Van Rensch P J H, Van de Pol G J, Goosen J H M, Wymenga A B, De Man F H R
Department of Orthopedics, Postoperative Joint Infection Unit, St Maartenskliniek, Hengstdal 3, 6522 JV, Nijmegen, The Netherlands,
Knee Surg Sports Traumatol Arthrosc. 2014 Aug;22(8):1940-8. doi: 10.1007/s00167-013-2539-3. Epub 2013 May 26.
Primary stability in arthrodesis of the knee can be achieved by external fixation, intramedullary nailing or plate fixation. Each method has different features and results. We present a practical algorithm for arthrodesis of the knee following a failed (infected) arthroplasty, based on our own results and a literature review.
Between 2004 and 2010, patients were included with an indication for arthrodesis after failed (revision) arthroplasty of the knee. Patients were analyzed with respect to indication, fusion method and bone contact. End-point was solid fusion.
Twenty-six arthrodeses were performed. Eighteen patients were treated because of an infected arthroplasty. In total, ten external fixators, ten intramedullary nails and six plate fixations were applied; solid fusion was achieved in 3/10, 8/10 and 3/6, respectively.
There is no definite answer as to which method is superior in performing an arthrodesis of the knee. Intramedullary nailing achieved the best fusion rates, but was used most in cases without--or cured--infection. Our data and the contemporary literature suggest that external fixation can be abandoned as standard fusion method, but can be of use following persisting infection. The Ilizarov circular external fixator, however, seems to render high fusion rates. Good patient selection and appropriate individual treatment are the key to a successful arthrodesis. Based upon these findings, a practical algorithm was developed.
膝关节融合术中的初始稳定性可通过外固定、髓内钉固定或钢板固定来实现。每种方法都有不同的特点和效果。基于我们自己的研究结果和文献综述，我们提出一种针对膝关节置换术失败（感染）后膝关节融合的实用算法。
2004年至2010年间，纳入膝关节置换术失败（翻修）后有膝关节融合指征的患者。对患者的指征、融合方法和骨接触情况进行分析。终点为牢固融合。
共进行了26例膝关节融合术。18例患者因感染性关节置换术接受治疗。总共应用了10个外固定器、10根髓内钉和6块钢板固定；分别有3/10、8/10和3/6实现了牢固融合。
对于膝关节融合术哪种方法更优尚无明确答案。髓内钉固定的融合率最高，但大多用于无感染或感染已治愈的病例。我们的数据和当代文献表明，外固定可不再作为标准融合方法，但在持续感染的情况下仍可使用。然而，伊里扎洛夫环形外固定器似乎能实现较高的融合率。良好的患者选择和适当的个体化治疗是膝关节融合术成功的关键。基于这些发现，制定了一种实用算法。
