骨水泥型髋关节置换术中扩髓与锉髓的比较：尸体股骨的力学稳定性
Reaming versus broaching in cemented hip arthroplasty: mechanical stability in cadaver femora.
作者信息
Ioannidis Theologos T, Apostolou Constantinos D, Korres Dimitrios S, Papaletsos Ioannis, Gandaifis Nikolaos D, Panagopoulos Christos N, Agathocleous Panagiotis E
机构信息
University Department of Orthopaedic Surgery, KAT Hospital, 2 Nikis Street, Kifissia, Athens, Greece.
出版信息
Acta Orthop. 2005 Jun;76(3):326-30.
INTRODUCTION
We used an experimental hip model to assess the mechanical stability of a hip prosthesis, and compared the femoral medullary canal preparation techniques of reaming and broaching.
METHODS
15 pairs of cadaveric femora had a simulated replacement, the right femur with a reaming technique and the left with a broaching technique. Both femurs were radiographed to assess component positioning and cement mantle. The femurs were osteotomized 30 days after the procedure. The shear strength of the interface was studied at 4 different levels along an aluminum rod during push-out tests.
RESULTS
The overall mean value of the interface failure load was 15% lower with the reaming technique (6.5 kN for the reaming technique versus 7.7 kN for the broaching technique; p = 0.02).
INTERPRETATION
Broaching was superior to reaming for the preparation of the femoral canal, and should be used in order to increase primary stability. Further in vivo studies are required to account for factors such as intramedullary pressure, bleeding and surgical variations, which could not be accounted for in our study.
引言
我们使用实验性髋关节模型来评估髋关节假体的机械稳定性，并比较了扩髓和拉削这两种股骨髓腔准备技术。
方法
对15对尸体股骨进行模拟置换，右侧股骨采用扩髓技术，左侧采用拉削技术。对双侧股骨进行X线摄影以评估假体位置和骨水泥壳。术后30天对股骨进行截骨。在推出试验中，沿着铝棒在4个不同水平研究界面的剪切强度。
结果
扩髓技术的界面破坏载荷总体平均值低15%（扩髓技术为6.5 kN，拉削技术为7.7 kN；p = 0.02）。
解读
在股骨髓腔准备方面，拉削优于扩髓，为提高初始稳定性应采用拉削技术。还需要进一步的体内研究以考虑诸如髓内压力、出血和手术差异等因素，这些因素在我们的研究中无法考虑到。
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