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1、人工髋关节置换——世纪性手术（柳叶刀翻译文献）Theoperationofthecentury:totalhipreplacement世纪性手术：全髋关节置换术Palaeopathologistshavediagnosedosteoarthritisofthehipinancientskeletons,1andprevalenceanddistributionofthediseasethenseemsnodifferentfromtoday.2However,littlemorethan100years
2、ago,thefirstattemptwasmadetotreathiparthritissurgically.Interpositionalarthroplasty,offeredinthelate19thandearly20thcenturies,entailedreplacingvarioustissues—includingfascialata,skin,andeventhesubmucosaofpig’sbladder—betweenthearticulatingsurfacesofthehi
3、p.Interpositionofavitalliumcup,whichcoveredthereshapedfemoralhead,bySmith-Petersonin1938heraldedaneweraofarthroplasty.3考古学家在古代尸体中就发现了髋关节骨性关节炎，其发病率和人群分布特征和现今一致。但仅仅到100多年以前，才开始外科治疗髋关节关节炎。植入关节成形术起始于19世纪末20世纪初，在髋关节表面使用了包括阔筋膜、皮肤甚至是猪膀胱的粘膜下层等各种替代物。1938年Smith-Pe
4、terson在整形后的股骨头上植入金属杯，这开启了关节成形术的新纪元。Wilesdevelopedthefirstprosthetictotalhipreplacementin1938,4andthisimplantisregardedastheprecedentofthemoderngenre.Subsequentattemptsatreconstructionofdestroyedarthriticjointsaretestimonytotheingenuityofsurgeonsofthattim
5、e.Theseearlyendeavourswerelargelybetrayedbypoordesign,inferiormaterials,andmechanicalfailure.Charnleyrevolutionisedmanagementofthearthritichipwiththeintroductionoflowfrictionarthroplasty(figure1).5Hemadethreemajorcontributionstotheevolutionoftotalhiprepl
6、acement:1)theideaoflowfrictiontorquearthroplasty;2)useofacryliccementtofixcomponentstolivingbone;and3)introductionofhigh-densitypolyethyleneasabearingmaterial.Reviewingfirst-generationresultsofCharnley’slowfrictionarthroplasty,Berryandcolleagues6andCalla
7、ghanandco-workers7reported81%and77%survivorship,respectively,at25-yearfollow-up,withrevisionofanycomponentastheendpoint.Similardatahavebeenreportedbyotherresearchers.8–10ThesefindingslendsupporttoCoventry’sobservationin1991that“Totalhiparthroplasty,indee
8、d,mightbetheorthopaedicoperationofthecentury”.111938年Wiles研究出第一个全髋置换假体，该假体被认为现代假体的先驱。随后为重建病变严重的骨性关节炎关节进行的各种尝试无疑是当时外科医生智慧的体现。早期的失败大部分归因于假体设计粗糙，材料本身的不足和力学的失败。Charnley研究出的低摩擦关节成形术为治疗髋关节骨性关节炎带来***性的进展。其为髋关节置换术带来了3个方面的主要进展：1)低摩
