Dombroski Derek, Garino Jonathan, Lee Gwo-Chin
Department of Orthopedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA.
Orthopedics. 2009 Jun;32(6):443. doi: 10.3928/01477447-20090511-26.
Despite recent advances in cartilage regeneration and restoration procedures, isolated, large, full-thickness cartilage lesions in young patients continue to pose significant challenges to patients and orthopedic surgeons. Treatment options for this difficult problem have traditionally included arthrodesis, osteotomy, osteochondral allograft, and prosthetic reconstruction. We present a case of an adolescent patient with isolated idiopathic lateral tibial chondrolysis treated with a custom ceramic hemi-unicondylar hemiarthroplasty. Preoperatively, a 3-dimensional computed tomography scan of the patient's knee was obtained to begin manufacturing a conforming custom ceramic insert that would articulate between the tibial base plate and the patient's native lateral femoral cartilage. Through a lateral parapatellar approach, the tibial preparation was carried out using the Zimmer M/G unicompartmental knee system (Warsaw, Indiana), and the tibial base plate was cemented into position in the standard fashion. A custom, conforming, prefabricated ceramic insert (CeramTec, Memphis, Tennessee) was then inserted onto the tibial base plate. At 5-year follow-up, this salvage procedure was successful in relieving pain and restoring function in this young patient. There were no signs of implant loosening or lysis. Magnetic resonance imaging of the knee at last follow-up revealed that the cartilage thickness of the patient's lateral femoral condyle remained unchanged. Unicondylar hemiarthroplasty performed in patients with large unipolar lesions in the knee can provide durable and reliable pain relief. Ceramic is a viable material that can be considered for articulation with native cartilage.
尽管近年来软骨再生和修复手术取得了进展，但年轻患者中孤立的、大面积的全层软骨损伤仍然给患者和骨科医生带来重大挑战。针对这一难题的传统治疗选择包括关节融合术、截骨术、骨软骨异体移植和假体重建。我们报告一例青少年患者，采用定制陶瓷半髁半关节置换术治疗孤立性特发性胫骨外侧软骨溶解症。术前，对患者膝关节进行三维计算机断层扫描，以开始制造一个贴合的定制陶瓷衬垫，该衬垫将在胫骨基板和患者天然外侧股骨软骨之间形成关节连接。通过外侧髌旁入路，使用 Zimmer M/G 单髁膝关节系统（印第安纳州华沙）进行胫骨准备，并以标准方式将胫骨基板用骨水泥固定到位。然后将一个定制的、贴合的预制陶瓷衬垫（田纳西州孟菲斯市的 CeramTec）插入胫骨基板上。在 5 年的随访中，这种挽救性手术成功地缓解了这位年轻患者的疼痛并恢复了功能。没有植入物松动或溶解的迹象。最后一次随访时膝关节的磁共振成像显示，患者外侧股骨髁的软骨厚度保持不变。对膝关节有大的单极病变的患者进行单髁半关节置换术可以提供持久可靠的疼痛缓解。陶瓷是一种可行的材料，可考虑用于与天然软骨形成关节连接。
