Bonnomet F, Vanhille W, Lefebvre Y, Clavert P, Gicquel P, Kempf J F
Département d'Orthopédie et de Traumatologie, Hôpital Hautepierre, Hôpitaux Universitaires, avenue Molière, 67098 Strasbourg Cedex, France.
Rev Chir Orthop Reparatrice Appar Mot. 2001 Oct;87(6):544-55.
We report our experience with the SKH(R) cemented acetabular cup, analyzing the clinical and radiographic consequences of using cement armed with a thick embedded wire mesh.
Between June 1990 and June 1991, 118 total hip arthroplasties (THAs) were performed in 110 patients (8 bilateral cases) using the SKH(R) cemented acetabular cup, a self-blocking cemented femoral stem with anterograde injection made of a Ti-6Al-7Nb alloy and a 28 mm ceramic polyethylene articulation. Mean follow-up for 97 implants (91 patients) was 7.1 years (3 - 9 years). Mean age at implantation was 65 years (36 - 85 years) (43 men and 48 women). THAs were performed for degenerative joint disease (n=79) including 67 cases of primary disease, necrosis (n=11), rheumatoid disease (n=6), and fracture of the femoral neck (n=1).
For the 118 procedures, there were 4 complications: 2 dislocations (no revision), one failure of the ceramic head and one implant infection (with revision). As assessed by the Postel-Merle-d'Aubigné score as modified by Charnley for the mobility criterion, clinical outcome was excellent or good in 82% of the cases, fair in 11% and poor in 7%. According to the Massin criteria at last follow-up, there were 13 cup loosenings (13.4%, 10 migrations and 3 total lucent lines > 1 mm); revision procedures were performed in 6 cases. A lucent line postoperatively, observed in 51% of the cases (p=0.025) and involving all or part of zone 1 in 44% (p=0.047), was predictive of acetabular failure. Linear polyethylene wear as measured manually was 0.08 mm/year (average) for non-loosened cups and 0.2 mm/year for loosened cups; the difference was significant (p=0.001). On the contrary, the thickness of the cement, measured at the limits of the three De Lee and Charnley zones, cup tilt and size, age, weight and patient activity level had no effect on failure rate. Actuarial survival of the cup at 9 years was 86.3% taking aseptic loosening (with or without revision) as the failure criterion and 93.8% taking revision for aseptic loosening as the failure criterion.
These results were rather disappointing. The thick layer of cement reinforced with the wire mesh produces a metal back effect with the known consequences in terms of loosening, cement-bone lucent line, and polyethylene wear. A modification is now undergoing thermal and mechanical assessment. A thinner and tighter mesh would appear to be preferable.
我们报告使用SKH®骨水泥固定髋臼杯的经验，分析使用带有厚嵌入式金属丝网的骨水泥的临床和影像学后果。
1990年6月至1991年6月期间，110例患者（8例双侧病例）接受了118例全髋关节置换术（THA），使用了SKH®骨水泥固定髋臼杯、由Ti-6Al-7Nb合金制成的带顺行注射的自锁定骨水泥股骨柄以及28毫米陶瓷聚乙烯关节。对97例植入物（91例患者）的平均随访时间为7.1年（3至9年）。植入时的平均年龄为65岁（36至85岁）（43名男性和48名女性）。进行THA的原因包括退行性关节疾病（n = 79），其中原发性疾病67例、坏死（n = 11）、类风湿性疾病（n = 6）以及股骨颈骨折（n = 1）。
在118例手术中，发生了4例并发症：2例脱位（未翻修）、1例陶瓷股骨头失效和1例植入物感染（进行了翻修）。根据Charnley修改后的用于活动标准的Postel-Merle-d'Aubigné评分评估，82%的病例临床结果为优或良，11%为一般，7%为差。根据最后随访时的Massin标准，有13例髋臼杯松动（13.4%，10例移位和3例总透亮线>1毫米）；6例进行了翻修手术。术后出现透亮线的情况在51%的病例中观察到（p = 0.025），其中44%累及全部或部分1区（p = 0.047），这是髋臼失效的预测指标。手动测量的线性聚乙烯磨损，未松动髋臼杯的平均磨损为0.08毫米/年，松动髋臼杯的为0.2毫米/年；差异具有统计学意义（p = 0.001）。相反，在三个De Lee和Charnley区的边界处测量的骨水泥厚度、髋臼杯倾斜度和尺寸、年龄、体重以及患者活动水平对失败率没有影响。以无菌性松动（有或无翻修）作为失败标准，髋臼杯9年的精算生存率为86.3%，以无菌性松动翻修作为失败标准时为93.8%。
这些结果相当令人失望。用金属丝网加固的厚骨水泥层会产生金属背效应，在松动、骨水泥-骨透亮线以及聚乙烯磨损方面会产生已知的后果。目前正在对一种改进型进行热学和力学评估。似乎更倾向于使用更薄且更紧密的金属丝网。
