骨骨溶蝕分區與評分範例..........................................................................43
圖2-12危險因子於PE襯墊磨耗位置及骨溶蝕型態的差異性統計流程圖........... 46
圖2-13植入時間於非連續性變數的差異性統計流程圖..........................................47
圖3-1髖臼骨溶蝕分數於Charnley區的分佈............................................................52
圖3-2股骨骨溶蝕分數於Gruen區的分佈…............................................................ 52
圖3-3股骨柄元件內翻或外翻其股骨骨溶蝕分佈....................................................54
圖3-4四種大於3例品牌型號其髖臼骨溶蝕分佈.....................................................56
圖3-5四種大於3例品牌型號其股骨骨溶蝕分佈.....................................................57
圖3-6第I、II、III型的髖臼杯傾斜角其髖臼骨溶蝕分佈...........................................58
圖3-7第I、II、III型的髖臼杯傾斜角其股骨骨溶蝕分佈...........................................59
圖3-8植入時間於三型傾斜角的分佈........................................................................61
圖3-9植入時間於三種球頭直徑的分佈....................................................................62
圖3-10植入時間於四種品牌型號的分佈..................................................................63
圖3-11植入時間於傾斜角各組之間的分佈..............................................................64
圖3-12植入時間於前傾角各組之間的分佈..............................................................65
圖4-1 Arthropor公司及Depuy公司的AML系列的髖臼杯金屬背襯元件.............69
圖4-2 Zimmer公司的HG系列的髖臼杯金屬背襯元件...........................................69
圖4-3人體股骨的前傾角............................................................................................72

































表目錄
表2-1 Omnifit、AML、HG I及Mecring之金屬背襯元件特徵..................................29
表2-2 Omnifit、AML、HG I及Mecring之金屬球頭材質..........................................29
表2-3 Omnifit、AML、HG I及Mecring之股骨柄元件特徵......................................29
表2-4 PE襯墊磨耗分區..............................................................................................39
表2-5程度因數............................................................................................................39
表2-6表現因數............................................................................................................40
表2-7髖臼骨溶蝕受損區等級....................................................................................42
表2-8股骨骨溶蝕受損區等級....................................................................................44
表3-1患者基本資料....................................................................................................48
表3-2取出物基本資料................................................................................................48
表3-3連續性變數是否呈現常態分佈........................................................................50
表3-4植入時間於PE襯墊磨耗分區、骨溶蝕型態的分佈........................................51
表3-5植入時間除外，其他連續性變數於PE襯墊磨耗分區、骨溶蝕型態的分佈..51
表3-6體重與植入時間的相關性................................................................................53
表3-7非連續性變數於PE襯墊磨耗分區、骨溶蝕型態的分佈................................55
表4-1危險因子於PE襯墊磨耗位置及骨溶蝕型態的差異性統計結果整理表......66
表4-2植入時間於非連續性變數的差異性統計結果整理表....................................67
表4-3金屬背襯元件有鎖螺釘在骨盆其髖臼骨溶蝕於Charnley區的分佈............68
表4-4性別其髖臼骨溶蝕於Charnley區的分佈........................................................70
表4-5前傾角其股骨骨溶蝕於Gruen區的分佈.........................................................71
表4-6三種品牌型號其金屬球頭直徑和髖臼杯金屬背襯元件有無螺孔整理........75
表4-7三種品牌型號其股骨柄材質與披覆整理........................................................76

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