Bierwagen U, Walter G, Hoffmann R
Septische Chirurgie, Berufsgenossenschaftliches Unfallkrankenhaus, Friedberger Landstraße 430, Frankfurt/Main.
Z Orthop Unfall. 2010 Sep;148(5):566-72. doi: 10.1055/s-0030-1249852. Epub 2010 Jul 19.
The number of total knee arthroplasties (TKA) has exploded in the industrialised countries in the last decade so it is inevitable that complications also rose. Persisting infection after exchange procedures sometimes cannot be cured other than by arthrodesis of the knee. Our aim was to study the results of this surgical intervention on the patients' quality of life.
Between 2001 and 2007 90 patients, mean age 69 years (range 20-88), underwent an arthrodesis of the knee. External fixation, compression nail and plate osteosynthesis were used to perform the procedure. In a retrospective cohort study we analysed patients' data comparing the different methods. Sixty patients were asked to fill out two questionnaires, SF-36 score and WOMAC score. Additionally, five free verbalised questions were used to ask for the functional outcome and quality of life.
According to the literature our results mark a change of practices over the years. In the last century the external fixation was the procedure of choice to stabilise the leg after implant-associated and post-traumatic infection. Since 2005 intramedullary compression nailing seems to have become superior (28 % - 100 %).
Our retrospective cohort study points to the tendency for compression nail arthrodesis after failed and infected TKA. It seems that patients can be mobilised earlier, feel less pain and have a better quality of life with this procedure. These trends need confirmation by prospective randomised studies.
在过去十年中，全膝关节置换术（TKA）的数量在工业化国家激增，因此并发症增加也在所难免。翻修手术后持续存在的感染有时除了膝关节融合术外无法治愈。我们的目的是研究这种手术干预对患者生活质量的影响。
2001年至2007年间，90例平均年龄69岁（范围20 - 88岁）的患者接受了膝关节融合术。采用外固定、加压钉和钢板内固定术来实施该手术。在一项回顾性队列研究中，我们分析了患者数据，比较了不同的方法。60例患者被要求填写两份问卷，即SF - 36评分和WOMAC评分。此外，还使用了5个自由回答的问题来询问功能结果和生活质量。
根据文献，我们的结果标志着多年来手术方式的变化。在上个世纪，外固定是处理植入物相关感染和创伤后感染后稳定腿部的首选手术方式。自2005年以来，髓内加压钉固定似乎已变得更具优势（28% - 100%）。
我们的回顾性队列研究指出了在失败和感染的全膝关节置换术后进行加压钉融合术的趋势。似乎采用这种手术方式患者能够更早活动，疼痛减轻，生活质量更高。这些趋势需要前瞻性随机研究来证实。
