Markel David C, Critchfield Jeff, Chaffin Abby, Wooley Paul H, Grimm Michele J
Department of Orthopaedic Surgery, Providence Hospital, Southfield, Michigan, USA.
Am J Orthop (Belle Mead NJ). 2003 May;32(5):229-33.
Cortical defects are common and problematic in cemented revision hip arthroplasty. Extruded cement can cause thermal injury, pain, and impingement. Decreased cement pressure limits bony interdigitation and leads to loosening. Historically, surgeons have used a finger to contain cement and improve pressure, and decrease porosity, but, with large or multiple defects, fingers are ineffective. Novel solutions--such as wrapping foil suture packaging or half a syringe barrel around the defects--have been previously published. In the study reported here, we used modern cementing techniques, continuous pressure monitoring, and porosity calculations to analyze the utility of the 3 provisional defect-fixation techniques. The foil and the hemisyringe worked as well as a finger (P > .05). All 3 techniques enhanced pressurization and maintained the porosity reduction. Although manually pressurizing cement and feeling resistance provide the surgeon with more tactile feedback, using the gun and a proximal adapter was more effective in improving pressure. Using these provisional defect-fixation techniques as well as a cement gun and proximal adapter can improve cement pressure and decrease porosity. These techniques are particularly useful with large or multiple cortical defects encountered in revision arthroplasty or total hip arthroplasty after open reduction.
皮质骨缺损在髋关节置换翻修术中很常见且成问题。挤出的骨水泥会导致热损伤、疼痛和撞击。骨水泥压力降低会限制骨交错生长并导致松动。从历史上看，外科医生会用手指控制骨水泥以提高压力并减少孔隙率，但对于大的或多个缺损，手指并不管用。此前已发表过一些新的解决方法，比如用箔片包裹缝线包装或半个注射器筒围绕缺损处。在本文报道的研究中，我们采用现代骨水泥技术、连续压力监测和孔隙率计算来分析三种临时缺损固定技术的效用。箔片和半注射器筒的效果与手指相当（P > .05）。所有三种技术都增强了压力并保持了孔隙率降低。虽然手动挤压骨水泥并感受阻力能为外科医生提供更多触觉反馈，但使用骨水泥枪和近端适配器在提高压力方面更有效。使用这些临时缺损固定技术以及骨水泥枪和近端适配器可以提高骨水泥压力并降低孔隙率。这些技术对于翻修关节成形术或切开复位后全髋关节置换术中遇到的大的或多个皮质骨缺损特别有用。
