Steens Wolfram, Souffrant Robert, Kluess Daniel, Mittelmeier Wolfram, Bader Rainer, Katzer Alexander
Department of Orthopaedics, University Medicine, Doberaner Strasse 142, 18057, Rostock, Germany.
, Roentgenstrasse 10, 45661, Recklinghausen, Germany.
Arch Orthop Trauma Surg. 2019 Apr;139(4):569-575. doi: 10.1007/s00402-019-03124-8. Epub 2019 Jan 22.
With this preliminary study we hypothesized a modified implantation technique may lead to higher primary stability than the conventional one.
In the conventional technique we used a sharp spoon to open the femoral cavity. Subsequently the opening was extended by increasing sizes of a sensing device to approve the final size. Finally, a bone compactor of the corresponding size was inserted in the cavity preparing it for implantation while compressing the surrounding cancellous bone. After initial opening of the femoral canal with a sharp spoon, the modified implantation technique was characterized by direct use of increasing sizes of bone compactors. A standardized procedure was implemented for micromotion analysis using LVDT's. Each specimen was positioned in a servo-hydraulic testing machine following a standardized test regime. A total of 1500 load cycles with a maximum hip reaction force of 1000 N were applied on each sample in three series of 500 cycles. The force was applied as a cyclic sinusoidal with a frequency of 1 Hz and a load ratio of R = 0.1.
No significant differences of micromotion between implant and surrounding bone stock could be detected regarding conventional vs. modified implantation technique. However, independent of the surgical technique used, significant differences were observed for the operated side, i.e. backhand driving of right-handed surgeon resulted in higher interfacial micromotions at the left side.
The results did not support our hypothesis. However, the correlation found between operated side and surgeon's backhand driving as a potential risk for reduced primary stability should encourage further investigations.
通过这项初步研究,我们假设一种改良的植入技术可能比传统技术具有更高的初始稳定性。
在传统技术中,我们使用锋利的匙形器械打开股骨腔。随后,通过增大传感装置的尺寸来扩大开口,以确定最终尺寸。最后,将相应尺寸的骨压实器插入腔中,在压缩周围松质骨的同时为植入做准备。在用锋利的匙形器械初步打开股骨髓腔后,改良植入技术的特点是直接使用尺寸逐渐增大的骨压实器。使用线性可变差动变压器(LVDT)实施了标准化的微动分析程序。按照标准化测试方案,将每个标本放置在伺服液压试验机中。对每个样本分三组,每组500个循环,总共施加1500个加载循环,最大髋关节反应力为1000 N。力以频率为1 Hz、载荷比R = 0.1的周期性正弦波形式施加。
关于传统植入技术与改良植入技术,在植入物与周围骨组织之间未检测到微动的显著差异。然而,无论使用何种手术技术,在手术侧均观察到显著差异,即右利手外科医生反手操作会导致左侧界面微动更高。
结果不支持我们的假设。然而,手术侧与外科医生反手操作之间的相关性作为初始稳定性降低的潜在风险,应鼓励进一步研究。