Department of Orthopaedics and Traumatology, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
Clinique de la Source, Avenue Bergières 2, 1004, Lausanne, Switzerland.
Knee Surg Sports Traumatol Arthrosc. 2023 Apr;31(4):1299-1306. doi: 10.1007/s00167-021-06693-7. Epub 2021 Aug 29.
Knee arthrodesis is an established procedure for limb salvage in cases of recurrent infection, total knee arthroplasty soft tissue defect, poor bone stock or a deficient extensor mechanism. Surgical options include compression plate, external fixator and arthrodesis nail. Different types of nail exist: long fusion nail, short modular nail and bridging nail. This study presents the results on knee arthrodesis using different types of intramedullary nails. The aim is to assess if a specific type of nail has a better fusion rate, clinical outcome and lower complication rate.
A mono-centric retrospective study of 48 knees arthrodesis was performed between 2000 and 2018. 15 T2 Arthrodesis Nail, 6 OsteoBridge Knee Arthrodesis and 27 Wichita fusion nail were used. The mean clinic and radiological follow-up was 9.8 ± 3.8 years (2.6-18 years).
Fusion rate was 89.6%. Time to fusion was 6.9 months. Mean Parker score was 6.9/9 points. Visual Analogic Scale was 1.9. The Wichita fusion nail showed better results in terms of fusion, time to fusion and clinical outcome measured by Parker score and VAS but without statistical significance. The early revision rate was 10.4% and 20.8% presented a late complication requiring a surgery, due to nonunion or infection. 93.3% of infection was cured. Two patients live with a fistula (4.2%) and 1 was amputated (2.1%).
Although burdened by a big complication rate, knee arthrodesis with an intramedullary nail provides satisfactory results and is a good alternative to above-knee-amputation. The Wichita fusion nail shows a tendency to better results compared to the two other nails.
Case series, level IV.
膝关节融合术是一种成熟的手术方法，适用于复发性感染、全膝关节置换软组织缺损、骨量不足或伸肌机制缺陷的病例。手术方法包括加压钢板、外固定架和融合钉。不同类型的钉存在：长融合钉、短模块钉和桥接钉。本研究介绍了使用不同类型髓内钉进行膝关节融合的结果。目的是评估特定类型的钉是否具有更高的融合率、临床效果和更低的并发症发生率。
对 2000 年至 2018 年间进行的 48 例膝关节融合术进行单中心回顾性研究。使用了 15 个 T2 融合钉、6 个 OsteoBridge 膝关节融合钉和 27 个 Wichita 融合钉。平均临床和放射学随访时间为 9.8±3.8 年（2.6-18 年）。
融合率为 89.6%。融合时间为 6.9 个月。平均 Parker 评分为 6.9/9 分。视觉模拟评分法为 1.9。Wichita 融合钉在融合、融合时间和临床结果方面表现更好，Parker 评分和 VAS 评分，但无统计学意义。早期翻修率为 10.4%，晚期并发症需要手术的发生率为 20.8%，原因是非愈合或感染。93.3%的感染得到治愈。2 例患者存在瘘管（4.2%），1 例患者截肢（2.1%）。
尽管并发症发生率较高，但髓内钉膝关节融合术可获得满意的结果，是膝关节以上截肢的良好替代方法。与另外两种钉相比，Wichita 融合钉显示出更好的结果趋势。
病例系列，IV 级。
