人工髋关节置换术的现状与热点

人工髋关节置换术近年来在许多方面都取得了长足的进展，也出现了一些备受关注的热点问题。在髋关节负重界面方面，高交联聚乙烯材料的改进使得陶瓷对高交联聚乙烯成为具有表现优异的负重面组合，陶瓷对陶瓷界面的碎裂风险随着新型复合陶瓷的出现也得到了大限度的降低，成为年轻患者负重界面的优选方案。金属对金属界面因存在不良软组织反应等潜在风险而引起了极大的关注，而金属锥部腐蚀这一问题更是成为近期瞩目的焦点，值得进一步深入研究。快速通道关节外科的迅速发展使得各种微创入路全髋关节置换手术再次赢得重视，但必须看到不可避免的学习曲线问题和微创技术本身可能存在的技术上的风险。在髋关节假体周围感染方面，目前的研究热点主要集中在感染的及时正确诊断和感染的积极预防上，多种新的诊断方法和具有抗菌或抑菌作用的新材料正被尝试用于感染的诊断和预防。各种高度多孔金属材料的临床应用改变了以往对于严重骨缺损的重建方法，为髋关节翻修带来了极大的便利。

To analyze the learning curve for cancer control from an initial 250cases(GroupI) and subsequent 250cases(GroupII) of robotic?assisted laparoscopic radical prostatectomy(RALP) performed by a single surgeon. Five hundred consecutive patients with clinically localized prostate cancer received RALP and were evaluated. Surgical parameters and perioperative complications were compared between the groups. Positive surgical margin(PSM) and biochemical recurrence(BCR) were assessed as cancer control outcomes. Patients in GroupII had signiifcantly more advanced prostate cancer than those in GroupI(22.2%vs 14.2%, respectively, with Gleason score 8–10,P=0.033; 12.8%vs 5.6%, respectively, with clinical stage T3,P=0.017). The incidence of PSM in pT3 was decreased signiifcantly from 49% in GroupI to 32.6% in GroupII. Ameaningful trend was noted for a decreasing PSM rate with each consecutive group of 50cases, including pT3 and high?risk patients. Neurovascular bundle(NVB) preservation was signiifcantly inlfuenced by the PSM in high?risk patients(84.1% in the preservation groupvs 43.9% in the nonpreservation group). The 3?year, 5?year, and 7?year BCR?free survival rates were 79.2%, 75.3%, and 70.2%, respectively. In conclusion, the incidence of PSM in pT3 was decreased signiifcantly after 250cases. There was a trend in the surgical learning curve for decreasing PSM with each group of 50cases. NVB preservation during RALP for the high?risk group is not suggested due to increasing PSM.