Brumby Scott A, Carrington Richard, Zayontz Shay, Reish Tim, Scott Richard D
Wakefield Orthopaedic Clinic, Adelaide, Australia.
J Arthroplasty. 2003 Sep;18(6):809-12. doi: 10.1016/s0883-5403(03)00330-9.
Unicompartmental knee arthroplasty has gained popularity recently as a treatment for unicompartmental tibiofemoral non inflammatory arthritis. Tibial plateau stress fracture after unicompartmental knee arthroplasty (UKA) through guide pin holes placed in the proximal tibia has not been previously reported. In each case in this report, the compressive strength of the proximal tibia was reduced by the drilling of multiple holes for the placement of guide pins and holes for the lugs of the tibia component resulting in fracture through these holes between 3 and 18 weeks (median 8 weeks) post-operatively. In at least one case, the medial tibial cortex was violated by one pin. All cases required revision total knee arthroplasty (TKA). It is intuitive to caution against the use of multiple guide holes in the proximal tibia in UKA. If 3 or more hole pins are deemed necessary, surgeons must be aware of the potential for stress fracture and monitor patients accordingly. Peripheral pins that infract the medial tibial cortex should also be avoided.
单髁膝关节置换术作为治疗单髁胫股非炎性关节炎的一种方法，近年来越来越受欢迎。通过在胫骨近端放置导针孔进行单髁膝关节置换术（UKA）后发生胫骨平台应力性骨折的情况此前未见报道。在本报告的每个病例中，由于为放置导针钻了多个孔以及为胫骨部件的凸耳钻了孔，导致胫骨近端的抗压强度降低，从而在术后3至18周（中位时间8周）通过这些孔发生骨折。至少有1例，一枚导针穿透了胫骨内侧皮质。所有病例均需翻修全膝关节置换术（TKA）。在UKA中，谨慎使用胫骨近端的多个导针孔是很直观的。如果认为需要3枚或更多孔的导针，外科医生必须意识到应力性骨折的可能性，并相应地对患者进行监测。也应避免穿透胫骨内侧皮质的周边导针。
