Kobori M, Kamisato S, Yoshida M, Kobori K
Seirei Mikatahara Hospital, 3453 Mikatahara-cho, Hamamatsu, Shizuoka 433-8558, Japan.
J Orthop Sci. 2000;5(5):436-8. doi: 10.1007/s007760070020.
Of 38 Miller/Galante-I total knee prostheses implanted between 1987 and 1990, 20 (53%) were revised. Failed metal-backed patella (15 knees; 40%) was the most frequent reason for revision. In most patients, the components were found well fixed to bone. The purpose of this study was to describe the revision technique we used for failed metal-backed patella. Total revision of all components would be ideal. However, removal of all components results in large bone loss, large blood loss, and a longer operation time. Because of the patients' relatively old age (78.7 years), less demanding activities of daily life (ADL), and the lower body weight of the Japanese patient, we chose a less invasive approach. The revision technique had the following features: (1) the grooved femoral component was not replaced, (2) the failed patellar component was replaced by an all-polyethylene patella, (3) synovectomy was performed, and (4) realignment of patellar tracking was done by lateral release and medial imbrication of the quadriceps mechanism. The mean follow-up after revision was 2 years, 4 months, and good short-term results were obtained. This less invasive approach would be beneficial for elderly patients whose ADL are less demanding.
在1987年至1990年间植入的38例Miller/Galante-I全膝关节假体中，20例（53%）进行了翻修。金属背衬髌骨失败（15膝；40%）是最常见的翻修原因。在大多数患者中，假体组件与骨固定良好。本研究的目的是描述我们用于失败的金属背衬髌骨的翻修技术。对所有组件进行全面翻修是理想的。然而，移除所有组件会导致大量骨质丢失、大量失血和更长的手术时间。由于患者年龄相对较大（78.7岁）、日常生活活动（ADL）需求较低以及日本患者体重较轻，我们选择了一种侵入性较小的方法。该翻修技术具有以下特点：（1）带槽股骨组件未更换；（2）失败的髌骨组件被全聚乙烯髌骨取代；（3）进行了滑膜切除术；（4）通过外侧松解和股四头肌机制内侧重叠来重新调整髌骨轨迹。翻修后的平均随访时间为2年4个月，获得了良好的短期效果。这种侵入性较小的方法对ADL需求较低的老年患者有益。
