Lauge-Pedersen Henrik, Aspenberg Per
Department of Orthopaedics, University Hospital, Lund, Sweden.
Acta Orthop Scand. 2002 Apr;73(2):186-9. doi: 10.1080/000164702753671786.
Arthrodesis is usually performed with joint resection or at least with removal of cartilage. Our recent experience with successful fusion in all 11 rheumatoid ankles treated only with percutaneous fixation questions the necessity of debridement of the joint before arthrodesis. In this rabbit study we tested the hypothesis that joints fuse because of rigid fixation. 9 skeletally mature loop-ear dwarf female rabbits were operated on. With the knee in about 45 degrees of flexion, two 1.5 mm cortical screws were inserted through the patellofemoral joint in an anterior-posterior direction with the lag screw technique. 3 rabbits were excluded due to technical problems. Of the remaining 6 rabbits, 5 underwent bony fusion and 1 fibrous healing. Fusion was confirmed with Micro-CT in 2 cases and by histological examination in all 5 cases. In those 5 cases, bony fusion was seen in almost all areas with close contact. Therefore, fusion occurred not only in relation to the screws, but also between the screws and in the periphery of the patella. Our findings show that bony fusion can occur in a healthy joint without joint resection or debridement.
关节融合术通常通过关节切除术或至少切除软骨来进行。我们最近对11例仅采用经皮固定治疗的类风湿性踝关节成功融合的经验，对关节融合术前进行关节清创的必要性提出了质疑。在这项兔子研究中，我们测试了关节因刚性固定而融合的假设。对9只骨骼成熟的环耳侏儒雌性兔子进行了手术。将膝关节置于约45度屈曲位，采用拉力螺钉技术从前向后经髌股关节插入两枚1.5毫米皮质螺钉。3只兔子因技术问题被排除。在其余6只兔子中，5只实现了骨融合，1只实现了纤维愈合。2例通过微型计算机断层扫描（Micro-CT）证实融合，所有5例均通过组织学检查证实。在这5例中，几乎所有区域都可见紧密接触的骨融合。因此，融合不仅发生在螺钉周围，也发生在螺钉之间以及髌骨周边。我们的研究结果表明，在没有关节切除术或清创的健康关节中也可发生骨融合。
