髖關節置換的長期臨床療效，仍一直是臨床醫師與人工關節設計師所關注的問題。骨組織切除量的多寡與手術後的穩定度，都是影響手術後療效的重要考量因素。相對而言，關節表面置換術(Joint Resurfacing Surgery)切除的骨頭量較少，因此能儘量保留自然的關節解剖外型，所以不會大幅改變關節的受力情形。另一方面，也可縮減麻醉時間與降低輸血及器械感染的機會，使得第二次手術成功率大幅提高。同時具有不需要淘空骨髓腔的手術特性，也適合微創型手術的應用。因此，目前關節表面置換手術在國外已又成為治療僅關節表面組織壞死或退化的方式了。 可將此類具有微骨切除量特性的關節表面置換術，細分成整體(Total)與局部(Partial)兩種型式。整體關節表面置換術會將有問題的關節骨頭表面整個切除，然後將具規格尺寸的置換物固定於削型後的關節面上。因此曲面與病患關節曲面無法完全配合。本研究針對現今臨床上表面置換型髖關節設計的缺點，考慮股骨球頭關節退化部位的曲面差異，結合醫學影像重建的技術。依據不同病患，建構客製化關節的曲面設計，以及相對應之手術器械。規劃模擬評估其整體可行性，並建構髖關節站立時的有限元素分析平台，藉以改進表面置換型人工髖關節之設計。 依據規劃之手術流程，加上實際打樣成品的設計修改，目前成果是具可行性的。再經由有限元素分析的結果證實本論文之設計確實有比使用中之人工關節效果好。 The lone-term clinical curative effect of the hip joint replacement has still been clinician and the joint prosthesis designer matter of concern. The number of quantity of the bone tissue excision and the stability after the operation both are the important consideration factors to influence the curative effect after the operation. Relatively, the joint resurfacing surgery excises the bone quantities are few, can therefore retain the natural joint anatomy property as far as possible, and the surgery will not chanfe joint’s stress situation largely. On the other hand, it may also reduce the anaesthesia time with to reduce the opportunity which the blood transfusion and the instrument infect, causes the second surgery success ratio to enhance largely. Simultaneously the surgery has the surgery characteristic that does not need to bail the well dry the medullary cavity of bones, is also suitable for the applications of the minimally incision surgery. Therefore, the joint resurfacing surgery in abroad has became the treatment way for only joint surface tissue necrosis or the degenerated again at present. We can subdivide the joint resurfacing surgery that has the kind of the minimally bone excision quantity characteristic into total and partial two patterns. The total joint resurfacing surgery will excise the necrotic tissues on the joint head surface entirely; will then put the implant with standard size to fix on articular surface in the paring type.Therefore the curved surface and patient’s joint surface are unable to fit completely. This research is directed against the design’s fedects on the clinical hip resurfacing today, and considers the surface’s differences between the femoral head joint degenerated position, then combines the technology of the medical image reconstruction technology. According to different patient, constructs the customization joint surface design, as well as corresponds the surgery instrument. Plan to estimate its whole feasivility in simulation, and constructs the finite element analysis platform when the hip joint stande, ues to improve the design of the resurfacing artificial hip joint. According to the operation procedures of planning, in addition, prototypes and revises the designs of implants and instruments, the achievement has feasibility at present. And then verify that the design of this thesis is really more effectual than the artificial joint prosthesis while using via the result of the finite element analysis.
