Kreutzer J, Schneider M, Schlegel U, Ewerbeck V, Breusch S J
Stiftung Orthopädische Universitätsklinik Heidelberg.
Z Orthop Ihre Grenzgeb. 2005 Jan-Feb;143(1):48-55. doi: 10.1055/s-2004-832406.
The results of a national survey from 1998 had shown at the time that only around 10 % of orthopaedic surgeons in Germany had strictly implemented modern cementing techniques in total hip arthroplasty (THA). The same study was repeated 5 years later to evaluate the current situation and to determine whether modern cementing techniques have become more popular.
A detailed, slightly modified questionnaire regarding cement and bone preparation, cementing techniques on acetabulum and femur, and implant types was sent to 572 German orthopaedic and trauma hospitals, as well as to visiting surgeons with an interest in THA. In total, 293 questionnaires were available for evaluation and statistical analysis.
Palacos bone cement remained the most widely used cement (> 90 %). The mixing times given varied significantly. Vacuum mixing systems had become more popular (67.9 %). In the femur 81.8 % of the surgeons attempted to preserve cancellous bone and 57.2 % used pulsatile lavage (jet-lavage). Retrograde cement application via a cement gun was done in 71.1 %. Cement restrictors were used in more than 95 %. Only two-thirds of the surgeons implemented sustained cement pressurisation and preferred a cement mantle thickness > 2mm (64 %). Only 16.9 % made multiple small acetabular keyholes and 48.6 % used jet-lavage. In 73.1 % no cement gun was used and in 68.3 % the cement was applied at high viscosity. Manual cement pressurisation was done in 58.1 %. The Muller straight stem device remained the most popular implant. For only 5 of the over 50 stem designs implanted have long-term results been published as yet. Only 10.6 % of surgeons/centres performed > 20 and almost 50 % implanted > 100 cemented THAs/year.
The results of this survey demonstrated that, in comparison to 1998, the current state of cemented THA, in particular cementing technique has significantly improved. Future emphasis should be on continued surgeon education and training, as the operative, i. e., cementing techniques are of utmost importance for long-term success.
1998年的一项全国性调查结果显示，当时德国只有约10%的骨科医生在全髋关节置换术（THA）中严格采用了现代骨水泥固定技术。5年后重复进行了相同的研究，以评估当前状况并确定现代骨水泥固定技术是否更受欢迎。
一份关于骨水泥和骨准备、髋臼和股骨的骨水泥固定技术以及植入物类型的详细且稍有修改的问卷被发送至572家德国骨科和创伤医院，以及对THA感兴趣的来访外科医生。总共293份问卷可供评估和统计分析。
帕拉科斯骨水泥仍然是使用最广泛的骨水泥（>90%）。给出的搅拌时间差异显著。真空搅拌系统更受欢迎（67.9%）。在股骨手术中，81.8%的外科医生试图保留松质骨，57.2%使用脉冲冲洗（喷射冲洗）。71.1%的手术通过骨水泥枪逆行注入骨水泥。超过95%的手术使用骨水泥限制器。只有三分之二的外科医生实施持续骨水泥加压，并且更倾向于骨水泥壳厚度>2毫米（64%）。只有16.9%的医生制作多个小髋臼钥匙孔，48.6%使用喷射冲洗。73.1%的手术未使用骨水泥枪，68.3%的手术以高粘度注入骨水泥。58.1%的手术采用手动骨水泥加压。穆勒直柄装置仍然是最受欢迎的植入物。在植入的50多种柄设计中，只有5种的长期结果已经发表。每年进行超过20例且几乎50%的医生/中心植入超过100例骨水泥固定THA的医生仅占10.6%。
本次调查结果表明，与1998年相比，目前骨水泥固定THA的状况，特别是骨水泥固定技术有了显著改善。未来应重点持续对外科医生进行教育和培训，因为手术操作，即骨水泥固定技术对长期成功至关重要。
