Yates Piers J, Quraishi Nasir A, Kop Allan, Howie Donald W, Marx Clare, Swarts Eric
Perth Orthopaedic Institute, Nedlands, Perth, Western Australia.
J Arthroplasty. 2008 Feb;23(2):188-96. doi: 10.1016/j.arth.2006.12.051. Epub 2007 Oct 24.
We present 14 cases of fracture of modern, high-nitrogen, stainless steel stems. Our clinical and radiological data suggest that heavy patients with small stems and poor proximal support are at risk for fracturing their implants. "Champagne-glass" canals can lead to the use of smaller stems often placed in varus, which can lead to cantilever bending and fatigue failure in the distal half of the stem. Metallurgical assessment of the retrieved high-nitrogen, stainless steel stems reveals microstructural inconsistencies that may contribute to their failure. Based on our findings, careful consideration and attention to technique is required when using stainless steel stems in patients with high body mass index or high weight. Technique is particularly important in femurs with champagne-glass canals.
我们报告了14例现代高氮不锈钢股骨柄骨折的病例。我们的临床和放射学数据表明，体型较大、股骨柄较小且近端支撑不佳的患者存在植入物骨折的风险。“香槟杯”形髓腔可能导致使用通常内翻置入的较小股骨柄，这可能导致股骨柄远端出现悬臂弯曲和疲劳失效。对取出的高氮不锈钢股骨柄进行的金相评估显示，微观结构不一致可能是导致其失效的原因。根据我们的研究结果，在体重指数高或体重较大的患者中使用不锈钢股骨柄时，需要仔细考虑并注重技术操作。在具有“香槟杯”形髓腔的股骨中，技术尤为重要。
