使用内固定锤对非骨水泥型股骨柄稳定性的体外评估
Ex vivo estimation of cementless femoral stem stability using an instrumented hammer
摘要：
非骨水泥型髋关节置换术的成功取决于股骨柄的初始稳定性。仍然难以评估最佳撞击次数，以保证股骨柄稳定性，同时避免骨折。本研究的目的是确认使用配有力传感器的骨锤监测股骨柄插入牛股骨样本的方法。方法将20种不同的非骨水泥型股骨柄打入5个牛股骨标本中，形成99种构型。使用三种方法量化插入终点：冲击锤、视频运动跟踪和外科医生本体感觉。对于每种配置，记录外科医生在感觉到正确插入之前进行的撞击次数Nsurg。通过视频运动跟踪测量插入深度E，并估计插入结束时对应的撞击数Nvid。从力的时间变化的分析中确定了两个指标，标记为I和D，25，并且估计了与D变化中达到的阈值相对应的冲击次数Nd。结果股骨柄的拔出力与I显著相关（R ${}^2$ =0.81）。所有配置的Nsurg、Nvid和Nd值相似。30解释结果验证了使用冲击锤评估股骨柄的初始稳定性，以及外科医生应停止冲击手术以获得最佳插入的时刻，这可能导致决策支持系统的开发。摘要：248字。正文：4658字
英文摘要：
Background 15 The success of cementless hip arthroplasty depends on the primary stability of the femoral stem. It remains difficult to assess the optimal number of impacts to guarantee the femoral stem stability while avoiding bone fracture. The aim of this study is to validate a method using a hammer instrumented with a force sensor to monitor the insertion of femoral stem in bovine femoral samples. Methods 20 Different cementless femoral stem were impacted into five bovine femur samples, leading to 99 configurations. Three methods were used to quantify the insertion endpoint: the impact hammer, video motion tracking and the surgeon proprioception. For each configuration, the number of impacts performed by the surgeon until he felt a correct insertion was noted Nsurg. The insertion depth E was measured through video motion tracking, and the impact number Nvid corresponding to the end of the insertion was estimated. Two indicators, noted I and D, 25 were determined from the analysis of the time variation of the force, and the impact number Nd corresponding to a threshold reached in D variation was estimated. Findings The pullout force of the femoral stem was significantly correlated with I (R${}^2$=0.81). The values of Nsurg, Nvid and Nd were similar for all configurations. 30 Interpretation The results validate the use of the impact hammer to assess the primary stability of the femoral stem and the moment when the surgeon should stop the impaction procedure for an optimal insertion, which could lead to the development of a decision support system. Abstract: 248 words. Main text: 4658 words
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