股骨颈保留型人工髋关节置换的临床应用及生物力学研究
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摘要
第一部分：股骨颈保留型人工髋关节置换的临床应用
第一节股骨颈保留型人工髋关节置换治疗髋部疾病
目的：
评价股骨颈保留型人工髋关节在髋关节置换中的临床效果。
方法
以2003年3月份至2008年4月同济医院收治的42例病人共52髋行股骨颈保留型人工髋关节置换，其中男性27例，女性15例，年龄17--65岁，平均41岁。双侧10例，单侧32例。观察手术时间，术中出血量，手术后住院天数，Harris评分及围手术期并发症。
结果
全部病例随访12-61个月，平均39个月。手术时间30-70min，平均45分钟。术中出血70-200ml，平均110 ml。术后第5天扶助行器下地活动。本组患者无一例发生伤口感染，术后脱位，下肢深静脉血栓及大腿痛，异位骨化等并发症。术后3个月Harris评分90—97分37例、81—89分5例，平均(93．2±4．1)分。
结论
股骨颈保留型人工髋关节置换具有创伤小，出血少，符合人体生物力学，假体稳定、假体磨损小的特点，可以成为传统股骨柄的替代方向。
第二节保留股骨颈人工髋关节置换治疗头下型股骨颈骨折
目的
评价股骨颈保留型人工髋关节置换治疗头下型股骨颈骨折的临床效果。
方法
选择华中科技大学附属同济医院骨科头下型股骨颈骨折患者12例，男8例，女4例，年龄45～65岁，均为单侧。根据Garden分型标准：GardenⅢ型4例，Ⅳ型8例，置换前Harris评分为差11例、可1例。全部患者均在入院后1周内施行股骨颈保留型人工髋关节置换治疗，记录置换时间，置换过程中出血量，Harris评分及围手术期并发症，置换后摄标准髋关节正侧位X射线平片，并测量髋臼外展角和前倾角。
结果
12例患者均获得随访，平均37个月。置换时间30～65 min，平均46．5 min；置换过程中出血量80～200 mL，平均120 mL。置换后X射线平片测量髋臼外展角40°～55°，平均48．3°；前倾角16°～23°，平均19．4°。全部患者置换后关节功能恢复情况良好，未发生伤口感染，置换后脱位，下肢深静脉血栓及大腿痛，异位骨化等并发症。置换后3个月Harris评分为优(90～97分)11例，良(81～89分)1例，平均(93.3±3．2)分。
结论
股骨颈保留型人工髋关节置换符合人体生物力学，具有假体稳定、假体磨损小的特点，为头下型股骨颈骨折患者的治疗提供了一个新途径。
第二部分基于DICOM数据构建股骨三维有限元物理模型及其生物力学意义
目的：利用有限元方法研究人体股骨在载荷下的受力状态，探索一种快速建立股骨有限元模型并能进行较为精确的力学分析的方法。
方法：选择标准成年男性志愿者行股骨CT扫描成像，得到股骨每层横截面图像，应用DICOM数据和MIMICS软件行三维重建，结合有限元分析软件ABQUS 6．8构建股骨三维有限元模型，并分析了股骨模型受载荷状态下的应力分布。
结果：基于DICOM数据建立的股骨三维有限元模型，划分网格后形成38636个节点，201422个单元，其中包括股骨松质骨体网格模型和皮质骨体网格模型。有限元分析结果与以往的实验数据一致性较好，能够客观反映股骨真实解剖形态及生物力学行为，分析精度较高。
结论：本研究运用Mimics软件提供了简单有效的建模方法，极大程度提高了建模效率，基于DICOM数据的三维有限元模型几何形状较准确，可以为股骨正常力学行为研究提供精确模型。利用ABQUS 6．8分析得到的应力分布情况跟临床观察一致。
第三部分股骨颈保留型髋关节置换生物力学特点的有限元研究
目的：探讨股骨颈保留型髋关节置换术后股骨侧应力分布情况，为临床改良人工髋关节置换术手术方案提供生物力学依据。
方法：采用64排螺旋CT扫描得到患者股骨颈保留型髋关节置换术后股骨数据，重建股骨颈保留型髋关节置换术后有限元分析模型，对该模型进行载荷和仿真计算。分析股骨颈保留型髋关节置换术后股骨侧的应力分布。
结果：股骨颈保留型髋关节置换术后股骨总体的应力模式无改变，股骨假体覆盖区无明显应力遮挡。保留股骨颈髋关节较正常股骨1区应力值增大，而4区，8区应力值减少。
结论：股骨颈保留型髋关节置换术后股骨总体的应力模式无改变，假体近端无明显应力遮挡，说明这种短柄，近端固定型假体生物力学上的表现是优异的。同时假体颈部可以在材料及结构上做进一步的改进。
PartⅠ: Clinical application of femoral neck preservation in total hip replacement.
Paper 1 The treatment of hip disease with femoral neck preservation in total hipreplacement
Objective:
To evaluate the clinical results of CFP prosthesis in total hip replacement.
.Methods:
From march 2003 to april 2008 52 hip of 42 patients underwent total hip arthroplastywith preservation of femoral neck. The study group included 27 males and 15 females with anaverage age of 41 years from 17 to 65 years.10 patients underwent bilateral THA and 32patients one side. Operation time ,blood loss, average postoperative hospitalization ,Harris hipscore and operation related complications were analyzed.
Results:
The patients were followed up from 12 to 61 months with an average of 39 months.Theoperation time was 30-70 mins with an average of 45 mins. The blood loss was 70-200mlwith an average of 110ml. All the patients were ambulatory 5 days after surgery with the helpof a walker.None of infection ,dislocation,deep venous thrombosis,thigh pain and heterotopicossification happened. Harris hip score are 88-97 points with an average age of 93.2 points 3months after surgery.
Conclusion:
Total hip arthroplasty with preservation of femoral neck has the advantages of minimalinvasion,less blood loss, good biodynamic harmony ,excellent stability of the prosthetic hip,and less prosthesis wear. It can replace traditional total hip arthroplasty as a new option.
Paper 2 Total hip replacement with femoral neck preservation for the treatment ofsub-capitated femoral neck fracture
Objective:
To evaluate the clinical results of CFP prosthesis in the treatment of sub-capitatedfemoral neck fracture.
Methods:
From march 2003 to may 2008, 12 hip of 12 patients underwent total hip arthroplastywith preservation of femoral neck. The study group included 8 males and 4 females with anaverage age of 50.4 years from 45 to 65 years.All patients underwent one side THA.Operation time ,blood loss, average postoperative hospitalization ,Harris hip score andoperation related complications were analyzed.
Results:
The patients were followed up from 29 to 50months with an average of 37 months.Theoperation time was 35-65 mins with an average of 46.5 min mins. The blood loss was 80-200mL with an average of 120 mL. All the patients were ambulatory 5 days after surgery with thehelp of a walker.None of infection ,dislocation,deep venous thrombosis,thigh pain andheterotopic ossification happened. Harris hip score are 86-97 points with an average age of93.3 points 3 months after surgery.
Conclusion:
Total hip arthroplasty with preservation of femoral neck has the advantages of goodbiodynamic harmony, excellent stability of the prosthetic hip, and less prosthesis wear.Itprolong the waiting time and provide good bone condition for the hip revision. It will be anew option for the treatment of sub-capitated femoral neck fracture.
PartⅡ: Construction of Three-dimensional Finite Element Model ofFemur Based on DICOM Data and its biomechanical significance
Objective:
To introduce a way of quick and precise construction of the three-dimensional finiteelement femur model and provide a new method for the construction of femur model.
Methods:
Normal male human femur was used as specimen for CT scan to obtain configuration,three-dimensional finite element model of the femur was obtained using MIMICS andABQUS 6.8 software.
Results:
Based on DICOM data, the three-dimensional finite element model of femur wasconstructed more quickly and precisely. The models were divided into 38636 nodes, 201422units. The model include the parts of coetical and cancellous bone. The biomechanical testresults accords with the previous results,so the model objectively reflected the real femurarthroplasty shape and biomechanical behavior.
Conclusion:
The research provides a more simple and precise method forthe construction of femur model and improve the efficiency based on Dicom standard andMimics software. The model was accurate and can be used for the reaseach on biomechanicalbehavior of femur.
PartⅢThe FEA research of CFP Prosthesis in total hip replacement
Objective:
To analyze the stress distribution on the femur after the hip arthroplasty with CFPprosthesis and provide biomechanical evidence for the improvement of femoral neckpreservation anhroplasty.
Methods:
The patients with the preservation of femoral neck in total hip replacement was used forCT scan to obtain configuration data to construct the three-dimensional finite elementmodel.The model was simulated under the load of body weight,and me stress distribution onthe femoral part was calculated.
Results:
The stress mode of the femoral part did not change in total hip replacement with collumfemoris reserved. There was no stress shielding around the femur prosthesis. The stress of 1zone increases and the stress of 4 and 8 zone decrease in total hip replacement with collumfemoris reserved.
Conclusion:
The stress mode of the femoral part did not change in total hip replacement with collumfemoris reserved. There was no stress shielding at the proximal part of the femurprosthesis. Illustrate this brachypus, proximal fixed prosthesis is excellent on thebiomechanical performance.
第一节股骨颈保留型人工髋关节置换治疗髋部疾病
目的：
评价股骨颈保留型人工髋关节在髋关节置换中的临床效果。
方法
以2003年3月份至2008年4月同济医院收治的42例病人共52髋行股骨颈保留型人工髋关节置换，其中男性27例，女性15例，年龄17--65岁，平均41岁。双侧10例，单侧32例。观察手术时间，术中出血量，手术后住院天数，Harris评分及围手术期并发症。
结果
全部病例随访12-61个月，平均39个月。手术时间30-70min，平均45分钟。术中出血70-200ml，平均110 ml。术后第5天扶助行器下地活动。本组患者无一例发生伤口感染，术后脱位，下肢深静脉血栓及大腿痛，异位骨化等并发症。术后3个月Harris评分90—97分37例、81—89分5例，平均(93．2±4．1)分。
结论
股骨颈保留型人工髋关节置换具有创伤小，出血少，符合人体生物力学，假体稳定、假体磨损小的特点，可以成为传统股骨柄的替代方向。
第二节保留股骨颈人工髋关节置换治疗头下型股骨颈骨折
目的
评价股骨颈保留型人工髋关节置换治疗头下型股骨颈骨折的临床效果。
方法
选择华中科技大学附属同济医院骨科头下型股骨颈骨折患者12例，男8例，女4例，年龄45～65岁，均为单侧。根据Garden分型标准：GardenⅢ型4例，Ⅳ型8例，置换前Harris评分为差11例、可1例。全部患者均在入院后1周内施行股骨颈保留型人工髋关节置换治疗，记录置换时间，置换过程中出血量，Harris评分及围手术期并发症，置换后摄标准髋关节正侧位X射线平片，并测量髋臼外展角和前倾角。
结果
12例患者均获得随访，平均37个月。置换时间30～65 min，平均46．5 min；置换过程中出血量80～200 mL，平均120 mL。置换后X射线平片测量髋臼外展角40°～55°，平均48．3°；前倾角16°～23°，平均19．4°。全部患者置换后关节功能恢复情况良好，未发生伤口感染，置换后脱位，下肢深静脉血栓及大腿痛，异位骨化等并发症。置换后3个月Harris评分为优(90～97分)11例，良(81～89分)1例，平均(93.3±3．2)分。
结论
股骨颈保留型人工髋关节置换符合人体生物力学，具有假体稳定、假体磨损小的特点，为头下型股骨颈骨折患者的治疗提供了一个新途径。
第二部分基于DICOM数据构建股骨三维有限元物理模型及其生物力学意义
目的：利用有限元方法研究人体股骨在载荷下的受力状态，探索一种快速建立股骨有限元模型并能进行较为精确的力学分析的方法。
方法：选择标准成年男性志愿者行股骨CT扫描成像，得到股骨每层横截面图像，应用DICOM数据和MIMICS软件行三维重建，结合有限元分析软件ABQUS 6．8构建股骨三维有限元模型，并分析了股骨模型受载荷状态下的应力分布。
结果：基于DICOM数据建立的股骨三维有限元模型，划分网格后形成38636个节点，201422个单元，其中包括股骨松质骨体网格模型和皮质骨体网格模型。有限元分析结果与以往的实验数据一致性较好，能够客观反映股骨真实解剖形态及生物力学行为，分析精度较高。
结论：本研究运用Mimics软件提供了简单有效的建模方法，极大程度提高了建模效率，基于DICOM数据的三维有限元模型几何形状较准确，可以为股骨正常力学行为研究提供精确模型。利用ABQUS 6．8分析得到的应力分布情况跟临床观察一致。
第三部分股骨颈保留型髋关节置换生物力学特点的有限元研究
目的：探讨股骨颈保留型髋关节置换术后股骨侧应力分布情况，为临床改良人工髋关节置换术手术方案提供生物力学依据。
方法：采用64排螺旋CT扫描得到患者股骨颈保留型髋关节置换术后股骨数据，重建股骨颈保留型髋关节置换术后有限元分析模型，对该模型进行载荷和仿真计算。分析股骨颈保留型髋关节置换术后股骨侧的应力分布。
结果：股骨颈保留型髋关节置换术后股骨总体的应力模式无改变，股骨假体覆盖区无明显应力遮挡。保留股骨颈髋关节较正常股骨1区应力值增大，而4区，8区应力值减少。
结论：股骨颈保留型髋关节置换术后股骨总体的应力模式无改变，假体近端无明显应力遮挡，说明这种短柄，近端固定型假体生物力学上的表现是优异的。同时假体颈部可以在材料及结构上做进一步的改进。
PartⅠ: Clinical application of femoral neck preservation in total hip replacement.
Paper 1 The treatment of hip disease with femoral neck preservation in total hipreplacement
Objective:
To evaluate the clinical results of CFP prosthesis in total hip replacement.
.Methods:
From march 2003 to april 2008 52 hip of 42 patients underwent total hip arthroplastywith preservation of femoral neck. The study group included 27 males and 15 females with anaverage age of 41 years from 17 to 65 years.10 patients underwent bilateral THA and 32patients one side. Operation time ,blood loss, average postoperative hospitalization ,Harris hipscore and operation related complications were analyzed.
Results:
The patients were followed up from 12 to 61 months with an average of 39 months.Theoperation time was 30-70 mins with an average of 45 mins. The blood loss was 70-200mlwith an average of 110ml. All the patients were ambulatory 5 days after surgery with the helpof a walker.None of infection ,dislocation,deep venous thrombosis,thigh pain and heterotopicossification happened. Harris hip score are 88-97 points with an average age of 93.2 points 3months after surgery.
Conclusion:
Total hip arthroplasty with preservation of femoral neck has the advantages of minimalinvasion,less blood loss, good biodynamic harmony ,excellent stability of the prosthetic hip,and less prosthesis wear. It can replace traditional total hip arthroplasty as a new option.
Paper 2 Total hip replacement with femoral neck preservation for the treatment ofsub-capitated femoral neck fracture
Objective:
To evaluate the clinical results of CFP prosthesis in the treatment of sub-capitatedfemoral neck fracture.
Methods:
From march 2003 to may 2008, 12 hip of 12 patients underwent total hip arthroplastywith preservation of femoral neck. The study group included 8 males and 4 females with anaverage age of 50.4 years from 45 to 65 years.All patients underwent one side THA.Operation time ,blood loss, average postoperative hospitalization ,Harris hip score andoperation related complications were analyzed.
Results:
The patients were followed up from 29 to 50months with an average of 37 months.Theoperation time was 35-65 mins with an average of 46.5 min mins. The blood loss was 80-200mL with an average of 120 mL. All the patients were ambulatory 5 days after surgery with thehelp of a walker.None of infection ,dislocation,deep venous thrombosis,thigh pain andheterotopic ossification happened. Harris hip score are 86-97 points with an average age of93.3 points 3 months after surgery.
Conclusion:
Total hip arthroplasty with preservation of femoral neck has the advantages of goodbiodynamic harmony, excellent stability of the prosthetic hip, and less prosthesis wear.Itprolong the waiting time and provide good bone condition for the hip revision. It will be anew option for the treatment of sub-capitated femoral neck fracture.
PartⅡ: Construction of Three-dimensional Finite Element Model ofFemur Based on DICOM Data and its biomechanical significance
Objective:
To introduce a way of quick and precise construction of the three-dimensional finiteelement femur model and provide a new method for the construction of femur model.
Methods:
Normal male human femur was used as specimen for CT scan to obtain configuration,three-dimensional finite element model of the femur was obtained using MIMICS andABQUS 6.8 software.
Results:
Based on DICOM data, the three-dimensional finite element model of femur wasconstructed more quickly and precisely. The models were divided into 38636 nodes, 201422units. The model include the parts of coetical and cancellous bone. The biomechanical testresults accords with the previous results,so the model objectively reflected the real femurarthroplasty shape and biomechanical behavior.
Conclusion:
The research provides a more simple and precise method forthe construction of femur model and improve the efficiency based on Dicom standard andMimics software. The model was accurate and can be used for the reaseach on biomechanicalbehavior of femur.
PartⅢThe FEA research of CFP Prosthesis in total hip replacement
Objective:
To analyze the stress distribution on the femur after the hip arthroplasty with CFPprosthesis and provide biomechanical evidence for the improvement of femoral neckpreservation anhroplasty.
Methods:
The patients with the preservation of femoral neck in total hip replacement was used forCT scan to obtain configuration data to construct the three-dimensional finite elementmodel.The model was simulated under the load of body weight,and me stress distribution onthe femoral part was calculated.
Results:
The stress mode of the femoral part did not change in total hip replacement with collumfemoris reserved. There was no stress shielding around the femur prosthesis. The stress of 1zone increases and the stress of 4 and 8 zone decrease in total hip replacement with collumfemoris reserved.
Conclusion:
The stress mode of the femoral part did not change in total hip replacement with collumfemoris reserved. There was no stress shielding at the proximal part of the femurprosthesis. Illustrate this brachypus, proximal fixed prosthesis is excellent on thebiomechanical performance.
引文
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13. Khanduja V, Tek v,Scott G .The effect of a neck-retaining femoral implant on leg-length inequality following total hip arthroplasty: aradiological study J Bone Joint Surg Br 2006; 88(6): 712-715
1. Probe R,Ward R. Internal fixation of femoral neck fractttr∞,. J Am Acad orthop Surg,2006; 14(9): 565-571
2. Cho MR,Lee SW,Shin DK, el al. A predictive method for subsequent avascular necrosis of the fernoral head(AVNFH)by observation of bleeding from the callnulated screw used for fixation of intracapsular femoral neck fractures. J Orthop Trauma.2007,21 (3):158-164
3. Roshan A, Ram S.The neglected femoral neck fracture jn young adults: review of a challenging pmblem.Clin Med Res,2008;6(1): 33-39
4. Raaymakers EL. Fractures of the femoral neck: a review and personal statement.Acta Chir Orthop Traumatol Cech. 2006; 73(1): 45-59
5．陆裕朴．实用骨科学．第一版．北京：人民军医出版社，1991：639．
6．罗先正，邱贵兴．人工髋关节学．第一版．北京：中国协和医科大学出版社，2003：141-142
7. Lu-Yao GL,Keller RB,Littenberg B,et al:Outcomes after displaced fractures of the femoral neck:a meta-analysis of one hundred and six published reports,J Bone Joint Surg 76-A: 15,1994
8. Kyle RF:Operative techniques of fixation for femoral neck fractures in young adults,Techn Orthop 1:33,1986
9. Pipino F, Keller A.Tissue-sparing surgery: 25 years' experience with femoral neck preserving hip arthroplasty. J Orthopaed Traumatal. 2006;7:36-41
10. Pipino F. Calderal PM. Biodynamic total hip prosthesis.Italian Journal of Orthopaedics and Traumatology. 1987; 13(3):289-297.
11. Devane et al.and Lombardi,et al.Correlation between prosthetic offset and polyethylene wear in total hip arthroplasty.67th Annual Meeting Proceedings,AAOS,March 2000,Orlando,S.552/553,198
12. Devane PA, Home JG. Assessment of polyethylene wear in total hip replacement.Clin Orthop Relat Res. 1999;(369):59-72.
1. Brekelmans WA,Poort HW,Slooff TJ.A new method to analyse the mechanical behaviour of skeletal parts.Acta Orthop Scand 1972;43(5):301-317
2. King AI. A review of biomechanical models. J Biomech Eng 1984; 106(2):97-104
3. Blernker SS, Asakawa DS, Gold GE, et al. Image-based musculoskeletal modeling: applications, advances, and future opportunities. J Magn Reson Imaging 2007;25(2):441-451
4. Stolk J,Verdonschot N,Cristofolini.et al.Finite element and experimental models of cemented hip joint reconstruction can produce similar bone and cement strains in pre-clinical tests.J Biomech,2002,35:499-510.
5. Bergmann F, Ggraichen,Rohlmann,A.Hip joint loading during walking and running,measured in two patients.J Biomech, 1993,26(8):969-990.
6．钟世镇。数字化虚拟中国人研究动态。医学研究通讯，2004，33(6)：5-6
7．魏斌。牙颌系统三维有限元建模方法的进展。口腔材料器械杂志，2002，11(2)：86-87
8. Kuroda T,Motohashi N,Tominaga R et al. Three-dimensional dental cast analyzing system using laser scanning. Am J Orthod Dentofacial Orthop, 1996 110:365-369
9. SONGHong-fang,ZHANG Qing-ming,LIU Zhi-cheng.A establishment of three--dimensional finite element model of proximal femur based on CT scan data。 J information of Medical Equipment, 2006, 21(12): 1-3.
10. National Electric Manufacturers Association.Digital Imaging and Communications in Medicine(DICOM protocolpart2, 3, 5, 6, 7, 8, 10, 11, 12)[z]. National Electrical Manufacturers Association, 2003.
11．张美超，刘阳，刘则玉，等．利用Mimics和Freeform建立中国数字人上颌第一磨牙三维有限元模型。医用生物力学，2006，24(3)：208-211
12. Visuri T, Hietaniemi K. Displaced stress fracture of the femoral shaft: a report of three cases[J]. Mil Med, 1992, 157(6): 325-327.
13. Lennon AB, Britton JR,MacNiocaill RF. Predicting revision risk for aseptic loosening of femoral components in total hip arthroplasty in individual patients-a finite element study. Journal of Orthopaedic Research.2007,25(6):779-788
1. Stolk J,Verdonschot N,Cristofolini.et al.Finite element and experimental models of cemented hip joint reconstruction can produce similar bone and cement strains in pre-clinical tests.J Biomech,2002,35:499-510.
2. Taylor ME,Tanner KE,Freeman MA,et al.Stress and strain distribution within the intact femur:compression or bending? Med Eng Phy, 1996,18:122-131.
3. Bergmann F, Ggraichen,Rohlmann,A.Hip joint loading during walking and running,measured in two patients.J Biomech, 1993,26(8):969-990.
4. Makarand GJ, Suresh G, Freeman M.Analysis of a femoral hip prosthesis designed to reduce stress shielding.Journal of biomechanics.2000,33 (12): 1655-1662
5. Biggi, Franchin, Lovato, Pipino. DEXA evaluation of total hip arthroplasty with neck-preserving technique:4-year follow-up.J Orthopaed Traumatol (2004)5:156-159
6. Devane et al.and Lombardi,et al.Correlation between prosthetic offset and polyethylene wear in total hip arthroplasty.67th Annual Meeting Proceedings,AAOS,March 2000,Orlando,S.552/553,198
7. 7 Devane PA, Horne JG. Assessment of polyethylene wear in total hip replacement.Clin Orthop Relat Res. 1999;(369):59-72.
8．巩慧明，侯亮，叶桂峰。髋关节置换的三维有限元分析。生物骨科材料与临床研究。2008， 5(5)：43-46
9. Domb B Hostin E, Mont MA, et al. Cortical strut grafting for enigmatic thigh pain ollowing total hip arthroplasty. Orthopedics, 2000, 23:21-24.
10. McLauhlin JR, Lee KR.Total hip arthroplasty in young patients.8-to 13-year results using an uncemented stem [J] .Clin Orthop Relat Res, 2000, (373):153-163
11. Huo MH, Brown BS.What's new in hip arthroplasty [J].J Bone Joint Surg Am, 2003, 85-A(9):1852-1864.
12. Reuben JD , Chang CH,Akin JE,et al. RL.A knowledge-based computer-aided design and manufacturing system for total hip replacement.Clin Orthop.1992,285:48.
13. Zheng G, Marx A, Langlotz U, et al. A hybrid CT free navigation system for total hip arthroplasty. Comput Aided Surg, 2002; 7(1): 129-145.
1．吴华，杨慧林，翁习生。骨科疑难问题解析。南京，江苏科技出版社。2009：340
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16．林荔军，靳安民，方国芳。全髋关节表面置换术后股骨侧应力分布的有限元分析。临床生物力学。2008，26(4)：426-428
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22. Beaule PE, le Duff, Campbell P, et al. Metal-on-metal surface arthroplasty with a cemented femoral comnponent: a 7-10 year follow up study. J Arthroplasty, 2004; 19(8 Suppl-3): 17-22
23. Amstutz HC, Antoniades JT, le Duff MJ. Results of metal-on-metat hybrid hip resurfacing for Crowe type-Ⅰ and Ⅱ developmental dysplasia。J Bone Joint SurgAm, 2007; 89(2): 339-346
24. Siebel T, Maubach S, Merlock MM. Lessons learned from early clinical experience and results of 300 ASR hip resurfacing implantations. Proc Inst Mech Eng[H], 2006; 220(2): 345-353
25. Pipino F, Keller A . Tissue-sparing surgery: 25 years' experience with femoral neck preserving hip arthroplasty. J Orthopaed Traumatal (2006)7:36-41
26. Tobin, W.J.: The Internal Architecture of the Femur and ist Clinical Significance. Journal of Bone and Joint Surgery, 37-A, 57,1955
27. Pipino CFP prosthetic stem in mini-invasive total hip arthroplasty J Orthopaed Traumatol (2004)4:165-171
28. Biggi, Franchin, Lovato, Pipino. DEXA evaluation of total hip arthroplasty with neck-preserving technique:4-year follow-up,J Orthopaed Traumatol (2004)5:156-159
1．依凤鸣，吴遇春．局部隐式有限元法．哈尔滨工业大学学报，1995，27(2)：47-50
2. Scholten R, Svensson NL,Wood RD.Three dimensional stress analysis of the human femur. [J.Comput Biol Med,1977,6:130
3. Brekelmans WA, Poort HW, Sloof TJ, et al. Acta Orthop Scand, 1972; 43(5): 301-317
4．钟世镇。数字化虚拟中国人研究动态。医学研究通讯，2004，33(6)：5-6
5．魏斌。牙颌系统三维有限元建模方法的进展。口腔材料器械杂志,2002，11(2)：86-87
6. Kuroda T, Motohashi N,Tominaga R et al. Three-dimensional dental cast analyzing system using laser scanning. Am J Orthod Dentofacial Orthop, 1996 110:365-369
7. SONGHong-fang, ZHANG Qing-ming, LIU Zhi--chengA establishment of three--dimensional finite element model of proximal femur based on CT scan data。J information of Medical Equipment, 2006, 21(12): 1-3.
8．严世贵，何荣新，陈维善。全髋关节置换前后股骨应力变化的有限元分析。中华骨科杂志，2004，24(9)：561-565
9．林凤飞，郑明，林朝晖。人工髋关节不同材料假体对骨界面的应力分布研究。中国矫形外科杂志，2008，16(7)：540-550
10．李伟，陆皓，孙康．复合材料与金属材料髋关节假体应力分布的三维有限元分析。生物骨科材料与临床研究，2005；2(3)：1-4
11. Namba RS, Keyak JH, Kim AS, et al. Cementless implant composition and femoral stress.A finite element analysis.Clin Orthop Relai Res, 1998.(347):261-267
12. Gross S,Abel EW.A finite element analysis of hollow stemmed hip prostheses as a means of reducing stress shielding of the femur.J Biomech,2001,34:995-1003.
13. Rik Huiskes, Harrie Weinans, Bert Van Rietbergen. The relationship between stress shieding and bone resorption around total hip stems and the effects of flexible materials. Clin Orthop, 1992,274:124
14. Lemis JL, Askew MJ, Wixson RL,et al. The influence of prosthetic stem stiffness and of a calcar collar on stresses in the proximal end of the femur with a cemented femoral component. J Bone Jiont Surg(Am), 1984,66:280
15. Peter B,Ramaniraka N,Rakotomanana LR,et al.Peri-implant bone remodeling after total hip replacement combined with systemic alendronate treatment:a finite element analysis[J].Comput Methods Biomech Biomed Eng.2004,7(2):73-78.
16. 16 Bevill SL,Bevill GR,Penmetsa JR,et al.Finite element simulation of early creep and wear in total hip arthroplasty.J Biomech,2005,38:2365-2374
17．李永奖，张力成，杨国敬。全髋关节置换术后假体脱位的有限元研究。中医正骨2007，19(12)：66-67
18. Nadzadi ME,Pedersen DR,Yack HJ,et al.Kinematics,kinetics,and finite element analysis of commonplace maneuvers at risk for total hip dislocation.J Biomech,2003,36:577-591.
19．何荣新，罗银淼，严世贵等。Elite全髋置换前后股骨应力变化的三维有限元分析。中华医学杂志，2004，84(18)：1549-1553
20. Bessho M,Ohnishi I,Okazaki H,et al.Prediction of the strength and fracture location of the femoral neck by CT-based finite-element method:a preliminary study on patients with hip fracture[J].J Orthop Sci,2004,9 (6):545-550.
21．21 郑晓雯，封小建，张延宾。人工股骨柄形状和表面处理对置换术后假体和人体股骨应力分布影响的有限元分析。医用生物力学，2004，21(4)：322-327
22. Joshi MG;Advani SG, Miller F, et al.Analysis of a femoral hip prosthesis designed to reduce stress shielding.J Biomech,2000,33:1655-1662
23．郭宏强，李涤尘，连芩。静态和动态条件下股骨假体结构参数研究。中国康复医学杂志。2008，23(8)：720-723
24. Keaveny TM,Bartel DL Effects of porous coating and support on early load for a cementless hip prosthesis.J Biomech, 1993,26:1205-1216.
25．林荔军，靳安民，方国芳。全髋关节表面置换术后股骨侧应力分布的有限元分析。临床生物力学。2008，26(4)：426-428
26. Little JP, Taddei F, Viceeconti M,et al.Changes in femur stress after hip resurfacing arthroplasty:Response to physiological loads.Clin Biomech,2007,22(4):440-448.
27. Mann KA,Damron LA,Miller MA,et al.Stem-cement porosity may explain early loosening of cemented femoral hip components:experimental-computational in vitro study.J Orthop Res,2007; 25(3):340-350
28. Powers CM, Lee IY, Skimmer HB, et al. Effects of distal cement voids on cement stress in total hip arthroplasty. J Arthroplasty, 1998, 13: 793-798.
29. Waide V,Cristofolini L,Stolkc J,et al.Modelling the fibrous tissue layer in cemented hip replacements:experimental and finite element methods [J]. Journal of Biomechanics,2004,37:13-26.
2.Pipino F, Keller A.Tissue-sparing surgery: 25 years' experience with femoral neck preserving hip arthroplasty. J Orthopaed Traumatal (2006)7:36-41
3.Tobin, W.J.: The Internal Architecture of the Femur and ist Clinical Significance. Journal of Bone and Joint Surgery, 37-A, 57,1955
4.Biggi,Franchin,Lovato,Pipino. DEXA evaluation of total hip arthroplasty with neck-preserving technique:4-year follow-up,J Orthopaed Traumatol (2004)5:156-159 DOI 10.1007/s 10195-004-0063-4
5．依凤鸣，吴遇春．局部隐式有限元法．哈尔滨工业大学学报，1995，27(2)：47-50
6.Brekelmans WA, Poort HW, Sloof TJ, et al. Acta Orthop Scand, 1972; 43(5), 301-317
7．钟世镇。数字化虚拟中国人研究动态。医学研究通讯，2004，33(6)：5-6
8．魏斌。牙颌系统三维有限元建模方法的进展。口腔材料器械杂志，2002，11(2)：86-87
9.Kuroda T, Motohashi N,Tominaga R et al. Three-dimensional dental cast analyzing system using laser scanning. Am J Orthod Dentofacial Orthop, 1996 110:365-369
10.SONGHong-fang, ZHANG Qing-ming, LIU Zhi--chengA establishment of three--dimensional finite element model of proximal femur based on CT scan data。 J information of Medical Equipment, 2006, 21(12): 1-3.
11．何荣新，罗银淼，严世贵等。Elite全髋置换前后股骨应力变化的三维有限元分析。中华医学杂志，2004，84(18)：1549-1553
1. Gocen Z, Sen A, Unver B, et al. The effect of preoperative physiotherapy and education on the outcome of total hip replacement: a prospective randomized controlled trial. Clin Rehabil, 2004; 18(4): 353-358.
2. Clohisy JC, Harris WH. Matched-pair analysis of cemented and eementless acetabular reconstruction in primary total hip arthroplasty. Arthroplasty. 2001; 16(6): 697-705.
3. Maurer SG, Baiher AG, Dicesare PE. Reconstruction of the failed femoral component and proximal femoral bone loss in revision hip surgery. J AAOS, 2000, 8: 354-363
4. Dellose SM, Kim AH, Sinha RK et al. Minimal incision hip surgery for total hip replacement; Aretrospective look[j]. Pittsburgh Orthop J. 2002: 13(2): 99-102.
5. Chimento GF, Pavone V, Sharrock N, et al.Minimally invasive total hip arthroplasty, a prospective randomizedstudy. Arthroplasty, 2005; 20: 139-144.
6．罗先正，邱贵兴．人工髋关节学．第一版．北京：中国协和医科大学出版社，2003：141-142
7. Pipino F, Keller A.Tissue-sparing surgery: 25 years' experience with femoral neck preserving hip arthroplasty. J Orthopaed Traumatal (2006)7:36-41
8. Pipino F Molfetta L. Femoral neck preservation in total hip replacement. Ita J Orthop Traumatol,2006; 19(1):5-12
9. Devane PA, Horne JG. Assessment of polyethylene wear in total hip replacement.Clin Orthop Relat Res. 1999 Dec;(369):59-72.
10. Devane et al.and Lombardi,et al.Correlation between prosthetic offset and polyethylene wear in total hip arthroplasty.67th Annual Meeting Proceedings,AAOS,March 2000,Orlando,S.552/553,198
11. Pipino F. Calderal PM. Biodynamic total hip prosthesis.Italian Journal of Orthopaedics and Traumatology. 1987 Sep;13(3):289-97.
12. Pipino F etal.Preservation of the femoral neck in hip arthroplasty: results of a 13- to 17-year follow-up. J Orthopaed Traumatal (2000) 1:31-39
13. Khanduja V, Tek v,Scott G .The effect of a neck-retaining femoral implant on leg-length inequality following total hip arthroplasty: aradiological study J Bone Joint Surg Br 2006; 88(6): 712-715
1. Probe R,Ward R. Internal fixation of femoral neck fractttr∞,. J Am Acad orthop Surg,2006; 14(9): 565-571
2. Cho MR,Lee SW,Shin DK, el al. A predictive method for subsequent avascular necrosis of the fernoral head(AVNFH)by observation of bleeding from the callnulated screw used for fixation of intracapsular femoral neck fractures. J Orthop Trauma.2007,21 (3):158-164
3. Roshan A, Ram S.The neglected femoral neck fracture jn young adults: review of a challenging pmblem.Clin Med Res,2008;6(1): 33-39
4. Raaymakers EL. Fractures of the femoral neck: a review and personal statement.Acta Chir Orthop Traumatol Cech. 2006; 73(1): 45-59
5．陆裕朴．实用骨科学．第一版．北京：人民军医出版社，1991：639．
6．罗先正，邱贵兴．人工髋关节学．第一版．北京：中国协和医科大学出版社，2003：141-142
7. Lu-Yao GL,Keller RB,Littenberg B,et al:Outcomes after displaced fractures of the femoral neck:a meta-analysis of one hundred and six published reports,J Bone Joint Surg 76-A: 15,1994
8. Kyle RF:Operative techniques of fixation for femoral neck fractures in young adults,Techn Orthop 1:33,1986
9. Pipino F, Keller A.Tissue-sparing surgery: 25 years' experience with femoral neck preserving hip arthroplasty. J Orthopaed Traumatal. 2006;7:36-41
10. Pipino F. Calderal PM. Biodynamic total hip prosthesis.Italian Journal of Orthopaedics and Traumatology. 1987; 13(3):289-297.
11. Devane et al.and Lombardi,et al.Correlation between prosthetic offset and polyethylene wear in total hip arthroplasty.67th Annual Meeting Proceedings,AAOS,March 2000,Orlando,S.552/553,198
12. Devane PA, Home JG. Assessment of polyethylene wear in total hip replacement.Clin Orthop Relat Res. 1999;(369):59-72.
1. Brekelmans WA,Poort HW,Slooff TJ.A new method to analyse the mechanical behaviour of skeletal parts.Acta Orthop Scand 1972;43(5):301-317
2. King AI. A review of biomechanical models. J Biomech Eng 1984; 106(2):97-104
3. Blernker SS, Asakawa DS, Gold GE, et al. Image-based musculoskeletal modeling: applications, advances, and future opportunities. J Magn Reson Imaging 2007;25(2):441-451
4. Stolk J,Verdonschot N,Cristofolini.et al.Finite element and experimental models of cemented hip joint reconstruction can produce similar bone and cement strains in pre-clinical tests.J Biomech,2002,35:499-510.
5. Bergmann F, Ggraichen,Rohlmann,A.Hip joint loading during walking and running,measured in two patients.J Biomech, 1993,26(8):969-990.
6．钟世镇。数字化虚拟中国人研究动态。医学研究通讯，2004，33(6)：5-6
7．魏斌。牙颌系统三维有限元建模方法的进展。口腔材料器械杂志，2002，11(2)：86-87
8. Kuroda T,Motohashi N,Tominaga R et al. Three-dimensional dental cast analyzing system using laser scanning. Am J Orthod Dentofacial Orthop, 1996 110:365-369
9. SONGHong-fang,ZHANG Qing-ming,LIU Zhi-cheng.A establishment of three--dimensional finite element model of proximal femur based on CT scan data。 J information of Medical Equipment, 2006, 21(12): 1-3.
10. National Electric Manufacturers Association.Digital Imaging and Communications in Medicine(DICOM protocolpart2, 3, 5, 6, 7, 8, 10, 11, 12)[z]. National Electrical Manufacturers Association, 2003.
11．张美超，刘阳，刘则玉，等．利用Mimics和Freeform建立中国数字人上颌第一磨牙三维有限元模型。医用生物力学，2006，24(3)：208-211
12. Visuri T, Hietaniemi K. Displaced stress fracture of the femoral shaft: a report of three cases[J]. Mil Med, 1992, 157(6): 325-327.
13. Lennon AB, Britton JR,MacNiocaill RF. Predicting revision risk for aseptic loosening of femoral components in total hip arthroplasty in individual patients-a finite element study. Journal of Orthopaedic Research.2007,25(6):779-788
1. Stolk J,Verdonschot N,Cristofolini.et al.Finite element and experimental models of cemented hip joint reconstruction can produce similar bone and cement strains in pre-clinical tests.J Biomech,2002,35:499-510.
2. Taylor ME,Tanner KE,Freeman MA,et al.Stress and strain distribution within the intact femur:compression or bending? Med Eng Phy, 1996,18:122-131.
3. Bergmann F, Ggraichen,Rohlmann,A.Hip joint loading during walking and running,measured in two patients.J Biomech, 1993,26(8):969-990.
4. Makarand GJ, Suresh G, Freeman M.Analysis of a femoral hip prosthesis designed to reduce stress shielding.Journal of biomechanics.2000,33 (12): 1655-1662
5. Biggi, Franchin, Lovato, Pipino. DEXA evaluation of total hip arthroplasty with neck-preserving technique:4-year follow-up.J Orthopaed Traumatol (2004)5:156-159
6. Devane et al.and Lombardi,et al.Correlation between prosthetic offset and polyethylene wear in total hip arthroplasty.67th Annual Meeting Proceedings,AAOS,March 2000,Orlando,S.552/553,198
7. 7 Devane PA, Horne JG. Assessment of polyethylene wear in total hip replacement.Clin Orthop Relat Res. 1999;(369):59-72.
8．巩慧明，侯亮，叶桂峰。髋关节置换的三维有限元分析。生物骨科材料与临床研究。2008， 5(5)：43-46
9. Domb B Hostin E, Mont MA, et al. Cortical strut grafting for enigmatic thigh pain ollowing total hip arthroplasty. Orthopedics, 2000, 23:21-24.
10. McLauhlin JR, Lee KR.Total hip arthroplasty in young patients.8-to 13-year results using an uncemented stem [J] .Clin Orthop Relat Res, 2000, (373):153-163
11. Huo MH, Brown BS.What's new in hip arthroplasty [J].J Bone Joint Surg Am, 2003, 85-A(9):1852-1864.
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