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人工关节周围感染伴大的骨缺损的膝关节翻修置换术第一阶段:双水泥固定法病例报告

The First Stage of Knee Revision Arthroplasty in Periprosthetic Infection with Replacement of a Large Defect Double Cementing Method: A Case Report.

作者信息

Balgazarov Serik, Belokobylov Alexey, Batpen Arman, Ramazanov Zhanatai, Dolgov Alexey, Rimashevskiy Denis, Kriklivyy Alexandr

机构信息

Department of Trauma Consequences and Combustiology, National Scientific Center of Traumatology and Orthopedics Named after Academician N.D. Batpenov, Astana, Republic of Kazakhstan.

Republican Center for Endoprosthetics, National Scientific Center of Traumatology and Orthopedics Named after Academician N.D. Batpenov, Astana, Republic of Kazakhstan.

出版信息

Int Med Case Rep J. 2023 Sep 6;16:513-520. doi: 10.2147/IMCRJ.S420109. eCollection 2023.

Abstract

AIM

Large bone defects in patients with chronic deep periprosthetic knee infection is a major problem. It is widely accepted that bone defects filling with polymethylmethacrylate (PMMA) cement could be used only in selected cases of small bone defects (up to 5 mm) and less than 50% of articular surface due to multiple reasons: risk of thermal bone damage, inadequate cement pressurization and bone cement shrinkage, etc. Staged cementing for preventing bone heating and over negative effects of cementing on a thick layer of bone cement has limited support in the literature.

CASE PRESENTATION

We present the case of 4.5 years follow up after temporary-permanent spacer implantation in a 63-year-old male with chronic deep knee PJI and tibial AORI type 3 bone defect reconstructed via double cementing method.

RESULTS

Method of double (staged) cementing used for reconstruction of epiphyseal tibial bone defect in a patient with fistula form of knee PJI shows excellent clinical results at 4.5 years follow up.

摘要

目的

慢性膝关节假体周围深部感染患者的大骨缺损是一个主要问题。由于多种原因,人们普遍认为,聚甲基丙烯酸甲酯(PMMA)骨水泥填充骨缺损仅适用于特定的小骨缺损(最大5毫米)且关节面受累小于50%的病例:存在热损伤骨的风险、骨水泥加压不足以及骨水泥收缩等。文献中关于采用分期骨水泥固定以防止骨加热和骨水泥对厚层骨水泥产生的负面影响的支持有限。

病例介绍

我们报告了一名63岁男性慢性膝关节假体周围深部感染且胫骨AORI 3型骨缺损患者,在临时-永久性间隔物植入后进行4.5年随访的病例,该患者通过双重骨水泥固定法进行了重建。

结果

对于膝关节假体周围感染瘘管型患者,采用双重(分期)骨水泥固定法重建胫骨骨骺骨缺损,在4.5年随访时显示出优异的临床效果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/893b/10493111/bb81913fe1f1/IMCRJ-16-513-g0001.jpg

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