Braun W, Claes L, Rüter A, Paschke D
Klinik für Unfall- und Wiederherstellungschirurgie, Augsburg.
Z Orthop Ihre Grenzgeb. 1992 May-Jun;130(3):236-43. doi: 10.1055/s-2008-1040145.
The increasing number of revision surgery for failed total arthroplasty including the most difficult aspects of cement removal has lead to various developments of new instruments and techniques to facilitate this procedure. In this in vitro study the effect of extracorporeal shockwaves on the bone-cement interface under this view was investigated. At first the pressure reduction of bounding shockwaves in their progress through compounds consisting of cortical bone-PMMA and cancellous bone-PMMA by means of a needle pressure probe was measured. In the second part of the experiments the mechanical and morphological effects of ESW on the PMMA-Bone-Interface of human femoral segments was tested. Using bone cement cadaveric femoral segments were implanted with stainless steel rods within the medullary canal and the PMMA-Bone-interface was treated with ESW. After treatment the segments were examined mechanically, radiologically and by microscopy. Between the treated and the control group no difference was found which could give any a reference to the disruption of the Cement-Bone-Interface caused by ESW. However, there were observations which indicated that ESW induces a increasing risk of intravasation of bone marrow. Considering these facts ESW seems not to be a good clinical adjunct in revision surgery.
全关节置换失败后翻修手术数量不断增加，其中包括最难的骨水泥清除方面，这促使了各种新器械和技术的发展，以方便进行该手术。在此项体外研究中，从这一角度研究了体外冲击波对骨水泥界面的影响。首先，通过针式压力探头测量了边界冲击波在穿过由皮质骨 - 聚甲基丙烯酸甲酯（PMMA）和松质骨 - PMMA组成的复合物时的压力降低情况。在实验的第二部分，测试了体外冲击波（ESW）对人股骨段PMMA - 骨界面的力学和形态学影响。使用骨水泥，将尸体股骨段在髓腔内植入不锈钢棒，并对PMMA - 骨界面进行体外冲击波治疗。治疗后，对股骨段进行力学、放射学和显微镜检查。在治疗组和对照组之间未发现任何差异可作为体外冲击波导致骨水泥 - 骨界面破坏的参考依据。然而，有观察结果表明体外冲击波会增加骨髓血管内侵入的风险。考虑到这些事实，体外冲击波似乎不是翻修手术中良好的临床辅助手段。
