Wilson Addison J, Nandi Sumon, Robbins Claire E, Bono James V
Naval Medical Center Portsmouth Department of Orthopedics, Portsmouth, Virginia, USA.
Orthopedics. 2012 Jun;35(6):e969-72. doi: 10.3928/01477447-20120525-44.
Proper component positioning is essential for successful total knee arthroplasty (TKA). Femoral component positioning presents a technical challenge when significant femoral deformity is present. Most commonly, an intramedullary guide is used to make an accurate distal femoral cut. However, in the presence of a significant femoral deformity, this is not a viable option.The use of clamshell osteotomy to restore anatomic alignment in patients with complex femoral diaphyseal deformity is described in the literature. This article describes a case of a patient who underwent staged TKA after clamshell osteotomy and retrograde femoral nailing to correct femoral diaphyseal malunion. The retrograde intramedullary nail was retained and used as an intramedullary guide, allowing for TKA in a routine manner. Using an intramedullary nail as an alignment guide may be more accurate than using extramedullary alignment and may avoid the increased surgical time and potential pin-site stress risers of navigation. It is a simple, effective way to treat complicated diaphyseal femoral deformities in the face of posttraumatic knee arthritis. Further study of this technique with longer follow-up and multiple surgeons is necessary to validate this treatment algorithm.
合适的假体组件定位对于全膝关节置换术（TKA）的成功至关重要。当存在明显的股骨畸形时，股骨组件的定位会带来技术挑战。最常见的是，使用髓内导向器进行准确的股骨远端截骨。然而，在存在明显股骨畸形的情况下，这不是一个可行的选择。文献中描述了使用蛤壳式截骨术来恢复复杂股骨干畸形患者的解剖对线。本文描述了一例患者，该患者在蛤壳式截骨术和逆行股骨交锁髓内钉固定以纠正股骨干骨不连后接受了分期TKA。保留逆行髓内钉并将其用作髓内导向器，从而能够以常规方式进行TKA。使用髓内钉作为对线导向器可能比使用髓外对线更准确，并且可以避免手术时间延长以及导航系统潜在的针道应力集中问题。面对创伤后膝关节炎，这是一种治疗复杂股骨干畸形的简单、有效方法。需要对该技术进行更长时间的随访并由多名外科医生进行进一步研究，以验证这种治疗方案。
