Senior Colin J, da Assunção Ruy E, Barlow Ian W
Arch Orthop Trauma Surg. 2008 Jul;128(7):683-7. doi: 10.1007/s00402-007-0386-8. Epub 2007 Jul 6.
The demand for revision and salvage procedures after knee arthroplasty is increasing as the number of primary procedures increases. Surgical salvage techniques when revision arthroplasty is contra-indicated include above knee amputation and arthrodesis. The results of arthrodesis are functionally superior to those of amputation but not all techniques of arthrodesis are associated with good results.
We present a single surgeon series of 14 consecutive patients who underwent arthrodesis of the knee with a customised intramedullary coupled nail (Mayday arthrodesis nail, Orthodesign Ltd, UK). All patients had a failed knee arthroplasty due to persistent sepsis. Pre-operative scaled radiographs were used to design and manufacture a custom-made implant for each patient. An identical surgical technique and post-operative rehabilitation regime were used in each case.
The mean hospital stay was 12 days (range 6-24). Union was achieved in all but one patient at a mean of 4 months (range 3-10). One diabetic patient required subsequent above knee amputation for infected non-union. Two other patients had significant transient complications.
We have found that the Mayday nail offers a straightforward, reproducible surgical option for difficult salvage surgery. Good results have been obtained in the majority of cases, avoiding the devastating consequences of above knee amputation.
随着初次膝关节置换手术数量的增加，膝关节置换术后翻修和挽救手术的需求也在上升。当翻修关节成形术为禁忌时，手术挽救技术包括膝上截肢和关节融合术。关节融合术的结果在功能上优于截肢术，但并非所有关节融合技术都能带来良好的效果。
我们展示了由同一位外科医生连续为14例患者进行膝关节融合术的系列病例，使用的是定制的髓内连接钉（“五月天”关节融合钉，英国Orthodesign有限公司）。所有患者均因持续性脓毒症导致膝关节置换失败。术前通过X线片为每位患者设计并制造定制植入物。每例手术均采用相同的手术技术和术后康复方案。
平均住院时间为12天（范围6 - 24天）。除1例患者外，其余患者均在平均4个月（范围3 - 10个月）时实现骨愈合。1例糖尿病患者因感染性骨不连随后接受了膝上截肢。另外2例患者出现了明显的短暂并发症。
我们发现“五月天”钉为困难的挽救手术提供了一种直接、可重复的手术选择。大多数病例都取得了良好的效果，避免了膝上截肢带来的严重后果。
