Wiedel Jerome D
University of Colorado Health Sciences Center, Aurora, 80045-0510, USA.
Clin Orthop Relat Res. 2002 Nov(404):139-42. doi: 10.1097/00003086-200211000-00024.
Currently the most common indication for an arthrodesis of the knee is a failed infected total knee prosthesis. Other causes of a failed total knee replacement that might necessitate a knee fusion include aseptic loosening, deficient extensor mechanism, poor soft tissues, and Charcot joint. Techniques available for achieving a knee fusion are external fixation and internal fixation methods. The external fixation compression devices have been the most widely used for knee fusion and have been successful until the indications for fusion changed to mostly failed prosthetic knee replacement. With failed total knee replacement, the problem of severe bone loss became an issue, and the external fixation compression devices, even including the biplane external fixators, have been the least successful method reported for gaining fusion. The Ilizarov technique has been shown to achieve rigid fixation despite this bone loss, and a review of reports are showing high fusion rates using this method. Internal fixation methods including plate fixation and intramedullary nails have had the best success in gaining fusion in the face of this bone loss and have replaced external fixation methods as the technique of choice for knee fusion when severe bone loss is present. A review of the literature and a discussion of different fusion techniques are presented including a discussion of the influence that infection has on the success of fusion.
目前，膝关节融合术最常见的指征是感染性全膝关节置换失败。全膝关节置换失败可能需要进行膝关节融合的其他原因包括无菌性松动、伸肌机制缺陷、软组织条件差以及夏科关节。可用于实现膝关节融合的技术有外固定和内固定方法。外固定加压装置在膝关节融合中应用最为广泛，并且一直很成功，直到融合指征主要变为人工膝关节置换失败。对于全膝关节置换失败，严重骨丢失问题凸显，而外固定加压装置，甚至包括双平面外固定器，据报道是实现融合最不成功的方法。尽管存在骨丢失，伊利扎洛夫技术已被证明能实现坚强固定，对相关报告的综述显示使用该方法融合率很高。包括钢板固定和髓内钉在内的内固定方法在面对这种骨丢失时融合成功率最高，并且在存在严重骨丢失时已取代外固定方法成为膝关节融合的首选技术。本文对文献进行了综述，并讨论了不同的融合技术，包括感染对融合成功的影响。
