Giannotti Stefano, Bottai Vanna, Dell'Osso Giacomo, Bugelli Giulia, Guido Giulio
IInd Orthopaedic and Traumatologic Clinic University of Pisa Pisa, Italy.
Surg Technol Int. 2014 Nov;25:246-50.
In revision arthroplasty the surgeon is often faced with the problem of removal of residual cement in the medullary canal. Conventional manual cement removal by hand or power-driven instruments can be time-consuming, can require osteotomy, and can be associated with complications such as cortical perforation, fracture, or bone loss. Ultrasonic devices offer an alternative method of cement removal, but the potential for thermal injury exists, in particular for the humerus and the radial nerve. Considering these problems with the use of ultrasound, and whereas the old cement mantle may be left in place in the hip or knee but not in the shoulder, we tried this new mechanical cement extractor also in the humerus. We utilized this extractor in 5 cases, and we eliminated all residual resin in an accurate and complete way without bone loss and without iatrogenic fractures in all cases. We believe this system, which was designed for revisions of hip and knee surgery, is also suitable for the shoulder.
在翻修关节成形术中,外科医生常常面临清除髓腔内残留骨水泥的问题。传统的手动或电动器械手动清除骨水泥可能耗时较长,可能需要进行截骨术,并且可能伴有诸如皮质穿孔、骨折或骨质丢失等并发症。超声设备提供了一种清除骨水泥的替代方法,但存在热损伤的风险,尤其是对于肱骨和桡神经。考虑到使用超声存在这些问题,而且旧的骨水泥壳在髋关节或膝关节翻修时可能会保留在原位,但在肩关节翻修时则不然,我们也在肱骨翻修中试用了这种新型机械骨水泥取出器。我们在5例手术中使用了该取出器,在所有病例中均准确、彻底地清除了所有残留树脂,且未出现骨质丢失和医源性骨折。我们认为,这种为髋关节和膝关节手术翻修设计的系统也适用于肩关节。