Georgiadis Gregory M, Skakun William C
Orthopaedic Trauma Service, Department of Orthopaedic Surgery, Promedica Toledo Hospital, Toledo, OH.
Am J Orthop (Belle Mead NJ). 2016 Nov/Dec;45(7):E481-E486.
Patients with retained tibial implants may later undergo total knee arthroplasty (TKA) after tibial osteotomy or fracture. Previous knee surgery can increase the rate of complications of joint replacement. Surgical scars may not be in optimal position for hardware removal and arthroplasty. The need for multiple incisions or larger subcutaneous skin flaps in at-risk areas may increase the possibility of wound complications and infection. In this article, we report 3 cases in which a patient who had knee arthrosis and retained tibial implants underwent single-stage conversion to TKA. In each case, selected minimally invasive hardware removal was performed through small incisions under fluoroscopic guidance. For insertion of the tibial base plate, only screws were removed; the retained plates were not disturbed. This technique allowed the TKA to be performed without making significant secondary incisions or raising larger-than-normal skin flaps.
保留胫骨植入物的患者可能会在胫骨截骨术或骨折后接受全膝关节置换术（TKA）。既往膝关节手术会增加关节置换的并发症发生率。手术疤痕对于取出内固定物和进行关节置换术而言可能并非处于最佳位置。在高危区域需要多个切口或更大的皮下皮瓣可能会增加伤口并发症和感染的可能性。在本文中，我们报告了3例患有膝关节病且保留胫骨植入物的患者接受单阶段转换为TKA的病例。在每例病例中，通过在透视引导下的小切口进行选定的微创内固定物取出。为了插入胫骨基板，仅取出螺钉；保留的钢板未受干扰。该技术使得TKA能够在不做显著的二次切口或掀起大于正常尺寸的皮瓣的情况下进行。
