Incavo S J, Lilly J W, Bartlett C S, Churchill D L
Department of Orthopaedics and Rehabilitation, The University of Vermont, College of Medicine, Burlington, USA.
J Arthroplasty. 2000 Oct;15(7):871-6. doi: 10.1054/arth.2000.9060.
Knee arthrodesis using an intramedullary nail has gained acceptance as treatment in difficult cases such as infection after total knee arthroplasty (TKA), neuropathic joint, and obesity. A retrospective review of 22 cases treated at our institution using an intramedullary nail for knee arthrodesis was performed. Deep infection after primary (11) or revision (6) TKA was the most common indication for this procedure. A long intramedullary nail was used in 3 cases, a long nail with a proximal interlocking screw was used in 6 cases, and a customized nail with a valgus bend and a proximal interlocking screw was used in 11 cases. A modular knee fusion nail was used in 1 case. Successful fusion occurred in all cases, although 4 patients required additional surgery. Average operative blood loss was 748 mL, and average time to union was 7 months. Shortening of the extremity averaged 3.2 cm. Tibiofemoral alignment was improved by using a customized valgus nail (average, 3.1 valgus; range, 1-5) when compared with a straight nail (average, 0.2 valgus; range, 3 varus to 3 valgus). No patient developed infection in the hip or ankle region as a result of the long intramedullary nail. Intramedullary nailing is an excellent technique for knee arthrodesis in difficult cases. A customized proximal interlocking nail with 5 degrees to 7 degrees of valgus and 5 degrees of anterior angulation improves tibiofemoral alignment and is straightforward to insert or extract should it be necessary. Stability and pain relief are rapid, and the fusion rate is maximized.
使用髓内钉进行膝关节融合术已被广泛接受，用于治疗诸如全膝关节置换术（TKA）后感染、神经性关节病和肥胖症等疑难病例。我们对本机构采用髓内钉治疗膝关节融合术的22例病例进行了回顾性研究。初次（11例）或翻修（6例）TKA后的深部感染是该手术最常见的适应证。3例使用长髓内钉，6例使用带近端锁定螺钉的长钉，11例使用带外翻弯曲和近端锁定螺钉的定制钉。1例使用模块化膝关节融合钉。所有病例均成功融合，尽管4例患者需要再次手术。平均术中失血量为748 mL，平均愈合时间为7个月。肢体短缩平均为3.2 cm。与直钉（平均外翻0.2°；范围为内翻3°至外翻3°）相比，使用定制的外翻钉（平均外翻3.1°；范围为1°至5°）可改善胫股对线。没有患者因长髓内钉而在髋部或踝部区域发生感染。髓内钉固定术是治疗疑难病例膝关节融合术的一种优秀技术。带有5°至7°外翻和5°前倾角的定制近端锁定钉可改善胫股对线，并且在必要时插入或取出都很简单。稳定性和疼痛缓解迅速，融合率最大化。
