Schuroff Ademir Antônio, Deeke Mark, Pedroni Marco Antônio, Lupselo Fernando Silva, Kunz Rodrigo Ernesto, Lima Alexandre Matos
Hospital Universitário Cajuru, Curitiba, PR, Brazil.
Rev Bras Ortop. 2017 Sep 5;52(Suppl 1):40-45. doi: 10.1016/j.rboe.2017.08.019. eCollection 2017.
To radiographically evaluate the quality of cementation and implantation technique using a polished, triple-tapered femoral stem in total hip arthroplasty (THA).
Retrospective study with radiographic evaluation of 86 hips in 83 patients who underwent to primary THA with the triple-tapered cemented femoral stem C-Stem (DePuy Orthopedics, Warsaw, Indiana). Cases with at least one-year of follow-up were included, and data related to preoperative, immediate postoperative, and late postoperative radiographic evolution were recorded. This study analyzed, among others, the proximal femoral anatomy, the quality of cementation as described by Barrack, and the implant positioning. Cementation was also evaluated and quantified in the Gruen zones with one-year of follow-up.
The mean age was 62.85 years. Proximal femoral anatomical conformation was Dorr type A in 34 (39.53%) cases, type B in 52 (60.46%), and no type C cases were found. Five (5.81%) cases were defined as type A by Barrack's cementation classification system, 46 (56.49%) type B, 27 (31.40%) type C, and eight (9.30%) type D. The greatest cement mantle thickness was observed in zones four (15.53 mm) and 11 (15.64 mm), and the smallest in zone nine (3.51 mm). Positioning in varus was observed in eight (9.3%) cases, valgus in 25 (29%), forward deviation in two (5%), and backward deviation in 55 (63.95%).
The C-Stem femoral system presented satisfactory results related to cementation pattern, positioning, osteolysis, and stress shielding with regard to literature referring to double-tapered or triple-tapered models, demonstrating to be a safe method, with a predictable and reliable cementing pattern.
通过影像学评估在全髋关节置换术（THA）中使用抛光的三锥度股骨柄的骨水泥固定质量和植入技术。
对83例接受初次THA并使用三锥度骨水泥固定股骨柄C型柄（DePuy Orthopedics，印第安纳州华沙）的患者的86髋进行回顾性影像学研究。纳入至少随访一年的病例，并记录术前、术后即刻和术后晚期影像学变化相关数据。本研究分析了股骨近端解剖结构、Barrack描述的骨水泥固定质量以及植入物位置。还在随访一年时对Gruen分区的骨水泥固定进行了评估和量化。
平均年龄为62.85岁。股骨近端解剖形态为Dorr A型34例（39.53%），B型52例（60.46%），未发现C型病例。根据Barrack骨水泥固定分类系统，5例（5.81%）为A型，46例（56.49%）为B型，27例（31.40%）为C型，8例（9.30%）为D型。骨水泥套厚度最大的区域为4区（15.53mm）和11区（15.64mm），最小的为9区（3.51mm）。观察到8例（9.3%）内翻位，25例（29%）外翻位，2例（5%）前向偏斜，55例（63.95%）后向偏斜。
与文献中提及的双锥度或三锥度模型相比，C型柄股骨系统在骨水泥固定模式、位置、骨溶解和应力遮挡方面呈现出令人满意的结果，证明是一种安全的方法，具有可预测和可靠的骨水泥固定模式。
