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全膝关节置换术周围的磨损与骨溶解

Wear and osteolysis around total knee arthroplasty.

作者信息

Naudie Douglas D R, Ammeen Deborah J, Engh Gerard A, Rorabeck Cecil H

机构信息

Division of Orthopaedic Surgery, University of Western Ontario, London Health Sciences Centre, London, ON, Canada.

出版信息

J Am Acad Orthop Surg. 2007 Jan;15(1):53-64. doi: 10.5435/00124635-200701000-00006.

Abstract

Osteolysis induced by wear debris of ultra-high-molecular-weight polyethylene has emerged as a significant problem after total knee arthroplasty. The generation of polyethylene wear and the development of osteolysis around total knee arthroplasty are caused by a combination of patient, implant, and surgical factors. Activity level over time may be the most important patient factor affecting the loads placed on a total knee replacement, but it is the most difficult to manage. Multiple factors related to the manufacturing of the polyethylene implant influence the extent of wear, and surgeons should be cautious in considering enhanced polyethylenes pending results of further investigations. The optimal design of the articular bearing surface remains controversial but needs to be considered with respect to the stresses imparted on component-bone and modular tibial backside interfaces. Surgical factors, including restoration of alignment and ligament balance, are important for long-term durability of the implant. Methods of measuring the wear of total knee implants are still evolving. Thus, when confronted with a worn total knee implant and developing osteolysis, the surgeon should consider each of these factors in selecting the best management option to eliminate the source of debris and minimize the potential for wear and osteolysis following revision.

摘要

超高分子量聚乙烯磨损颗粒诱导的骨溶解已成为全膝关节置换术后的一个重要问题。全膝关节置换术后聚乙烯磨损的产生以及骨溶解的发展是由患者、植入物和手术因素共同导致的。随着时间推移的活动水平可能是影响全膝关节置换负荷的最重要患者因素,但也是最难控制的因素。与聚乙烯植入物制造相关的多个因素会影响磨损程度,在进一步研究结果出来之前,外科医生在考虑使用增强型聚乙烯时应谨慎。关节轴承表面的最佳设计仍存在争议,但需要考虑其施加在组件 - 骨和模块化胫骨后侧界面上的应力。包括对线恢复和韧带平衡在内的手术因素对植入物的长期耐久性很重要。测量全膝关节植入物磨损的方法仍在不断发展。因此,当面对磨损的全膝关节植入物并出现骨溶解时,外科医生在选择最佳处理方案以消除磨损颗粒来源并将翻修后磨损和骨溶解的可能性降至最低时,应考虑上述每一个因素。

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