Schurman D J, Maloney W J
Stanford University Medical School, California.
Clin Orthop Relat Res. 1992 Dec(285):158-63.
Cement removal in revision total hip arthroplasty can be technically challenging. Traditional methods involve using a combination of chisels, power burrs, and drills, as well as windowing the femoral cortex to gain access to cement distally. These methods can be associated with femoral fracture or uncontrolled cortical perforation and bone loss. A new technique had been developed that permits segmental extraction of bone cement from the femoral canal. Fresh cement is introduced into the old cement mantle and a threaded rod is placed into the wet cement and held in place while the cement hardens. The thread-forming rod is then removed leaving a threaded channel in the cement. Extraction rods are then screwed 1.5 to 2.5 cm into the threaded channel. A slap hammer, which attaches to the opposite end of the extraction rod, is used to remove 1.5- to 2.5-cm segments of cement. Fifteen cases involving revision of cemented femoral components were analyzed using this system. Complete cement removal was achieved in 12 cases with much less damage to the femur when compared with conventional methods. In two cases, there was retained cement along the medial wall of the femur and, in one case, the plug could not be extracted using this system. There were no fractures or cortical perforations in this series.
翻修全髋关节置换术中的骨水泥取出在技术上可能具有挑战性。传统方法包括使用凿子、动力磨头和钻头相结合，以及在股骨皮质开窗以进入远端的骨水泥。这些方法可能会导致股骨骨折或不受控制的皮质穿孔及骨质流失。一种新技术已经被开发出来，该技术允许从股骨髓腔内分段取出骨水泥。将新鲜骨水泥注入旧的骨水泥壳内，然后将一根螺纹杆放入湿骨水泥中，在骨水泥硬化时将其固定在原位。然后取出螺纹成型杆，在骨水泥中留下一个螺纹通道。接着将取出杆拧入螺纹通道1.5至2.5厘米。一个连接在取出杆另一端的敲击锤用于取出1.5至2.5厘米长的骨水泥段。使用该系统对15例涉及骨水泥固定股骨假体翻修的病例进行了分析。与传统方法相比，12例实现了完全取出骨水泥，对股骨的损伤要小得多。2例股骨内侧壁有残留骨水泥，1例使用该系统无法取出塞子。该系列中没有发生骨折或皮质穿孔。
