Einfluß der Raspeloberfläche auf die Zementpenetration an gepaarten Leichenfemora[1]

 

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Zusammenfassung.

Fragestellung: Die Zielsetzung dieser Studie war es, zu untersuchen, ob verschiedene Raspeloberflächen das Knochenlager und damit die Penetrationstiefe von Knochenzement unterschiedlich stark beeinflussen. Methode: An 15 Paaren humaner Leichenfemora wurde der Markraum mit standardisierter Präparationstechnik, links durch Raspeln mit gezahnter, handgeschlagener Reibefläche („chipped tooth”) und rechts durch Raspeln mit stufenweisen machinengefrästen Hinterschneidungen („diamond tooth”) Raspeln vorbereitet. Alle Präparate wurden nach Knochenreinigung mittels 1 Liter Jet-Lavage in speziell angefertigte Kunstoffzylinder eingegipst. Nach retrograder Zementapplikation erfolgte die Druckbeaufschlagung des Zementes mit einer konstanten Kraft von 3000 N. Die Mikroradiogramme von den spiegelbildlich identisch angefertigten horizontalen Sägeschnitten wurden mittels Bildanalyse morphometrisch ausgewertet. Ergebnisse: Die aufgezeichneten Druckkurvenverläufe waren bei allen Präparaten vergleichbar. Bezüglich Penetrationstiefe von Zement im spongiösen Lager fanden sich keine signifikanten Unterschiede zwischen den untersuchten Raspelgruppen. Dies war auf allen Schnittebenen der Fall. Schlußfolgerungen: Das entwickelte Modell erlaubt die Untersuchung einzelner Parameter, die die Zementeindringtiefe beeinflussen. Die Zementpenetration im mittels Jet-Lavage gereinigten Knochenlager am koxalen Femurende ist unabhängig von den untersuchten Raspeloberflächen.

Aim: The purpose of this investigation was to study two different broach surface designs with regard to cement penetration into human cancellous bone. Methods: In a cadaver study 15 paired human cadaver femora were prepared using broaches of identical geometry but different surface characteristics. All left femora were prepared using chipped toothed broaches, all right femora using diamond shaped broaches. Cancellous bone was irrigated with 1 liter pulsed lavage. The specimens were imbedded in specially designed pots. Bone cement was applied in a retrograde manner and subjected to a standard pressure protocol with a constant force of 3000 N. Radiographs were taken and horizontal sections were obtained at predefined levels using a diamond saw. Microradiographs were taken and analyzed using image analysis to assess cement penetration into cancellous bone. Results: Pressure curves recorded during cement pressurisation were comparable. The microradiographic evaluation revealed no significant morphometric differences in the different groups with regard to cement penetration into cancellous bone. These findings were similar in all sections obtained. Conclusions: A standardized model was developed allowing comparison of cement penetration into cancellous bone depending on bone preparation. In the presence of pulsed lavage there is no significant influence of broach surface characteristics on cement penetration into cancellous bone of the upper end of the femur.

1 Diese Studie wurde unterstützt von DePuy/Johnson & Johnson Orthopaedics, Howmedica und Biomet-Merck durch kostenfreie Zurverfügungstellung der verwendeten Sachmittel.

Literatur

1 Diese Studie wurde unterstützt von DePuy/Johnson & Johnson Orthopaedics, Howmedica und Biomet-Merck durch kostenfreie Zurverfügungstellung der verwendeten Sachmittel.

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Dr. med. Steffen Breusch

Abteilung Orthopädie IStiftung Orthopädische Universitätsklinik Heidelberg

Schlierbacher Landstr. 200a

69118 Heidelberg