Breusch S J, Draenert Y, Draenert K
Abteilung Orthopädie I, Stiftung Orthopädische Universitätsklinik Heidelberg.
Z Orthop Ihre Grenzgeb. 1998 Nov-Dec;136(6):554-9. doi: 10.1055/s-2008-1045185.
The purpose of this study was to compare cemented anatomic stems with cemented straight stems regarding cement mantle and stem orientation in the medullary canal.
In a cadaver study, 10 anatomic SP II stems and 10 MEM straight stems were implanted in paired human femora using a standardised modern cementing technique. In one group the femoral canal was prepared using conventional broaches, in the other group diamond hollow-cutters were used. Standardised horizontal cuts were made and evaluated regarding stem orientation and cement mantle using digitised image analysis.
All SP II stems in the "diamond group" showed good stem centralisation without cement mantle defects. In the "broach group" all diaphyseal cancellous bone had been removed and only 3/5 stems were well orientated. No reproducible stem centralisation was achieved with the straight stems. All stems showed an oblique orientation from antero-proximally to postero-distally with direct stem to bone contact. The variation from the optimal stem alignment along the canal axis showed a mean deviation of 3.1 mm in the anatomic stem group and 10 mm in the straight stem group. The canal preparation using broaches showed frequent fractures of the cancellous bone and debris interposition despite the use of jet-lavage. Most of the cancellous bone in the diaphysis had been destroyed.
Anatomic stems show a better stem centralisation and a more even cement mantle than straight MEM stems. The use of high volume straight stems carries a significant risk of producing cement mantle defects. Diamond instruments are less traumatic than broaches for femoral canal preservation and help to preserve diaphyseal cancellous bone, which improves stem self-centralisation.
本研究旨在比较骨水泥型解剖型股骨柄与骨水泥型直柄股骨柄在髓腔内的骨水泥壳及柄的方向。
在一项尸体研究中，采用标准化的现代骨水泥技术，将10个解剖型SP II股骨柄和10个MEM直柄股骨柄植入配对的人体股骨中。一组使用传统拉刀准备股骨髓腔，另一组使用金刚石空心铣刀。制作标准化的水平切口，并使用数字化图像分析评估柄的方向和骨水泥壳。
“金刚石组”中的所有SP II股骨柄均显示出良好的柄中心化，且无骨水泥壳缺陷。在“拉刀组”中，所有骨干松质骨均被去除，仅有3/5的柄方向良好。直柄股骨柄未实现可重复的柄中心化。所有柄均显示从前近端到后远端的倾斜方向，柄与骨直接接触。解剖型股骨柄组沿髓腔轴线与最佳柄对齐的偏差平均值为3.1mm，直柄组为10mm。尽管使用了喷射冲洗，但使用拉刀准备髓腔仍频繁出现松质骨骨折和碎屑嵌入。骨干中的大部分松质骨已被破坏。
解剖型股骨柄比直柄MEM股骨柄显示出更好的柄中心化和更均匀的骨水泥壳。使用大容量直柄股骨柄产生骨水泥壳缺陷的风险显著。对于保留股骨髓腔，金刚石器械比拉刀创伤性小，有助于保留骨干松质骨，从而改善柄的自中心化。
