Mauerhan David R
Department of Orthopaedic Surgery, Carolinas Medical Center, PO Box 32861, Charlotte, NC 28232 USA.
J Arthroplasty. 2003 Oct;18(7):942-5. doi: 10.1016/s0883-5403(03)00333-4.
Fracture of the tibial post in posterior cruciate-substituting total knee arthroplasty has been described in several reports. Additionally, wear of the cam and post mechanism, including polyethylene debris generation and osteolysis of the peri-implant bone stock as been described. Users of a cam and post type posterior stabilized total knee arthroplasty are also familiar with the rare occurrence of the "patellar clunk syndrome," in which suprapatellar fibrous nodular scar tissue becomes entrapped in the intercondylar box of the femoral component as the knee extends from the flexed position and produces a palpable and sometimes audible "clunk." This condition is easily managed with arthroscopic excision of the scar tissue. A small series of 5 patients who presented with symptoms of a patellar clunk syndrome but who in fact had a fracture of the tibial post causing subluxation of the femur on the tibia is presented. The diagnostic characteristics that will help differentiate between the 2 problems is highlighted.
后交叉韧带置换型全膝关节置换术中胫骨柱骨折已在多篇报道中被提及。此外，也有关于凸轮和胫骨柱机制磨损的报道，包括聚乙烯碎屑产生以及植入物周围骨量的骨质溶解。使用凸轮和胫骨柱型后稳定型全膝关节置换术的用户也熟知罕见的“髌骨卡顿综合征”，即在膝关节从屈曲位伸展时，髌上纤维结节状瘢痕组织被困于股骨部件的髁间盒内，产生可触及甚至有时可听到的“卡顿”声。这种情况通过关节镜切除瘢痕组织很容易处理。本文报告了一小系列5例患者，他们表现出髌骨卡顿综合征的症状，但实际上是胫骨柱骨折导致股骨在胫骨上半脱位。文中强调了有助于区分这两种问题的诊断特征。
