氨甲环酸对骨水泥型人工半髋置换术治疗股骨颈骨折患者出血量的影响

目的探讨氨甲环酸对骨水泥型人工半髋置换术治疗股骨颈骨折患者术中、术后出血量的影响。方法选取医院2018年2月至2019年2月行骨水泥型人工半髋置换术治疗的股骨颈骨折患者112例,按随机数字表法分为对照组和观察组,各56例。研究组患者分别于切皮前及关闭切口时静脉滴注氨甲环酸注射液15 mg/kg,对照组患者同时点静脉滴注0.9%氯化钠注射液100 mL。结果观察组患者术中出血量、输血量、术后24 h出血量显著少于对照组,输血率显著低于对照组(P<0.05);术后24 h,观察组患者血红蛋白(Hb)和红细胞比容(PCV)显著高于对照组(P<0.05);观察组不良事件发生率为7.14%,与对照组的10.71%相当(P>0.05)。结论应用骨水泥型人工半髋置换术治疗股骨颈骨折时静脉滴注氨甲环酸,能显著减少患者术中和术后出血量,降低输血率。     

Polished,Collarless, Tapered,Cemented Stems for Primary Hip Arthroplasty May Exhibit High Rate of Periprosthetic Fracture at Short-Term Follow-Up

Background

Cemented stems are designed to follow 1 of 2 principles of fixation: composite beams or slide taper. Stems in the latter category have a collarless, polished, tapered (CPT) design and subside into the cement mantle, creating hoop stresses. We compared the rate of periprosthetic fracture (PPF) of stem designed with these 2 principles of fixation. In addition, we examined radiographic factors that may predispose to the development of PPF.

Management of Periprosthetic Joint Infection After Total Hip Arthroplasty Using a Custom Made Articulating Spacer (CUMARS); the Exeter Experience

Periprosthetic joint infection (PJI) after THA is a major complication with an incidence of 1%–3%. We report our experiences with a technique using a custom-made articulating spacer (CUMARS) at the first of two-stage treatment for PJI. This technique uses widely available all-polyethylene acetabular components and the Exeter Universal stem, fixed using antibiotic loaded acrylic cement. Seventy-six hips were treated for PJI using this technique. Performed as the first of a two-stage procedure, good functional results were commonly seen, leading to postponing second stage indefinitely with retention of the CUMARS prosthesis in 34 patients. The CUMARS technique presents an alternative to conventional spacers, using readily available components that are well tolerated, allowing weight bearing and mobility, and achieving comparable eradication rates.     

“钢筋混凝土”在髋臼重建中的应用

背景：在全髋关节置换中,髋臼缺损很常见,为重建一个稳定、牢固的髋臼,置换过程中往往需要髋臼的重建。目的：探讨螺钉固定钛网结合骨水泥型髋臼杯在髋臼重建中应用的早期疗效。方法：纳入采用螺钉固定钛网结合骨水泥型臼杯重建髋臼髋关节翻修的患者23例。疼痛病史1-3年,术前Harris评分20-48分,平均34分。重建后采用X射线平片评价髋臼假体松动标准进行影像学评价及Harris评分定期随访。结果与结论：重建后随访1-3年,平均随访24个月,无脱失。重建后3个月Harris评分较重建前显著增高,置换后2年髋关节活动度较置换前显著增高,差异均有显著性意义（P〈0.05）。2例患者下肢不等长,1例患者下蹲后出现脱位,保守治疗后好转。最后一次随访时无早期感染、脱位,无盆腔不适感。重建后随访影像学上显示无髋臼假体松动与移位,未发生钛网断裂。说明螺钉固定钛网结合骨水泥型髋臼杯治疗65岁以上髋关节翻修患者其近期疗效十分满意,后期疗效还有待于进一步随访观察。     

人工股骨头置换术治疗高龄股骨粗隆间不稳定型骨折

目的:探讨高龄股骨粗隆间不稳定型骨折的人工股骨头置换术治疗的适应证及围手术期处理的注意事项。方法:高龄患者32例,男14例,女18例;年龄78~92岁,平均84.5岁,进行手术前基础疾病干预后采用小切口骨水泥型双极人工股骨头置换术治疗。结果:术后随访1~3.5年,按Harris评分系统评定,优(90~100分)12例,良(80~89分)14例,可(70~79分)4例,差(<70分)2例。优良率81.25%。结论:高龄股骨粗隆间不稳定型骨折,在控制好基础疾病后采用小切口骨水泥型双极人工股骨头置换术治疗具有卧床时间短,早期康复,关节功能恢复较好较快之优势。     

骨水泥型长柄人工股骨头置换治疗老年股骨转子间型骨折23例临床分析

目的 评价应用骨水泥型长柄双极股骨头置换治疗老年患者不稳定粗隆间骨折的方法及疗效.方法 回顾分析应用加长柄双极股骨头置换治疗老年不稳定粗隆间骨折23例.骨折类型按Evans-Jenson分类,ⅡA:6例,ⅡB:11例,Ⅲ:6例.结果 随访期间1例死于慢性支气管炎呼吸衰竭.所有患者均获随访,随访时间6～30月,平均15月,获得随访的患者中无关节脱位,人工假体均无松动、下沉及断裂.最后一次随访时Harris评分平均为84.8分.结论 骨水泥型加长柄双极股骨头置换治疗高龄患者股骨粗隆间不稳定骨折是一种效果确切的方法.     

可调性Cem-Ostetic^TN人工骨浆和自体富血小板血浆复合物修复骨不连的实验研究

目的探讨复合富血小板血浆（PRP）和可调性Cem-Ostetic^TM人工骨浆对管状骨骨不连的修复作用。方法新西兰大白兔28只,在双侧前臂桡骨中上段截除1．5cm骨段（包括骨膜）,骨断端用骨蜡封闭髓腔,制成骨不连模型。取其中24只,一侧桡骨作实验侧,骨不连处填入复合PRP的人工骨浆;另一侧为对照侧,仅填人人工骨浆,另外4只作为空白对照组。分别在术后第2、4、8和12周通过大体观察、X线片、组织学及生物力学检测等手段观察桡骨愈合情况。结果术后第2周,实验侧和对照侧的新生纤维组织和骨组织均主要集中在截骨端,实验侧新生组织略多于对照侧。第4、8周,实验侧人工骨表面及孔隙内被大量新生骨组织覆盖和填充,人工骨与宿主骨桥接紧密;对照侧的新生骨组织主要限于人工骨两端,且相对实验侧较幼稚。第12周,实验侧骨缺损完全修复,髓腔再通;对照侧断端间新骨形成骨桥,但尚未见到髓腔再通,空白对照组均未见骨痂。结论复合富血小板血浆（PRP）和可调性Cem-Ostetic^TM人工骨浆对管状骨骨不连的修复有促进作用。     

Despite Improved Survivorship of Uncemented Fixation in Total Knee Arthroplasty for Osteoarthritis,Cemented Fixation Remains the Gold Standard: An Analysis of a National Joint Registry

BackgroundTotal knee arthroplasty (TKA) numbers are increasing worldwide. While cement fixation for both femoral and tibial components is commonly used, alternatives include hybrid and uncemented TKAs. This study aimed to evaluate survivorship, revision rates, and patient-reported outcomes for cemented, hybrid, and uncemented TKAs using New Zealand Joint Registry (NZJR) data.MethodsNZJR data relating to all TKAs performed during the 19 years up to the end of December 2017 were analyzed. Outcomes were assessed using prosthesis survivorship data (including reasons for revision) and Oxford scores at 6 months, 5 years, and 10 years postoperatively.ResultsA total 96,519 primary TKAs were performed during the period examined. Most (91.5%) were fully cemented with 4.8% hybrid and 3.7% uncemented. Mean Oxford scores at 6 months were highest in cemented and lowest in uncemented TKAs (P < .001). However, this was not clinically significant. There was no difference at 5 or 10 years. Ten-year survival rates were 97%, 94.5%, and 95.8% for cemented, uncemented, and hybrid TKAs, respectively. Revision rates were 0.47, 0.74, and 0.52 per 100 component years for cemented, uncemented, and hybrid prostheses, respectively. The revision rate for uncemented prostheses compared with cemented was higher (P < .001). When stratified by age group, there were differences in survival rates between cemented and uncemented groups (P = .001) and hybrid and uncemented groups (P = .038) in patients aged <55 years; between cemented and uncemented groups in those aged 55-64 years (P = .031); and between cemented and hybrid groups in those aged >75 years (P = .004).ConclusionUncemented TKAs had similar patient-reported outcomes but higher revision rates and worse survivorship compared with hybrid or fully cemented TKAs.