Kukreja Mohit M, Swanson Todd V
Swanson Hip and Knee Center of Excellence and Research Institute Desert Orthopaedic Center, Las Vegas, NV, USA; Desert Orthopedic Center & Swanson Hip/Knee Research Foundation, 2800 E.Desert Inn, Suit 100, Las Vegas, NV, 89121, USA.
Int J Surg Case Rep. 2018;53:200-206. doi: 10.1016/j.ijscr.2018.09.028. Epub 2018 Sep 23.
For extensive metaphyseal defects, the use of tantalum cones is usually combined with adjuvant stems which may be cemented/cementless and metallic bone augments for additional stability. A Tibial baseplate-Cone construct with proud tibial cones and without metallic augments has been described for AORI type 2B/3 tibial defects.
A case series analysis of 6 patients with AORI type 3 defects treated with unstepped proud Tantalum tibial metaphyseal cones without metallic wedges/full width augments. A follow-up analysis done with clinico-radiographic interpretation.
100% osteointegration noted in final radiographs of all patients at an average follow-up of 4.1 years. Preoperative average ROM/KSS of 75/49 improved to postoperative ROM/KSS of 104/79. Outcomes were interpreted as excellent in 50% of cases and good in the remaining 50%.
The "Tibial base plate-cone without augments (BCCA)"type of a construct may offer a valid long term advantage over the Tibial base plate-Augment-Cone combination in massive tibial bone defects. Simply building up the tantalum cone to the native joint line position by increasing cone height can exclude use of augments or wedges.
对于广泛的干骺端缺损，钽锥体的使用通常与辅助柄相结合，辅助柄可以是骨水泥固定/非骨水泥固定的，还可使用金属骨增强材料以增加稳定性。一种用于AO/OTA 2B/3型胫骨缺损的带有突出胫骨锥体且无金属增强材料的胫骨基板 - 锥体结构已被描述。
对6例接受未分级突出钽制胫骨干骺端锥体且无金属楔块/全宽增强材料治疗的AO/OTA 3型缺损患者进行病例系列分析。通过临床影像学解释进行随访分析。
所有患者在平均4.1年的随访期后的最终X线片显示100%骨整合。术前平均ROM/KSS为75/49，术后改善为104/79。50%的病例结果被判定为优秀，其余50%为良好。
在大面积胫骨骨缺损中，“无增强材料的胫骨基板 - 锥体（BCCA）”型结构可能比胫骨基板 - 增强材料 - 锥体组合具有有效的长期优势。通过增加锥体高度将钽锥体简单地构建到天然关节线位置可以避免使用增强材料或楔块。
