Best A J, Fender D, Harper W M, McCaskie A W, Oliver K, Gregg P J
Department of Orthopaedic Surgery, University of Leicester, Glenfield General Hospital.
Ann R Coll Surg Engl. 1998 Sep;80(5):350-5.
As part of the National Study of Primary Hip Replacement Outcome, 402 consultant orthopaedic surgeons from three regions were contacted by postal questionnaire which covered all aspects of total hip replacement (THR). There was a 70% response rate of which 71 did not perform hip surgery, a further 33 refused to take part, leaving 181 valid responses. Preoperative assessment clinics were used by 89% of surgeons, but anaesthetists and rehabilitation services were rarely involved at this stage. Of respondents, 99% used routine thromboprophylaxis, with 79% using a combination of mechanical and chemical methods. Of surgeons, 84% routinely used stockings, whereas 95.5% used chemical prophylaxis, 63% employed low molecular weight heparins. Theatre facilities were shared with other surgical specialties by 6% of surgeons and 18% regularly used body exhaust suits for THR. Antibiotic loaded cement was used by 69% of surgeons, the majority (65%) used a single brand of normal viscosity cement with 9% using reduced viscosity formulations. Modern cementing techniques were commonly used at least in part, 87% used a cement gun and 94% a cement restrictor for femoral cementing. On the acetabulum, 47% pressurised the cement. In all, 36 different femoral stems and 35 acetabular cups were in routine use, but the majority of surgeons (55%) used Charnley type prostheses. Of the surgeons, 57% performed only cemented THR, while 3% exclusively used uncemented THR. Of consultants, 21% followed up their patients to 5 years, the majority discharge patients within the first year. Of concern is a large proportion of surgeons using low molecular weight heparins despite a lack of evidence with regard to reducing fatal pulmonary embolism, and also the small number of surgeons using prostheses of unproven value. Third generation cementing techniques have yet to be fully adopted. The introduction of a national hip register could help to resolve some of these issues.
作为国家初次髋关节置换术结果研究的一部分，通过邮政问卷联系了来自三个地区的402名骨科顾问外科医生，问卷涵盖了全髋关节置换术（THR）的各个方面。回复率为70%，其中71人不进行髋关节手术，另有33人拒绝参与，剩下181份有效回复。89%的外科医生使用术前评估诊所，但麻醉师和康复服务在这一阶段很少参与。在受访者中，99%使用常规血栓预防措施，79%使用机械和化学方法相结合的方式。在外科医生中，84%常规使用弹力袜，而95.5%使用化学预防措施，63%使用低分子肝素。6%的外科医生与其他外科专科共享手术室设施，18%在全髋关节置换术中定期使用身体排气服。69%的外科医生使用含抗生素骨水泥，大多数（65%）使用单一品牌的正常粘度骨水泥，9%使用低粘度配方。现代骨水泥技术至少部分被普遍使用，87%在股骨骨水泥固定时使用骨水泥枪，94%使用骨水泥限制器。在髋臼方面，47%对骨水泥进行加压。总共常规使用36种不同的股骨柄和35种髋臼杯，但大多数外科医生（55%）使用Charnley型假体。在外科医生中，57%仅进行骨水泥固定的全髋关节置换术，而3%仅使用非骨水泥固定的全髋关节置换术。在顾问医生中，21%对患者随访至5年，大多数在第一年内就让患者出院。令人担忧的是，尽管缺乏关于降低致命性肺栓塞的证据，但仍有很大比例的外科医生使用低分子肝素，而且使用未经证实价值的假体的外科医生数量较少。第三代骨水泥技术尚未得到充分采用。引入全国髋关节登记册有助于解决其中一些问题。
