Gore Donald R, Gassner Kyle
Department of Orthopedic Surgery, Medical College of Wisconsin, Milwaukee, USA.
J Knee Surg. 2003 Jul;16(3):165-7.
A retrospective review was conducted of 20 consecutive patients (10 men and 10 women) with failed total knee arthroplasty (TKA) who underwent arthrodesis using an intramedullary rod. Average patient age was 70.5 years. One patient was lost to follow-up, and the remaining 19 patients were evaluated an average of 4.5 years postoperatively (range: 1-24 years). Three patients without infections achieved a solid arthrodesis without complications. In 16 patients, the indication for fusion was an infection, and 12 of these patients had an uncomplicated postoperative course and achieved a solid arthrodesis. Of the remaining 4 patients, 1 required revision for a nonunion, 1 a skin graft, and 2 had recurrence of their infections in the postoperative period. Both patients had positive cultures at attempted arthrodesis. One patient underwent debridement at 3 months, and a solid fusion was obtained. The other patient required rod removal and currently has a nonunion, uses a brace, and is on suppressive antibiotic treatment. An intramedullary rod is the ideal fixation choice for knee arthrodesis in patients with a failed, noninfected TKA; however, in patients with an infection, the infection must be eradicated prior to rod use.
对20例连续接受全膝关节置换术（TKA）失败后使用髓内棒行关节融合术的患者（10例男性和10例女性）进行了回顾性研究。患者平均年龄为70.5岁。1例患者失访，其余19例患者在术后平均4.5年（范围：1 - 24年）接受评估。3例无感染的患者实现了牢固的关节融合且无并发症。16例患者的融合指征为感染，其中12例患者术后病程顺利并实现了牢固的关节融合。其余4例患者中，1例因骨不连需要翻修，1例需要植皮，2例在术后出现感染复发。这2例患者在尝试关节融合时培养结果均为阳性。1例患者在3个月时接受了清创术，并获得了牢固的融合。另1例患者需要取出髓内棒，目前存在骨不连，使用支具，并接受抑制性抗生素治疗。对于失败的、未感染的TKA患者，髓内棒是膝关节融合术的理想固定选择；然而对于感染患者，在使用髓内棒之前必须根除感染。
