聚乙烯材料质量影响翻修膝关节衬垫的生存率。
Polyethylene quality affects revision knee liner exchange survivorship.
机构信息
Anderson Orthopaedic Clinic, Anderson Orthopaedic Research Institute, PO Box 7088, Alexandria, VA 22307, USA.
出版信息
Clin Orthop Relat Res. 2012 Jan;470(1):193-8. doi: 10.1007/s11999-011-1997-5.
BACKGROUND
Options to treat patients with wear or osteolysis include full revision, partial (tibial or femoral) revision, and isolated polyethylene exchange. It is unclear whether one choice is superior to the other. Polyethylene quality reportedly influences the survivorship of primary TKA, but similar reports are not described for revision TKA.
QUESTIONS/PURPOSES: We compared the failure rate for the three procedures and the influence of polyethylene quality on failure.
PATIENTS AND METHODS
We retrospectively evaluated 123 patients with 135 TKAs in which wear or osteolysis was thought to have contributed to the need for surgery. Twenty-five percent had an isolated polyethylene exchange, 39% a single-component revision, and 36% a full revision. We determined survivorship of the revisions. The mean follow-up for the 123 patients was 6.2 years. Fifteen patients (16 knees, or 12%) were lost before 5-year evaluations leaving 108 patients (119 knees, or 88%) for comparison of rerevision rates.
RESULTS
Five-year survivorship was similar for all three procedures: 82% ± 14% for polyethylene exchange, 89% ± 8% for partial revision, and 88% ± 10% for a full revision. Polyethylene sterilization had the strongest influence on rerevision. Survivorship was 73% ± 16% for knees revised with gamma-in-air polyethylene compared to 92% ± 6% for nongamma or gamma-in-barrier sterilization methods.
CONCLUSIONS
The survival rates of isolated polyethylene exchange for wear or osteolysis are similar to those of a single-component or full revision when the components are well aligned and well fixed. Polyethylene sterilization influenced revision TKA survivorship in this study and should be reported in future studies.
背景
治疗磨损或骨溶解的患者的方案包括全翻修、半翻修（胫骨或股骨）和单纯聚乙烯置换。目前尚不清楚哪种方案更优。据报道，聚乙烯的质量会影响初次全膝关节置换术的存活率，但在翻修全膝关节置换术中尚未有类似报道。
问题/目的：我们比较了三种手术的失败率以及聚乙烯质量对失败的影响。
患者和方法
我们回顾性评估了 123 例因磨损或骨溶解而需手术治疗的患者，共 135 例膝关节。25%行单纯聚乙烯置换，39%行单组件翻修，36%行全翻修。我们评估了翻修的存活率。123 例患者的平均随访时间为 6.2 年。15 例（16 膝，或 12%）在 5 年评估前失访，留下 108 例（119 膝，或 88%）进行再次翻修率的比较。
结果
三种手术的 5 年存活率相似：聚乙烯置换为 82%±14%，部分翻修为 89%±8%，全翻修为 88%±10%。聚乙烯的灭菌方式对再次翻修的影响最大。经空气伽马射线灭菌的膝关节再次翻修的存活率为 73%±16%，而非伽马射线或伽马射线屏障灭菌方法的存活率为 92%±6%。
结论
当组件排列良好且固定良好时，单纯聚乙烯置换治疗磨损或骨溶解的生存率与单组件或全翻修相似。在本研究中，聚乙烯的灭菌方式影响了翻修全膝关节置换术的存活率，在未来的研究中应予以报道。
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