Peppers T A, Jobe C M, Dai Q G, Williams P A, Libanati C
Department of Orthopaedic Surgery, Loma Linda University, School of Medicine, CA, USA.
J Shoulder Elbow Surg. 1998 Jul-Aug;7(4):414-8. doi: 10.1016/s1058-2746(98)90034-9.
Surgeons often avoid cementing a proximal humeral prosthesis. Occasionally bony augmentation is needed. This study was undertaken to compare proximal cementation in combination with distal press with total cementation or press fit alone. In phase 1 axial micromotion with axial loading was measured in 15 pairs of humeri: 5 fully cemented versus proximally cemented, 5 fully cemented versus press fit, and 5 proximally cemented versus press fit. X-ray films of the specimens were obtained to assess canal fill. In phase 2 axial micromotion was measured in 5 pairs of high mineral density and 5 pairs of low mineral density to compare proximal cementation with press fit. The 3 M modular prosthesis was used in both phases. No difference was found in phase 1 among the 3 fixation techniques. A strong reverse statistical correlation (P = .007) (r = .55) was seen between axial micromotion and fill of the canal with the prosthesis. In the second phase no statistically significant difference was found between the techniques of fixation or between the 2 bone densities. Fill of the canal at the distal end of the prosthesis was the only variable found that affected axial micromotion, but it accounted for only approximately 30% of the variance. Bone quality and augmentation of the proximal bone with cement did not affect axial micromotion in this experiment but warrant further study.
外科医生通常避免对肱骨近端假体进行骨水泥固定。偶尔需要进行骨增强。本研究旨在比较近端骨水泥固定联合远端压配与全骨水泥固定或单纯压配的效果。在第一阶段，对15对肱骨测量轴向加载时的轴向微动：5对全骨水泥固定与近端骨水泥固定，5对全骨水泥固定与压配，以及5对近端骨水泥固定与压配。获取标本的X线片以评估髓腔填充情况。在第二阶段，对5对高骨密度和5对低骨密度的标本测量轴向微动，以比较近端骨水泥固定与压配。两个阶段均使用3M模块化假体。在第一阶段，三种固定技术之间未发现差异。轴向微动与假体对髓腔的填充之间存在强烈的反向统计学相关性（P = 0.007）（r = 0.55）。在第二阶段，固定技术之间或两种骨密度之间均未发现统计学上的显著差异。假体远端髓腔的填充是唯一被发现影响轴向微动的变量，但它仅占方差的约30%。在本实验中，骨质量和近端骨的骨水泥增强未影响轴向微动，但值得进一步研究。
