González Della Valle A, Sharrock N, Barlow M, Caceres L, Go G, Salvati E A
Hospital for Special Surgery, 535 East 70th Street, New York, 20012, USA.
Bone Joint J. 2016 Jan;98-B(1 Suppl A):54-9. doi: 10.1302/0301-620X.98B1.36409.
We describe our technique and rationale using hybrid fixation for primary total hip arthroplasty (THA) at the Hospital for Special Surgery. Modern uncemented acetabular components have few screw holes, or no holes, polished inner surfaces, improved locking mechanisms, and maximised thickness and shell-liner conformity. Uncemented sockets can be combined with highly cross-linked polyethylene liners, which have demonstrated very low wear and osteolysis rates after ten to 15 years of implantation. The results of cement fixation with a smooth or polished surface finished stem have been excellent, virtually eliminating complications seen with cementless fixation like peri-operative femoral fractures and thigh pain. Although mid-term results of modern cementless stems are encouraging, the long-term data do not show reduced revision rates for cementless stems compared with cemented smooth stems. In this paper we review the conduct of a hybrid THA, with emphasis on pre-operative planning, surgical technique, hypotensive epidural anaesthesia, and intra-operative physiology.
我们描述了在特种外科医院使用混合固定技术进行初次全髋关节置换术（THA）的方法和原理。现代非骨水泥髋臼组件的螺孔很少或没有螺孔，内表面经过抛光，锁定机制得到改进，厚度和髋臼杯与内衬的贴合度达到最大化。非骨水泥髋臼杯可与高度交联的聚乙烯内衬相结合，这些内衬在植入10至15年后显示出极低的磨损和骨溶解率。表面光滑或经过抛光处理的骨水泥固定柄的骨水泥固定效果极佳，几乎消除了非骨水泥固定所出现的并发症，如围手术期股骨骨折和大腿疼痛。尽管现代非骨水泥柄的中期结果令人鼓舞，但长期数据并未显示非骨水泥柄与骨水泥光滑柄相比翻修率有所降低。在本文中，我们回顾了混合全髋关节置换术的实施情况，重点关注术前规划、手术技术、低血压硬膜外麻醉和术中生理学。
