衬垫置换和植骨：治疗稳定型 TKA 磨损和松解的罕见选择。
Liner exchange and bone grafting: rare option to treat wear & lysis of stable TKAs.
机构信息
University of Iowa, 200 Hawkins Drive, UIHC, 01029 JPP, Iowa City, IA 52242, USA.
出版信息
Clin Orthop Relat Res. 2011 Jan;469(1):154-9. doi: 10.1007/s11999-010-1521-3.
BACKGROUND
Liner exchange and bone grafting are commonly performed for wear and osteolysis around well-fixed modular acetabular components that otherwise would require structural allografting and revision THA. However, liner exchange in the face of substantial lysis around TKA has been performed rarely with reports of failure rates of up to 25% at 3 year followup.
QUESTIONS/PURPOSES: We therefore evaluated the technique of liner exchange and bone grafting for cases of wear and extensive osteolysis around TKAs in which the components were well-fixed and well-aligned to determine (1) rerevision rates; (2) fate of the bone graft; (3) radiographic loosening rates; and (4) functional scores.
METHODS
We retrospectively reviewed 22 patients (25 knees) who underwent revision TKA with exchange of the modular polyethylene insert and bone grafting in cases with well-fixed components and large areas of osteolysis (up to 54 cm(2) on a single projection) at the time of revision. The average area of osteolysis was 21 cm(2) and 10 cm(2) on the AP projection of the femur and tibia, respectively. On the lateral projection, the average area of osteolysis for the femur and tibia was 22 cm(2) and 9.3 cm(2). Minimum clinical and radiographic followup was 22 and 22 months (average, 61 and 59; range, 22-142 and 22-130, respectively).
RESULTS
One of the 25 knees was revised for aseptic loosening or recurrence of osteolysis. On radiographs, 84.6% and 70% of femoral and tibial osteolytic lesions, respectively, showed evidence of complete or near complete graft incorporation. The remaining lesions showed evidence of partial graft incorporation with the exception of one tibial lesion, which was in the revised case. All other components were well fixed with no evidence of radiographic loosening.
CONCLUSIONS
In this selected series of cases with extensive osteolysis around well-fixed and well-aligned TKAs, liner exchange and bone grafting provided durable midterm results with extensive graft incorporation.
LEVEL OF EVIDENCE
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
背景
对于固定良好的模块化髋臼组件周围因磨损和骨溶解而导致的问题，通常采用更换衬垫和植骨的方法进行处理，否则就需要进行结构性同种异体移植和翻修全髋关节置换术。然而，在 TKA 周围有大量骨溶解的情况下，更换衬垫的操作很少见，据报道，在 3 年的随访中，其失败率高达 25%。
问题/目的：因此，我们评估了在固定良好、对线良好的 TKA 周围因磨损和广泛骨溶解而进行衬垫更换和植骨的技术，以确定：(1)再次翻修率；(2)植骨的结局；(3)影像学松动率；(4)功能评分。
方法
我们回顾性分析了 22 例（25 膝）患者，这些患者在翻修时存在固定良好的组件和大面积骨溶解（单投影最大可达 54cm2），行翻修 TKA 并更换模块化聚乙烯衬垫和植骨。平均骨溶解面积为股骨和胫骨的 AP 投影分别为 21cm2 和 10cm2。在侧位投影中，股骨和胫骨的平均骨溶解面积分别为 22cm2 和 9.3cm2。最小临床和影像学随访时间为 22 和 22 个月（平均 61 和 59 个月；范围分别为 22-142 个月和 22-130 个月）。
结果
25 个膝关节中有 1 个因无菌性松动或骨溶解复发而再次翻修。在影像学上，分别有 84.6%和 70%的股骨和胫骨骨溶解病变显示出完全或接近完全植骨融合的证据。其余病变显示出部分植骨融合的证据，除了 1 例胫骨病变是在翻修病例中。所有其他组件均固定良好，无影像学松动的证据。
结论
在这一系列选定的、固定良好且对线良好的 TKA 周围有广泛骨溶解的病例中，更换衬垫和植骨提供了耐用的中期结果，并实现了广泛的植骨融合。
证据水平
IV 级，治疗性研究。有关证据水平的完整描述，请参见作者指南。
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