Proximally coated ingrowth prostheses. A review.
Proximally coated ingrowth prostheses. A review.
复制标题
近端涂层向内生长假体。
DOI：
10.1097/00003086-199711000-00015
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发表时间：
1997
影响因子：
4.2
通讯作者：
D. Hungerford
中科院分区：
文献类型：
--
作者：
M A Mont;D. Hungerford
近端涂层股骨假体用于非骨水泥全髋关节置换术是在20世纪80年代初构思出来的，是为了应对广泛涂层装置中出现的近端应力屏蔽现象。这项研究的主要目的是根据目前使用的设备的结果分析这些假体是否仍然是可行的选择，同时详细说明第一代设备遇到的问题。回顾了这些设计的演变以及它们是如何针对早期问题进行修改的。最初的迭代不太成功，因为它们有时不稳定，存在大腿疼痛和进行性骨溶解的问题。然而，临床经验超过5年的第二代设备似乎很有希望，并且显示出非常低的无菌松动率(1%-3%)，以及较少的大腿疼痛(在大多数研究中低于5%)。读者还必须等待更长期的研究，才能知道进行性骨溶解是否会是一个问题。这些令人鼓舞的中期结果可以归功于改进的几何结构、器械和技术，确保了初始种植体的稳定性。近端的涂层必须是圆周的，以密封骨干不受碎屑的影响。在加入了针对早期器械重大故障的设计变化后，只要实现了环向涂层和刚性初始稳定性的双重要求，非骨水泥股骨柄近端涂层的概念似乎是可行的。
Proximally coated femoral components for cementless total hip replacement were conceived in the early 1980s in response to the proximal stress shielding that was seen with extensively coated devices. The main purpose of this study was to analyze whether these prostheses remain viable options based on the results of presently used devices, while detailing the problems encountered with first generation devices. The evolution of these designs and how they were modified in response to early problems, was reviewed. Initial iterations were less successful because they were sometimes not stable, had problems with thigh pain, and progressive osteolysis. However, second generation devices with greater than 5 years clinical experience seem promising and have shown very low aseptic loosening rates (1%-3%), and less thigh pain (under 5% in most studies). The reader still must await longer term studies to know whether progressive osteolysis will be a problem. These encouraging midterm results can be attributed to improved geometry, instruments, and technique which ensure initial implant stability. Proximal coating must be circumferential, to seal the diaphysis from were debris. After incorporating design changes in response to the significant failures of early devices, the concept of proximal coating for cementless femoral stems seem viable, as long as the twin requirements of circumferential coating and rigid initial stability are realized.