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首页> 外文期刊>Journal of orthopaedics and traumatology: official journal of the Italian Society of Orthopaedics and Traumatology >Cement mantle defects in total hip arthroplasty: influence of stem size and cementing technique
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Cement mantle defects in total hip arthroplasty: influence of stem size and cementing technique

机译：全髋关节置换术中的水泥套缺损：茎大小和固井技术的影响

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The cause of isolated osteolysis in the femoral shaft around stem implants in patients with cemented THR has so far not been established. A number of factors have been considered such as torsional stability of the femoral stem implant, the time of reduction intraoperatively after cementing and iatrogenic and load-induced defects in the cement mantle. The aim of this in vitro investigation was to determine if the cementing technique or the thickness of the prosthesis stem, and thus its bending strength, influences the formation, extent and localisation of cement mantle defects. In vitro biomechanical loading tests were performed on twelve anatomically shaped femoral stem prostheses of two different thicknesses which were implanted in artificial bone. Six of the implants were fixed by conventional cementing technique, the other six by means of the vacuum technique. Compared with thicker implant stems, the slimmer stems fixed with the conventional cementing technique had a higher number of cracks in the cement mantle. Pore formation was localised predominantly in the interface area between the bone cement and the “cancellous” bone or “cortex” of the artificial bone. This was observed especially in the non-vacuum mixed cement, regardless of stem thickness. Large pores were found mainly in the cement around the thicker stems which had been mixed by the conventional method. The thickness of the stems, whether fixed with vacuum-mixed or non-vacuum mixed cement, had no significant influence on the percentage of pore area in the cement. In the nonvacuum mixed cement, there was no significant difference between the percentages of pore area in the proximal and distal parts of the shafts, whereas in the vacuum mixed cement the percentage of pore area was significantly larger in the distal than in the proximal part of the shafts. In the specimens of both stem sizes, the percentage of pore area in the vacuum mixed cement was significantly smaller than in the nonvacuum mixed cement. This explains the greater fatigue strength of vacuum mixed cement. The cyclic loading on the thicker stem prostheses, especially in those fixed with vacuum mixed cement, resulted in fracture between the prosthesis tip and the clamping device due to the local stiffness of the artificial bone. Due to this unfavourable biomechanical property of the artificial bone, further studies will be carried out on human femurs. Nevertheless, in view of the results presented here, the vacuum mixing technique has to recommended as the “state of the art” method in cemented total hip arthroplasty.
机译：骨水泥型THR患者股骨干周围股骨干孤立性骨溶解的原因至今尚未确定。已经考虑了许多因素，例如股骨柄植入物的扭转稳定性，在固井后术中复位的时间以及在水泥罩中的医源性和负荷诱发的缺陷。这项体外研究的目的是确定固井技术或假体茎的厚度，从而确定其抗弯强度是否会影响水泥膜缺损的形成，程度和位置。体外生物力学负载测试是在两种不同厚度的十二种解剖形状的股骨假体上进行的，这些假体被植入人造骨中。其中的六种植入物通过常规固井技术固定，其余六种通过真空技术固定。与较厚的种植茎相比，采用常规固井技术固定的较细茎在水泥幔中的裂缝数量更多。孔的形成主要定位在骨水泥与人造骨的“松质”骨或“皮质”之间的界面区域。无论杆厚如何，在非真空混合水泥中都可以观察到这一点。大孔主要存在于通过常规方法混合的较粗茎周围的水泥中。杆的厚度，无论是用真空混合水泥还是非真空混合水泥固定，对水泥中的孔面积百分比均无显着影响。在非真空混合水泥中，竖井近端和远端的孔面积百分比之间无显着差异，而在真空混合水泥中，远端的孔面积百分比明显大于轴的近端孔面积百分比。轴。在两个杆尺寸的样品中，真空混合水泥中的孔面积百分比显着小于非真空混合水泥中的孔面积百分比。这解释了真空混合水泥具有更高的疲劳强度。由于人造骨的局部刚度，在较厚的茎假体上的周期性载荷，尤其是在用真空混合水泥固定的假体中，导致假体尖端与夹紧装置之间的断裂。由于人造骨的这种不利的生物力学特性，将对人类股骨进行进一步的研究。尽管如此，鉴于此处介绍的结果，真空混合技术必须推荐为全髋关节置换术的“最新技术”方法。

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