Urist M R
University of California, Los Angeles Bone Research Laboratory.
Curr Probl Surg. 1975 Nov:1-54. doi: 10.1016/s0011-3840(75)80007-4.
Surgical management of osteoarthritis, aseptic necrosis and rheumatoid arthritis has been revolutionized by the introduction of acrylic cement-stabilized joint surface replacement. Although single joint surface replacements have been employed extensively for more than half a century, total surface replacement operations with a wear-resistant high-density polyethylene and noncorrosive stainless steel stabilized by acrylic cement were introduced only a little more than 12 years ago. This evolved with Charnley's discovery of the high level of bone tolerance for acrylic cement. Acrylic cement made it possible mechanically to bond artificial joint surfaces to the bone ends and produce an insensitive Charcot-like functioning joint. A barium sulfate additive makes the cement radiopaque for visualizing the bone-cement interface. Barium sulfate additive also lowers the polymerization temperature and opens the polymer for influx of interstitial fluids. Antibiotics have also been added to the cement for prevention and treatment of infection of the surrounding tissues. In aged individuals with cardiovascular disease, the absorption of the acrylic monomer depresses cardiac output and produces hypotension for 2-5 minutes after impaction of acrylic cement into spongy bone. The hypotension has been minimized by cautious fluid replacement and maintenance of adequate blood volume before, during and after the operation. Approximately 30,000 total hip arthroplasties are performed in the United States annually in patients older than 50 years of age with fractured femoral head replacements, bilateral rheumatoid arthritis, old neglected congenital dislocations of the hip or osteonecrosis with and without osteoarthritis. The pain relief is more complete and the functional improvement more predictable than in any other previously recommended surgical operation for the purpose. For this reason, total hip arthroplasty has almost completely supplanted mold-arthroplasty, osteotomy, capsulotomy (hanging hip) and resection of the femoral head. Hemiarthroplasty in the form of femoral head replacement still is the procedure of choice in patients with fractures of the neck of the femur and a normal acetabular articular cartilage, irrespective of age. As a countermeasure against loosening of the prosthesis in patients with osteoporosis and a hollow proximal end of the femur, the stem can be stabilized with acrylic cement. A standard replaceable femoral head for subsequent conversion of femoral head replacement to total hip arthroplasty is an important consideration and presently is under investigation in several medical centers.(ABSTRACT TRUNCATED AT 400 WORDS)
丙烯酸骨水泥固定的关节表面置换术的引入，彻底改变了骨关节炎、无菌性坏死和类风湿性关节炎的外科治疗方式。尽管单关节表面置换术已广泛应用了半个多世纪，但采用耐磨的高密度聚乙烯和由丙烯酸骨水泥固定的非腐蚀性不锈钢进行的全表面置换手术，仅仅是在12年多以前才开始应用。这一技术随着Charnley对丙烯酸骨水泥具有高骨耐受性的发现而得以发展。丙烯酸骨水泥使得人工关节表面能够机械地与骨端结合，并产生一个类似夏科氏关节（Charcot-like）的不敏感功能关节。硫酸钡添加剂使骨水泥具有放射性不透明性，以便观察骨-骨水泥界面。硫酸钡添加剂还能降低聚合温度，并使聚合物开放以便间质液流入。抗生素也已添加到骨水泥中，用于预防和治疗周围组织的感染。在患有心血管疾病的老年个体中，丙烯酸单体的吸收会降低心输出量，并在将丙烯酸骨水泥注入松质骨后2至5分钟内产生低血压。通过在手术前、手术中和手术后谨慎补液并维持足够的血容量，已将这种低血压降至最低程度。在美国，每年大约有30,000例全髋关节置换术用于50岁以上患有股骨头骨折置换、双侧类风湿性关节炎、陈旧性被忽视的先天性髋关节脱位或伴有或不伴有骨关节炎的骨坏死的患者。与以往任何为此目的推荐的外科手术相比，疼痛缓解更彻底，功能改善更可预测。因此，全髋关节置换术几乎已完全取代了模造关节成形术、截骨术、关节囊切开术（悬吊髋关节）和股骨头切除术。对于股骨颈骨折且髋臼关节软骨正常的患者，无论年龄大小，股骨头置换形式的半髋关节置换术仍然是首选的手术方法。作为预防骨质疏松且股骨近端空心的患者假体松动的对策，假体柄可用丙烯酸骨水泥固定。一个标准的可替换股骨头，以便随后将股骨头置换转换为全髋关节置换术，是一个重要的考虑因素，目前正在几个医疗中心进行研究。（摘要截选至400字）
