应用三维重建技术优化成人髋关节发育不良假体置换的实验研究
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摘要
成人髋关节发育不良往往导致髋关节迟发性骨性关节炎,最终需要通过全关节置换术解决严重的髋关节功能障碍,恢复髋关节的生物、机械性能的最终方法,但手术过程往往具有挑战性,最主要的原因是相关的骨质畸形。通过对成人髋臼发育不良的髋臼及股骨三维大体形态三维重建分析,寻找到三维测量的方法及参数,进而指导成人髋臼发育不良全髋关节置换的术前设计及手术。
髋臼的重建是全髋关节置换治疗成人髋臼发育不良中的关键问题,理想的人工臼杯安置的部位应在真臼的水平。利用3D-CT定量测量技术来界定发育不良髋臼的几何中心以及髋臼在10°旋转增量的前提下来测量边缘中心角(CE角),髋臼角(Sharp角),髋臼指数(AI),髋臼指数深度比,最终综合评估量化髋臼的容积率及预测真臼骨质对髋臼假体的覆盖率,量化分析髋臼的大小和位置,全面观察髋臼的形态及髋臼的厚度。对于选择理想的髋臼置换位置、臼假体的选择及定制、髋臼骨移植重建部位、定量指导手术及术前计划具有重要作用。
通过对股骨的CT扫描资料进行研究测量,获得股骨重建图像和尺寸精确度,并依此来评价每例股骨的尺寸差异和每例股骨的大小、形态特点。通过与正常对照组患者的比较,研究了成人髋臼发育不良患者股骨的三维解剖结构。进而构建股骨的三维、表面Splined的模型,通过研究准确地获得了股骨三维几何参数及生物力学参数,从而为定制型股骨假体研究打下了基础,实现人工股骨假体的优化设计创造良好条件。
本论文针对发育畸形的髋臼及股骨,提出了一套新三维重建模型的研究思路及方法,从而获得成人髋臼发育不良人工关节置换的理论基础及优化选择模型建立的方法。
Adult acetebular dysplasia of the hip is the most common underlying condition leading to secondary osteoarthritis (OA) of the hip, many patients ultimately progress to having total hip arthroplasty (THA). Although arthroplasty often is the only definitive way of restoring the normal biomechanics of the dysplastic joint, these procedures often are challenging, primarily because of the associated bony deformities. Typically, the dysplastic joint consists of a subluxed or even dislocated femur with a straight, narrow canal and a short excessively anteverted neck, and a shallow, vertically-inclined acetabulum. The increased surgical demands of the dysplastic joint often result in inferior results after total hip replacement (THR) with an increased incidence of loosening and dislocation at long-term followup.These procedures also are associated with an increased prevalence of intraoperative complications, and most notably cortical fracture because of the difficulties of inserting conventional prostheses into canals of distorted shape and version.
Three-dimensional computerized tomography scans of a patient who had a acetebular dysplasia of the hip. Based on the results of the current study, we think that greater attention should be given to the morphologic characteristics of normal and dysplastic acetabulum and femurs in the patients. Lateral oblique view of the hip. The hypoplastic true acetabulum, triangular in shape, has segmental deficiency of the entire acetabular rim, a narrow opening, and inadequate depth. The femoral head is small, there is increased anteversion of the femoral neck, and the diaphysis has a thin cortex and a narrow canal. Lateral oblique view of the defective acetabulum after removal of the femoral head. Bone stock at the level of the true acetabulum is mainly superoposterior. The anterior acetabular wall is defective. The entire iliac bone is in increased anteversion. The hollow in the iliac wing represents the false articulation of the dislocated femoral head.
This anatomic observation has several important clinical implications. Orthopaedic surgeons appreciate the fact that, during radiographic examination of the hip, the neck-shaft angle of the femur and the medial offset of the femoral head only are depicted accurately if the femoral neck is oriented parallel to the xray cassette. In the case of the dysplastic femur, in which anteversion is exaggerated, rotational orientation dramatically affects not only the appearance of the proximal femur, but the size and shape of the canal. Moreover, as the canal is twisted, the elliptical shape of the canal at the isthmus, does not lie in the plane of the neck, but rather at 30°to 60°to the sagittal and coronal planes. Consequently, the minor axis of the isthmus appears on neither the AP nor the lateral radiograph and so measurements of canal size taken from the AP radiograph overestimate the minimum canal diameter by as much as 2 mm. This explains why it often is difficult to select prostheses to fit the dysplastic canal during THR, and why surgeons have favored the use of undersized cemented components that allow greater latitude intraoperatively.
These findings and those of earlier studies indicated that prosthetic devices primarily designed for individuals of larger anatomy do not fit the femora of patients, or patients with dysplasia. Furthermore, in cases with excessive anteversion, the concomitant twist of the femoral canal makes joint replacement doubly difficult. Hopefully, the knowledge gained through this study will provide greater insight into the morphologic characteristics of the dysplastic acetabulum and femur and the challenges confronting the joint replacement surgeon.
髋臼的重建是全髋关节置换治疗成人髋臼发育不良中的关键问题,理想的人工臼杯安置的部位应在真臼的水平。利用3D-CT定量测量技术来界定发育不良髋臼的几何中心以及髋臼在10°旋转增量的前提下来测量边缘中心角(CE角),髋臼角(Sharp角),髋臼指数(AI),髋臼指数深度比,最终综合评估量化髋臼的容积率及预测真臼骨质对髋臼假体的覆盖率,量化分析髋臼的大小和位置,全面观察髋臼的形态及髋臼的厚度。对于选择理想的髋臼置换位置、臼假体的选择及定制、髋臼骨移植重建部位、定量指导手术及术前计划具有重要作用。
通过对股骨的CT扫描资料进行研究测量,获得股骨重建图像和尺寸精确度,并依此来评价每例股骨的尺寸差异和每例股骨的大小、形态特点。通过与正常对照组患者的比较,研究了成人髋臼发育不良患者股骨的三维解剖结构。进而构建股骨的三维、表面Splined的模型,通过研究准确地获得了股骨三维几何参数及生物力学参数,从而为定制型股骨假体研究打下了基础,实现人工股骨假体的优化设计创造良好条件。
本论文针对发育畸形的髋臼及股骨,提出了一套新三维重建模型的研究思路及方法,从而获得成人髋臼发育不良人工关节置换的理论基础及优化选择模型建立的方法。
Adult acetebular dysplasia of the hip is the most common underlying condition leading to secondary osteoarthritis (OA) of the hip, many patients ultimately progress to having total hip arthroplasty (THA). Although arthroplasty often is the only definitive way of restoring the normal biomechanics of the dysplastic joint, these procedures often are challenging, primarily because of the associated bony deformities. Typically, the dysplastic joint consists of a subluxed or even dislocated femur with a straight, narrow canal and a short excessively anteverted neck, and a shallow, vertically-inclined acetabulum. The increased surgical demands of the dysplastic joint often result in inferior results after total hip replacement (THR) with an increased incidence of loosening and dislocation at long-term followup.These procedures also are associated with an increased prevalence of intraoperative complications, and most notably cortical fracture because of the difficulties of inserting conventional prostheses into canals of distorted shape and version.
Three-dimensional computerized tomography scans of a patient who had a acetebular dysplasia of the hip. Based on the results of the current study, we think that greater attention should be given to the morphologic characteristics of normal and dysplastic acetabulum and femurs in the patients. Lateral oblique view of the hip. The hypoplastic true acetabulum, triangular in shape, has segmental deficiency of the entire acetabular rim, a narrow opening, and inadequate depth. The femoral head is small, there is increased anteversion of the femoral neck, and the diaphysis has a thin cortex and a narrow canal. Lateral oblique view of the defective acetabulum after removal of the femoral head. Bone stock at the level of the true acetabulum is mainly superoposterior. The anterior acetabular wall is defective. The entire iliac bone is in increased anteversion. The hollow in the iliac wing represents the false articulation of the dislocated femoral head.
This anatomic observation has several important clinical implications. Orthopaedic surgeons appreciate the fact that, during radiographic examination of the hip, the neck-shaft angle of the femur and the medial offset of the femoral head only are depicted accurately if the femoral neck is oriented parallel to the xray cassette. In the case of the dysplastic femur, in which anteversion is exaggerated, rotational orientation dramatically affects not only the appearance of the proximal femur, but the size and shape of the canal. Moreover, as the canal is twisted, the elliptical shape of the canal at the isthmus, does not lie in the plane of the neck, but rather at 30°to 60°to the sagittal and coronal planes. Consequently, the minor axis of the isthmus appears on neither the AP nor the lateral radiograph and so measurements of canal size taken from the AP radiograph overestimate the minimum canal diameter by as much as 2 mm. This explains why it often is difficult to select prostheses to fit the dysplastic canal during THR, and why surgeons have favored the use of undersized cemented components that allow greater latitude intraoperatively.
These findings and those of earlier studies indicated that prosthetic devices primarily designed for individuals of larger anatomy do not fit the femora of patients, or patients with dysplasia. Furthermore, in cases with excessive anteversion, the concomitant twist of the femoral canal makes joint replacement doubly difficult. Hopefully, the knowledge gained through this study will provide greater insight into the morphologic characteristics of the dysplastic acetabulum and femur and the challenges confronting the joint replacement surgeon.
引文
1. Wiberg G (1939) Studies on dysplasti cacetabula and congenital subluxation ofthe hip joint. Acta Chir Scand Suppl 58
2. Tonnis D. Congenital dysplasia and dislocation of the hip in children and adults. Berlin : Springer2Verleg , 1987. 241～250.
3. Lombardi AV , Mallory TH , Ebrele RW , et al. Failure of intraoperatively customized nonporous femoral componets inserted without cement in total hip arthroplasty. J Bone Joint Surg ,1995 , 77 : 1836～1844.
4. Dieter Christian Wirtz , Norbert Schiffers, Thomas Pandorf . Critical evaluation of knownbone material properties to realize anisotropic FE-simulation of the proximal femur, 2000,33:1325.
5. Marco Viceconti, Debora Testi. An automated method to position prosthetic componentswithin multiple anatomical spaces Computer Methods and Programs in Biomedicine 70(2003) 121–127
6. Fulvia Taddei , Alberto Pancanti, Marco Viceconti. An improved method for the automatic mapping of computedtomography numbers onto finite element models Medical Engineering & Physics 26 (2004) 61–69
7. M. Doblare, J.M. Garcia. Application of an anisotropic bone-remodelling model based on a damage-repair theory to the analysis of the proximal femur before and after total hipreplacement Journal of Biomechanics 34 (2001) 1157–1170
8. Georg N Duda Erich Schneider. Internal forces and moments in the femur during walkingJ. Biomechanics, vol. 30 No. 9 1997 933-941
9. R.M. Gillies, P.H. Morberg. The influence of design parameters on cortical strain distribution of a cementless titanium femoral stem Medical Engineering & Physics 24 (2002)109–114
10. Marco Viceconti, Roberto Muccini. Large-sliding contact elements accurately predict levelsof bone-implant micro-motion relevant to osseointegration Journal of Biomechanics 33(2000) 1611-1618
11. J.R. Britton, L.A. Walsh, P.J. Prendergast. Mechanical simulation of muscle loading on the proximal femur: analysis of cemented femoral component migration with and withoutmuscle loading Clinical Biomechanics 18 (2003) 637–646
12. Charnley J, Feagin J. Low friction arthroplasty in congenital subluxation of the hip. Clin Orthop 1973;91:98-113.
13. Crowe JF, Mani V, Ranawat CS. Total hip replacement in congenital dislocation and dysplasia of the hip. J Bone Joint Surg [Am] 1979;61-A:15-23.
14. Dunn HK, Hess W. Total hip reconstruction in chronically dislocated hips. J Bone Joint Surg [Am] 1976;58-A:838-45.
15. Mendes DG. Total hip arthroplasty in congenital dislocated hips. Clin Orthop 1981;161:163-79.
16. Woolson ST, Harris WH. Complete total hip replacement for dysplastic or hypoplastic hips using miniature or microminiature components. J Bone Joint Surg [Am] 1983;65-A:1099-108.
17. Robertson D, Essinger J, Imura S, et al. Femoral deformity in adults with developmental hip dysplasia. Clin Orthop 1996;327:196-206.
18. Sugano N, Noble PC, Kamaric E, et al. The morphology of the femur in developmental dysplasia of the hip. J Bone Joint Surg[Br] 1998;80-B:711-19.
19. Noble PC, Kamaric E, Sugano N, et al. The three-dimensional shape of the dysplastic femur: implications for THR. Clin Orthop 2003;417:27-40.
20. Mendes DG. The role of computerized tomography scans in preoperative evaluation of the adult dislocated hip. Clin Orthop 1981;161:198-202.
21. Rubin PJ, Leyvraz PF, Aubaniac JM, et al. The morphology of the proximal femur: a three-dimensional radiographic analysis. J Bone Joint Surg [Br] 1992;74-B:28-32.
22. Noble PC, Alexander JW, Lindahl LJ, et al. The anatomic basis of femoral component design. Clin Orthop 1988;235:148-52.
23. Husmann O, Rubin PJ, Leyvraz PF, De Roguin B, Argenson JN. Three-dimensional morphology of the proximal femur. J Arthroplasty 1997;12:444-50.
24. 朱振安.先天性髋关节发育不良的全髋关节置换术[J].国外医学骨科学分册,2004,25:5-6.
25. 沈彬,等.全髋关节置换术治疗成人先天性髋关节脱位[J].中华骨科杂志,2002,22:212-215.
26. Holtgrewe JL, Hungerford DS. Primary and revision total hip replacement without cement and with associated femoral osteotomy. J Bone Joint Surg [Am] 1989;71-A:1487-95.
27. 吕厚山,主编.人工关节外科学[M].科学出版社,1998.125.
28. Jasty M, Anderson MJ, Harris WH. Total hip replacement for developmental dysplasia of the hip. Clin Orthop 1995;311:40-5.
29. Jaroszynski G, Woodgate IG, Saleh KJ, Gross AE. Total hip replacement for the dislocated hip. Instr Course Lect 2001;50:307-16.
30. 卢世壁,主译.坎贝尔骨科手术学[M].第 9 版.山东科学技术出版社,2001.356-362.
31. Pagnano W, Hanssen AD, Lewallen DFG, Shaughnessy WJ. The effect of superior placement of the acetabular component on the rate of loosening after total hip arthroplasty. J Bone Joint Surg [Am] 1996;78:1004-14.
32. Gross AE, Duncan CP, Garbuz D, Mohamed EM. Revision arthroplasty of the acetabulum in association with loss of bone stock. Instr Course Lect 1999;48:57-66.
33. Garbuz D, Morsi E, Mohamed N, Gross AE. Classification and reconstruction in revision acetabular arthroplasty with bone stock deficiency. Clin Orthop 1996;324:98-107.
34. Gross AE. Revision arthroplasty of the acetabulum with restoration of bone stock. Clin Orthop 1999;369:198-207.
35. Yoder SA, Brand RA, Pedersen DR, O'Gorman TW. Total hip acetabular component position affects component loosening rates. Clin Orthop 1988;228:79-87.
36. 宋展昭,徐朋,张伟,等. 髋臼加深全髋置换治疗成人先天髋臼发育不良. 中国矫形外科杂志 ,2001 ,9 :8442846.
37. DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop 1976 ;121:20-32.
38. Mulroy RD Jr, Harris WH. Failure of acetabular autogenous grafts in total hip arthroplasty: increasing incidence. J Bone Joint Surg [Am] 1990;72-A:1536-40.
39. Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36): I: conceptuals framework and item selection. Med Care 1992;30:473-83.
40. Jasty M, Freiburg AA. The use of a high-hip center in revision total hip arthroplasty. Semin Arthroplasty 1995;6:103-8.
41. Nilsdotter AK, Lohmander LS. Patient relevant outcomes after total hip replacement: a comparison between different surgical techniques. Health Qual Life Outcomes 2003;1:21.
42. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty: an end-result study using a new method of result evaluation. J Bone Joint Surg [Am] 1969;51-A:737-55.
43. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patient with osteoarthritis of the hip or knee. J Rheumatol 1988;15:1833-40.
44. Soderman P, Malchau H. Is the Harris hip score system useful to study the outcome of total hip replacement? Clin Orthop 2001;384:189-97.
45. Tanzer M. Role and results of the high hip center. Orthop Clin North Am 1998;29:241-7.
46. Perka C, Schneider F, Labs K. Revision acetabular arthroplasty using a pedestal cup in patients with previous congenital dislocation of the hip: four case reports and review of treatment. Arch Orthop Trauma Surg 2002;122:237-40.
47. Woodgate IG, Saleh KJ, Jaroszynski G, et al. Minor column structural acetabular allografts in revision hip arthroplasty. Clin Orthop 2000;371:75-85.
48. Gross AE, Garbuz D, Morsi ES. Acetabular allografts for restoration of bone stock in revision arthroplasty of the hip. Instr Course Lect 1996;45:135-42.
49. Shinar AA, Harris WH. Bulk structural autogenous grafts and allografts for reconstruction of the acetabulum in total hip arthroplasty: sixteen-year-average follow-up. J Bone Joint Surg [Am] 1997;79-A:159-68.
50. Johnston RC, Brand RA, Crowninshield RD. Reconstruction of the hip: a mathematical approach to determine optimum geometric relationships. J Bone Joint Surg [Am] 1979 ;61-A:639-52.
51. Delp SL, Wixson RL, Komattu AV, Kocmond JH. How superiorplacement of the joint center in hip arthroplasty affects the abductor muscles. Clin Orthop 1996;328:137-46.
52. 郭 艾 ,王志义 ,罗先正 ,等 1 先天性髋关节脱位的全髋置换术[J ]1 中华骨科杂志 ,2002 ,22(9) :5171
53. Callaghan JJ, Salvati EA, Pellicci PM, Wilson PD Jr, Ranawat CS. Results of revision for mechanical failure after cemented total hip replacement, 1979 to 1982: a two to five-year follow-up. J Bone Joint Surg [Am] 1985;67-A:1074-85.
54. Gerber SD, Harris WH. Femoral head autografting to augment acetabular deficiency in patients requiring total hip replacement: a minimum five-year and an average seven-year follow-up study. J Bone Joint Surg [Am] 1986;68-A:1241-8.
55. Bobak P, Wroblewski BM, Siney PD, Fleming PA, Hall R. Charnley low-friction arthroplasty with an autograft of the femoral head for developmental dysplasia of the hip: the 10- to 15-year results. J Bone Joint Surg [Br] 2000;82-B:508-11.
56. Hasegawa Y, Iwata H, Iwase T, Kawamoto K, Iwasada S. Cementless total hip arthroplasty with autologenous bone grafting for hip dysplasia. Clin Orthop 1995;324:179-86.
2. Tonnis D. Congenital dysplasia and dislocation of the hip in children and adults. Berlin : Springer2Verleg , 1987. 241～250.
3. Lombardi AV , Mallory TH , Ebrele RW , et al. Failure of intraoperatively customized nonporous femoral componets inserted without cement in total hip arthroplasty. J Bone Joint Surg ,1995 , 77 : 1836～1844.
4. Dieter Christian Wirtz , Norbert Schiffers, Thomas Pandorf . Critical evaluation of knownbone material properties to realize anisotropic FE-simulation of the proximal femur, 2000,33:1325.
5. Marco Viceconti, Debora Testi. An automated method to position prosthetic componentswithin multiple anatomical spaces Computer Methods and Programs in Biomedicine 70(2003) 121–127
6. Fulvia Taddei , Alberto Pancanti, Marco Viceconti. An improved method for the automatic mapping of computedtomography numbers onto finite element models Medical Engineering & Physics 26 (2004) 61–69
7. M. Doblare, J.M. Garcia. Application of an anisotropic bone-remodelling model based on a damage-repair theory to the analysis of the proximal femur before and after total hipreplacement Journal of Biomechanics 34 (2001) 1157–1170
8. Georg N Duda Erich Schneider. Internal forces and moments in the femur during walkingJ. Biomechanics, vol. 30 No. 9 1997 933-941
9. R.M. Gillies, P.H. Morberg. The influence of design parameters on cortical strain distribution of a cementless titanium femoral stem Medical Engineering & Physics 24 (2002)109–114
10. Marco Viceconti, Roberto Muccini. Large-sliding contact elements accurately predict levelsof bone-implant micro-motion relevant to osseointegration Journal of Biomechanics 33(2000) 1611-1618
11. J.R. Britton, L.A. Walsh, P.J. Prendergast. Mechanical simulation of muscle loading on the proximal femur: analysis of cemented femoral component migration with and withoutmuscle loading Clinical Biomechanics 18 (2003) 637–646
12. Charnley J, Feagin J. Low friction arthroplasty in congenital subluxation of the hip. Clin Orthop 1973;91:98-113.
13. Crowe JF, Mani V, Ranawat CS. Total hip replacement in congenital dislocation and dysplasia of the hip. J Bone Joint Surg [Am] 1979;61-A:15-23.
14. Dunn HK, Hess W. Total hip reconstruction in chronically dislocated hips. J Bone Joint Surg [Am] 1976;58-A:838-45.
15. Mendes DG. Total hip arthroplasty in congenital dislocated hips. Clin Orthop 1981;161:163-79.
16. Woolson ST, Harris WH. Complete total hip replacement for dysplastic or hypoplastic hips using miniature or microminiature components. J Bone Joint Surg [Am] 1983;65-A:1099-108.
17. Robertson D, Essinger J, Imura S, et al. Femoral deformity in adults with developmental hip dysplasia. Clin Orthop 1996;327:196-206.
18. Sugano N, Noble PC, Kamaric E, et al. The morphology of the femur in developmental dysplasia of the hip. J Bone Joint Surg[Br] 1998;80-B:711-19.
19. Noble PC, Kamaric E, Sugano N, et al. The three-dimensional shape of the dysplastic femur: implications for THR. Clin Orthop 2003;417:27-40.
20. Mendes DG. The role of computerized tomography scans in preoperative evaluation of the adult dislocated hip. Clin Orthop 1981;161:198-202.
21. Rubin PJ, Leyvraz PF, Aubaniac JM, et al. The morphology of the proximal femur: a three-dimensional radiographic analysis. J Bone Joint Surg [Br] 1992;74-B:28-32.
22. Noble PC, Alexander JW, Lindahl LJ, et al. The anatomic basis of femoral component design. Clin Orthop 1988;235:148-52.
23. Husmann O, Rubin PJ, Leyvraz PF, De Roguin B, Argenson JN. Three-dimensional morphology of the proximal femur. J Arthroplasty 1997;12:444-50.
24. 朱振安.先天性髋关节发育不良的全髋关节置换术[J].国外医学骨科学分册,2004,25:5-6.
25. 沈彬,等.全髋关节置换术治疗成人先天性髋关节脱位[J].中华骨科杂志,2002,22:212-215.
26. Holtgrewe JL, Hungerford DS. Primary and revision total hip replacement without cement and with associated femoral osteotomy. J Bone Joint Surg [Am] 1989;71-A:1487-95.
27. 吕厚山,主编.人工关节外科学[M].科学出版社,1998.125.
28. Jasty M, Anderson MJ, Harris WH. Total hip replacement for developmental dysplasia of the hip. Clin Orthop 1995;311:40-5.
29. Jaroszynski G, Woodgate IG, Saleh KJ, Gross AE. Total hip replacement for the dislocated hip. Instr Course Lect 2001;50:307-16.
30. 卢世壁,主译.坎贝尔骨科手术学[M].第 9 版.山东科学技术出版社,2001.356-362.
31. Pagnano W, Hanssen AD, Lewallen DFG, Shaughnessy WJ. The effect of superior placement of the acetabular component on the rate of loosening after total hip arthroplasty. J Bone Joint Surg [Am] 1996;78:1004-14.
32. Gross AE, Duncan CP, Garbuz D, Mohamed EM. Revision arthroplasty of the acetabulum in association with loss of bone stock. Instr Course Lect 1999;48:57-66.
33. Garbuz D, Morsi E, Mohamed N, Gross AE. Classification and reconstruction in revision acetabular arthroplasty with bone stock deficiency. Clin Orthop 1996;324:98-107.
34. Gross AE. Revision arthroplasty of the acetabulum with restoration of bone stock. Clin Orthop 1999;369:198-207.
35. Yoder SA, Brand RA, Pedersen DR, O'Gorman TW. Total hip acetabular component position affects component loosening rates. Clin Orthop 1988;228:79-87.
36. 宋展昭,徐朋,张伟,等. 髋臼加深全髋置换治疗成人先天髋臼发育不良. 中国矫形外科杂志 ,2001 ,9 :8442846.
37. DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop 1976 ;121:20-32.
38. Mulroy RD Jr, Harris WH. Failure of acetabular autogenous grafts in total hip arthroplasty: increasing incidence. J Bone Joint Surg [Am] 1990;72-A:1536-40.
39. Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36): I: conceptuals framework and item selection. Med Care 1992;30:473-83.
40. Jasty M, Freiburg AA. The use of a high-hip center in revision total hip arthroplasty. Semin Arthroplasty 1995;6:103-8.
41. Nilsdotter AK, Lohmander LS. Patient relevant outcomes after total hip replacement: a comparison between different surgical techniques. Health Qual Life Outcomes 2003;1:21.
42. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty: an end-result study using a new method of result evaluation. J Bone Joint Surg [Am] 1969;51-A:737-55.
43. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patient with osteoarthritis of the hip or knee. J Rheumatol 1988;15:1833-40.
44. Soderman P, Malchau H. Is the Harris hip score system useful to study the outcome of total hip replacement? Clin Orthop 2001;384:189-97.
45. Tanzer M. Role and results of the high hip center. Orthop Clin North Am 1998;29:241-7.
46. Perka C, Schneider F, Labs K. Revision acetabular arthroplasty using a pedestal cup in patients with previous congenital dislocation of the hip: four case reports and review of treatment. Arch Orthop Trauma Surg 2002;122:237-40.
47. Woodgate IG, Saleh KJ, Jaroszynski G, et al. Minor column structural acetabular allografts in revision hip arthroplasty. Clin Orthop 2000;371:75-85.
48. Gross AE, Garbuz D, Morsi ES. Acetabular allografts for restoration of bone stock in revision arthroplasty of the hip. Instr Course Lect 1996;45:135-42.
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