Daniilidis K, Jakubowitz E, Stukenborg-Colsman C, Calließ T, Windhagen H, Yao D
Orthopädische Klinik, Medizinische Hochschule Hannover im Annastift, Hannover, Deutschland,
Orthopade. 2015 Jun;44(6):458-64. doi: 10.1007/s00132-015-3112-1.
We report an unusual case of a 38-year-old physically active patient, who suffered a Ewing sarcoma during adolescence and was therefore treated with a tumor endoprostheses ex domo (replacement of distal femur and proximal tibia). Since then he had undergone a couple of surgical interventions for revision and is currently suffering from persistent pain in the leg concerned. An aseptic loosening of the tibial component was evident after radiologic examinations. Because he had suffered for so long our patient refused further surgery to retain the affected limb and he preferred amputation.
We would have taken the risk of a femoral residual limb that is much too short compared with a classical above-knee amputation. In this regard we saw difficulties in exoprosthetic treatment with functional limitations that could easily have influenced the outcome negatively.
Consequently, we decoupled the tibial component from the femoral one within the knee joint and thus performed a knee disarticulation leaving the femoral component.
Postoperatively, we found a mostly harmonious gait pattern with a pure mechanical interim prosthesis regarding time-distance parameters, which may be even further improved with the final prosthesis. Sagittal joint angles are comparable to conventionally knee exarticulated ones.
To date, no comparable case of such an alloarthroplasty, which could regain mobility with an exoprosthetic treatment has been highlighted in the literature. In the result, a knee disarticulation within the area of a knee arthroplasty leaving the femoral component is not inferior to"ordinary" knee disarticulation.
我们报告了一例不同寻常的病例，一名38岁身体活跃的患者，在青春期患尤因肉瘤，因此接受了定制肿瘤假体（远端股骨和近端胫骨置换）治疗。从那时起，他接受了几次翻修手术，目前患侧腿部仍持续疼痛。影像学检查显示胫骨假体出现无菌性松动。由于长期遭受病痛折磨，我们的患者拒绝进一步手术以保留患肢，他更倾向于截肢。
与经典的膝上截肢相比，我们将面临股骨残肢过短的风险。在这方面，我们认为假体治疗存在困难，功能受限很容易对结果产生负面影响。
因此，我们在膝关节内将胫骨假体与股骨假体分离，从而进行了保留股骨假体的膝关节离断术。
术后，就时间 - 距离参数而言，我们发现使用纯机械临时假肢时步态模式大多和谐，使用最终假肢可能会进一步改善。矢状关节角度与传统膝关节离断术相当。
迄今为止，文献中尚未强调过这样一种同种异体关节成形术的类似病例，即通过假体治疗能够恢复活动能力。结果表明，在膝关节置换区域内保留股骨假体进行膝关节离断术并不逊于“普通”膝关节离断术。
