Zusammenfassung
Fragestellung: Die retrograde Zementapplikation wird heutzutage als integraler Bestandteil moderner femoraler Zementiertechnik angesehen. Sowohl die Druckentwicklung als auch die schnelle Zementapplikation reduzieren das Risiko für Einblutungen am Zement-Knochen Interface und Zementlaminationen. In diesem Zusammenhang hat die Funktion der Zementpistole bisher wenig Beachtung gefunden. Methode: Wir untersuchten in unserer Studie die Handhabung von vier verschiedenen Zementapplikationssystemen (Syringe®-, Vaku-Mix®-, Optivac®- und MixOR®-System). Um die Zementviskosität als weitere Variable zuzulassen, wurden in jedem System sechs verschiedene Knochenzemente getestet (Palacos® R, Palamed® G®, CMW 1 Radiopak®, CMW 2000®, Simplex® P, VersaBond®). Wir registrierten die Eigenschaften der Zementpistolen hinsichtlich Handhabung und Effektivität und bestimmten die Zementaustreibungszeiten und die maximalen Zementapplikationsgeschwindigkeiten aller möglichen Kombinationen von Mischsystem und Knochenzement. Ergebnisse: Die schnellste Zementapplikation konnte mit dem Vaku-Mix®-System und der dazugehörigen Zementpistole (Mark III) erreicht werden. Im Hinblick auf den Zementtyp erzielten VersaBond® und vorgekühlter Palacos® aufgrund ihrer reduzierten Viskosität signifikant kürzere Austreibungszeiten als die meisten der anderen Zemente. Schlussfolgerung: Unserer Ergebnisse zeigen signifikante Unterschiede in der Effektivität von üblichen Zementapplikationssystemen, die im klinischen Alltag zur Anwendung kommen. Verbesserte mechanische Applikationspistolen wären wünschenswert.
Abstract
Aim: Retrograde cement application is considered an integral part of the modern femoral cementing technique. Both pressurisation and rapid cement application reduce the risk of interface bleeding and blood laminations. In this context cement gun performance has received little attention. Method: In our study we examined the handling characteristics of four different cement delivery systems (Syringe®, Vaku-Mix®, Optivac® and MixOR®-System). To allow for cement viscosity as another variable, six different bone cements (Palacos® R, Palamed G®, CMW 1 Radiopak®, CMW 2000®, Simplex® P, VersaBond®) were used with each system. We recorded cement gun performance and measured extrusion times and maximum cement delivery speeds of all possible combinations (gun/mixing system plus cement type). Results: The fastest cement application could be achieved with the Vaku-Mix® cement delivery system and the corresponding cement gun (Mark III). With regard to cement type, VersaBond® and prechilled Palacos® yielded significantly shorter extrusion times than most of the other cements due to their lower viscosities. Conclusion: Our results have shown significantly different efficacies of commonly used cement delivery systems/guns in clinical routine. Improved systems should be provided by the suppliers.
Schlüsselwörter
Hüfttotalendoprothese - Zementpistole - zementiert - Viskosität - Zementapplikation
Key words
Total hip replacement - cement gun - cemented - viscosity - cement application
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PD Dr. med. S. J. Breusch
Stiftung Orthopädische Universitätsklinik Heidelberg
Schlierbacher Landstraße 200 a
69118 Heidelberg
Phone: 06221-969245
Fax: 06221-969245
Email: steffen.breusch@urz.uni-heidelberg.de
