Trabecular Metal 植入物融合后全踝关节置换失败的不良结局：11 例患者的早期结果。
Poor outcomes of fusion with Trabecular Metal implants after failed total ankle replacement: Early results in 11 patients.
机构信息
Service de chirurgie orthopédique et traumatologique, centre hospitalier Lyon-Sud, hospices Civils de Lyon, 69495 Pierre-Bénite cedex, France; Service de chirurgie orthopédique et traumatologique, université Clermont Auvergne, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France.
Service de chirurgie orthopédique et traumatologique, centre hospitalier Lyon-Sud, hospices Civils de Lyon, 69495 Pierre-Bénite cedex, France.
出版信息
Orthop Traumatol Surg Res. 2018 Apr;104(2):231-237. doi: 10.1016/j.otsr.2017.11.022. Epub 2018 Jan 31.
INTRODUCTION
One of the reasons for revision of total ankle replacement (TAR) implants is loosening due to subchondral cysts. Reconstruction and fusion of the ankle is often the first choice for revision procedures due to the large bone defects, which are typically filled with autograft and/or allograft. Filling the defect with a trabecular metal tantalum implant is a potential alternative given the biomechanical properties of this component.
HYPOTHESIS
Using tantalum as a spacer provides primary stability and contributes to fusion of the ankle joint after removal of failed TAR implants.
METHODS
Eleven patients underwent arthrodesis an average of 6.9 years after TAR. The mean height of the bone defect was 32mm. It was filled with a specially designed quadrangular implant (Trabecular Metal™, Zimmer/Biomet) combined with an iliac crest graft. Ten patients underwent tibio-talo-calcaneal (TTC) arthrodesis fixed with an angled retrograde nail and one patient underwent talocrural arthrodesis fixed with two plates (anterolateral and anteromedial). The clinical, functional (AOFAS and SF36 scores) and radiological (plain X-rays and CT scan) outcomes were determined.
RESULTS
At a mean follow-up of 19.3 months, the mean total AOFAS score was 56 (21-78) and the mean SF36 score was 60.5 (19-84). One patient was lost to follow-up and four patients still had pain. The tantalum implant was integrated in six patients. Five patients achieved fusion of the subtalar joint and 8 achieved fusion of the talocrural joint. Three patients required surgical revision.
DISCUSSION
Our hypothesis was not confirmed. The clinical outcomes after more than 1 year of follow-up are disappointing, as was the large number of nonunion cases and the lack of tantalum integration. These technical failures can be explained by insufficient construct stability and/or insufficient implant porosity.
LEVEL OF EVIDENCE
IV (retrospective cohort study).
简介
全踝关节置换术（TAR）植入物松动的原因之一是软骨下囊肿。由于存在大的骨缺损，通常选择踝关节重建和融合作为翻修手术的首选，这些骨缺损通常用自体移植物和/或同种异体移植物填充。由于该部件的生物力学特性，用多孔钽金属小梁植入物填充缺损是一种潜在的替代方法。
假设
用钽作为间隔物可提供初始稳定性，并有助于在去除失败的 TAR 植入物后融合踝关节。
方法
11 例患者在 TAR 后平均 6.9 年接受融合术。骨缺损的平均高度为 32mm。使用专门设计的四边形植入物（Zimmer/Biomet 公司的 Trabecular Metal™）与髂嵴移植物相结合进行填充。10 例患者接受胫距跟（TTC）融合术，使用角度逆行钉固定，1 例患者接受跗跖关节融合术，使用两块钢板（前外侧和前内侧）固定。确定临床、功能（AOFAS 和 SF36 评分）和影像学（普通 X 线和 CT 扫描）结果。
结果
平均随访 19.3 个月时，平均 AOFAS 总评分 56（21-78），SF36 平均评分为 60.5（19-84）。1 例患者失访，4 例患者仍有疼痛。6 例患者的钽植入物已整合，5 例患者距下关节融合，8 例患者距跟关节融合。3 例患者需要手术翻修。
讨论
我们的假设未得到证实。超过 1 年的随访后的临床结果令人失望，因为大量病例出现骨不连，而且钽的整合也不理想。这些技术失败可以用结构稳定性不足和/或植入物孔隙率不足来解释。
证据等级
IV（回顾性队列研究）。
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