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单髁膝关节置换金属沉着病采用单对单翻修治疗:一例报告

Unicompartimental knee arthroplasty metallosis treated with uni-on-uni revision: A case report.

作者信息

Toro Giuseppe, Braile Adriano, Conza Gianluca, De Cicco Annalisa, Abu Mukh Assala, Placella Giacomo, Salini Vincenzo

机构信息

Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples 80138, Italy.

Department of Orthopaedics and Traumatology, San Raffaele Hospital, Milan 20132, Italy.

出版信息

World J Orthop. 2023 Dec 18;14(12):889-896. doi: 10.5312/wjo.v14.i12.889.

Abstract

BACKGROUND

Metallosis is the result of metallic wear debris in the soft tissues and is associated to both local and systemic inflammatory response. Metallosis has been reported after total hip and total knee arthroplasty (TKA), but rarely after a unicompartimental knee arthroplasty (UKA). In the context of UKA metallosis, surgeons often opt for revision using a TKA. However, in this paper, the authors successfully treated UKA revising the metal back only.

CASE SUMMARY

Prior to treat our patient we conducted a literature research through which we identified eleven cases of metallosis after UKA, ten (90.9%) were treated revising using though a TKA. Only one case was managed through a uni-on-uni revision, reporting high knee function. Our patient complained worsening pain and function after a snap occurred at 16 mo after UKA implantation. At 18 mo following surgical debridment and uni-on-uni revision surgery, our patient exhibited a relevant improvement in Oxford Knee Score and a reduction of metal ion levels in the blood.

CONCLUSION

Our study highlights that in case of metallosis after UKA, the treatment may be based on surgical debridement and just revising the mobilized components.

摘要

背景

金属沉着病是软组织中金属磨损碎屑的结果,与局部和全身炎症反应相关。全髋关节置换术和全膝关节置换术(TKA)后曾有金属沉着病的报道,但单髁膝关节置换术(UKA)后则很少见。在UKA金属沉着病的情况下,外科医生通常选择采用TKA进行翻修。然而,在本文中,作者仅通过翻修金属部件成功治疗了UKA。

病例摘要

在治疗我们的患者之前,我们进行了文献研究,通过该研究我们确定了11例UKA后金属沉着病的病例,其中10例(90.9%)通过TKA翻修进行治疗。只有1例通过单对单翻修进行处理,膝关节功能良好。我们的患者在UKA植入后16个月出现断裂后,抱怨疼痛和功能恶化。在手术清创和单对单翻修手术后18个月,我们的患者牛津膝关节评分有显著改善,血液中金属离子水平降低。

结论

我们的研究强调,在UKA后发生金属沉着病的情况下,治疗可以基于手术清创并仅翻修松动的部件。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4e6f/10758592/dea79ddee3a9/WJO-14-889-g001.jpg

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