Thadani P J, Vince K G, Ortaaslan S G, Blackburn D C, Cudiamat C V
Kerlan-Jobe Orthopaedic Clinic, Anaheim, CA 92806, USA.
Clin Orthop Relat Res. 2000 Nov(380):17-29. doi: 10.1097/00003086-200011000-00004.
The Insall-Burstein Posterior Stabilized knee prosthesis (Insall-Burstein I), developed at The Hospital for Special Surgery in 1978, has a metal-backed nonmodular tibial component. The polyethylene articular surface was directly molded. The purpose of the current study was to evaluate long-term wear with this design. The first 100 total knee arthroplasties (86 patients) performed by the senior author were followed prospectively. The average age of the patients at the time of surgery was 69.7 years (range, 45-89 years). The primary diagnoses were osteoarthritis in 77 knees (66 patients), inflammatory arthritis in 17 knees (14 patients), and posttraumatic arthritis in the remaining six knees (six patients). Thirty-eight knees (35 patients) had varus angulation, 14 knees (13 patients) had valgus angulation, and 48 knees (40 patients) had a 0 degrees to 10 degrees tibiofemoral angle preoperatively. All patients were evaluated at 10 to 12 years followup. Knee Society scores and radiographs were obtained. Thirty-six knees were in 30 patients who had died and two knees were in two patients who were infirm. Telephone evaluation only was available for eight knees (seven patients), leaving 54 knees (47 patients) for direct clinical and radiographic evaluation. No patients were lost to followup. The average Knee Society clinical score at latest followup was 91.6 points. The average function score was 69 points. One knee arthroplasty failed because of tibial loosening, one failed because of patella wear and fracture, two failed because of sepsis, and two failed because of nonspecific pain. There were seven patella fractures (7%) in the 100 knees. One of the fractures resulted in a total knee revision (noted above), two resulted in patellar component revision, and another resulted in patellar component removal. The remaining three patella fractures were discovered incidentally and were asymptomatic. There were no patellar dislocations. At long-term radiographic analysis, valgus alignment averaged 6 degrees (range, 0 degrees-11 degrees). Polyethylene wear averaged 0.40 mm. There was no catastrophic wear of tibial polyethylene. Thirty-two knees in 32 patients (65%) had radiolucencies in at least one zone; no lucency filled a zone, and none was wider than 2 mm. The absence of clinically significant tibial polyethylene wear at long-term followup is of particular interest. The performance of the molded, nonmodular polyethylene articulation is encouraging and needs to be analyzed critically against the more widely used machined, modular components used today.
1978年由特种外科医院研发的Insall-Burstein后稳定型膝关节假体（Insall-Burstein I型），其胫骨部件为金属背衬且不可模块化。聚乙烯关节面是直接模制而成。本研究的目的是评估这种设计的长期磨损情况。对资深作者实施的首批100例全膝关节置换术（86例患者）进行了前瞻性随访。手术时患者的平均年龄为69.7岁（范围45 - 89岁）。主要诊断为77膝（66例患者）骨关节炎、17膝（14例患者）炎性关节炎以及其余6膝（6例患者）创伤后关节炎。术前38膝（35例患者）有内翻畸形，14膝（13例患者）有外翻畸形，48膝（40例患者）胫股角为0度至10度。所有患者均在随访10至12年时接受评估。获取了膝关节协会评分及X线片。36膝属于已死亡的30例患者，2膝属于身体虚弱的2例患者。仅通过电话评估了8膝（7例患者），其余54膝（47例患者）接受了直接临床及X线评估。无患者失访。最新随访时膝关节协会临床评分平均为91.6分。功能评分平均为69分。1例膝关节置换术因胫骨松动失败，1例因髌骨磨损及骨折失败，2例因感染失败，2例因非特异性疼痛失败。100膝中有7例（7%）发生髌骨骨折。其中1例骨折导致全膝关节翻修（如上文所述），2例导致髌骨部件翻修，另1例导致髌骨部件移除。其余3例髌骨骨折为偶然发现且无症状。无髌骨脱位。在长期X线分析中，外翻对线平均为6度（范围0度 - 11度）。聚乙烯磨损平均为0.40毫米。胫骨聚乙烯未出现灾难性磨损。32例患者的32膝（65%）至少在一个区域出现透光线；无透光线填满一个区域，且无一宽于2毫米。长期随访时未出现具有临床意义的胫骨聚乙烯磨损这一情况尤其值得关注。模制的、不可模块化的聚乙烯关节面的表现令人鼓舞，需要与当今更广泛使用的机械加工的、模块化部件进行严格分析对比。
