Brand M G, Daley R J, Ewald F C, Scott R D
Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
Clin Orthop Relat Res. 1989 Nov(248):71-9.
Peripheral defects in the proximal tibia can be difficult to treat during total knee arthroplasty. Attempts can be made to solve the problem with cement, cement with screws, bone grafts, metal wedges, and custom components. In vitro testing has shown that a custom-augmented prosthesis with a built-up metal wedge is mechanically superior in resisting deflections when loaded. Using modular metal wedges, the tibial tray can be customized at the time of surgery. In vitro testing has also shown the wedge to be superior to the use of cement alone or cement reinforced by screws. The authors report on modular metal wedges to augment tibial bone stock deficiency. Twenty-two knees (20 patients) were followed for a minimum of two years with an average follow-up time of 37 months. The average age of the patients at the time of surgery was 70 years. There have been no failures of this technique and no loosening of tibial components. The incidence of nonprogressive radiolucent lines was 27%. All but one patient was pain-free, and this patient's discomfort was not related to the tibial component fixation. No patient has had subsequent revision surgery. This technique should be considered in the treatment of severe peripheral tibial deficiencies in the elderly, low-demand patient.
在全膝关节置换术中，胫骨近端的周边缺损可能难以治疗。可以尝试用骨水泥、带螺钉的骨水泥、骨移植、金属楔块和定制部件来解决这个问题。体外测试表明，带有内置金属楔块的定制增强假体在加载时抵抗变形的机械性能更优越。使用模块化金属楔块，可以在手术时定制胫骨托。体外测试还表明，楔块优于单独使用骨水泥或用螺钉增强的骨水泥。作者报告了使用模块化金属楔块来增加胫骨骨量不足的情况。对22个膝关节（20例患者）进行了至少两年的随访，平均随访时间为37个月。手术时患者的平均年龄为70岁。该技术没有失败病例，胫骨部件也没有松动。非进行性透亮线的发生率为27%。除1例患者外，所有患者均无疼痛，该患者的不适与胫骨部件固定无关。没有患者进行后续翻修手术。对于老年、需求较低的患者，在治疗严重的胫骨周边缺损时应考虑这种技术。
