Macmull S, Bartlett W, Miles J, Blunn G W, Pollock R C, Carrington R W J, Skinner J A, Cannon S R, Briggs T W R
The Royal National Orthopaedic Hospital, Stanmore Middlesex HA7 4LP, United Kingdom.
Knee. 2010 Dec;17(6):403-6. doi: 10.1016/j.knee.2009.11.004. Epub 2009 Dec 8.
Polymethyl methacrylate spacers are commonly used during staged revision knee arthroplasty for infection. In cases with extensive bone loss and ligament instability, such spacers may not preserve limb length, joint stability and motion. We report a retrospective case series of 19 consecutive patients using a custom-made cobalt chrome hinged spacer with antibiotic-loaded cement. The "SMILES spacer" was used at first-stage revision knee arthroplasty for chronic infection associated with a significant bone loss due to failed revision total knee replacement in 11 patients (58%), tumour endoprosthesis in four patients (21%), primary knee replacement in two patients (11%) and infected metalwork following fracture or osteotomy in a further two patients (11%). Mean follow-up was 38 months (range 24-70). In 12 (63%) patients, infection was eradicated, three patients (16%) had persistent infection and four (21%) developed further infection after initially successful second-stage surgery. Above knee amputation for persistent infection was performed in two patients. In this particularly difficult to treat population, the SMILES spacer two-stage technique has demonstrated encouraging results and presents an attractive alternative to arthrodesis or amputation.
聚甲基丙烯酸甲酯间隔物常用于分期翻修膝关节置换术治疗感染。在存在广泛骨丢失和韧带不稳定的情况下，此类间隔物可能无法维持肢体长度、关节稳定性和活动度。我们报告了一个回顾性病例系列，连续19例患者使用了定制的含抗生素骨水泥的钴铬铰链式间隔物。“SMILES间隔物”用于11例（58%）因全膝关节置换翻修失败导致慢性感染并伴有明显骨丢失、4例（21%）肿瘤假体、2例（11%）初次膝关节置换以及另外2例（11%）骨折或截骨术后感染金属植入物的患者的一期翻修膝关节置换术治疗慢性感染。平均随访38个月（范围24 - 70个月）。12例（63%）患者感染得到根除，3例（16%）患者持续感染，4例（21%）在最初成功的二期手术后出现进一步感染。2例患者因持续感染接受了膝上截肢。在这个特别难以治疗的人群中，SMILES间隔物两阶段技术已显示出令人鼓舞的结果，为关节融合术或截肢术提供了有吸引力的替代方案。
