徒手钻孔技术在亚洲人膝关节中植入第二代干骺端锥形假体的短期疗效良好——病例系列报告
Promising short-term outcomes of free-hand burring technique to implant second-generation metaphyseal cone in Asian knees - a case series.
作者信息
Leung Thomas Ka Chun, Chan Ping Keung, Fu Henry, Cheung Amy, Luk Michelle Hilda, Lau Lawrence Chun Man, Chiu Kwong Yuen
机构信息
Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong SAR, China.
Department of Orthopaedics and Traumatology, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China.
出版信息
Arthroplasty. 2024 Jul 2;6(1):35. doi: 10.1186/s42836-024-00254-2.
BACKGROUND
The second-generation metaphyseal cone was useful in managing bone defects in revision knee arthroplasty. However, due to the anatomical constraints in Asian osteometry, the authors utilized a novel free-hand burring technique instead of cannulated reaming for bone preparation. We reported the short-term outcomes of our surgical techniques specific to Asian osteometry.
METHODS
We conducted a case series by consecutively recruiting 13 female and 12 male patients (involving 25 knees), with a mean age of 71 years (range, 54-88 years). The patients underwent revision total knee arthroplasty during the period from April 2017 to June 2022. Twenty-three tibial cones and 4 femoral cones using free-hand burring technique were implanted. The mean follow-up duration was 51 months (range 18-80 months). Due to the relatively small bone size and meta-diaphyseal center mismatch in the Asian knees, the free-hand burring technique instead of the cannulated reaming technique was adopted in preparing for cone implantation. The clinical outcomes were knee ranges of motion, the Knee Society Knee scores (KSS), end-of-stem pain, infection, and the need for revision surgery. The radiological outcomes included osteointegration, fracture, and loosening.
RESULTS
Mean knee range of motion improved from 83 degrees (range 0°-120°) preoperatively to 106 degrees (range 60°-125°) postoperatively (P < 0.001). Mean KSS improved significantly from 29 (range 0-70) to 69 (range 5-100) (P < 0.001). All cones were osteointegrated. One case had transient end-of-stem pain, two developed intraoperative minor femoral fractures and one suffered from recurrent infection that did not require cone revision. Cone revision-free survivorship was 100%. There was no aseptic loosening.
CONCLUSIONS
The second-generation cone implanted with free-hand burring bone preparation yielded promising short-term outcomes in Asian knees.
背景
第二代干骺端锥体在翻修膝关节置换术中处理骨缺损方面很有用。然而，由于亚洲人骨骼测量的解剖学限制，作者采用了一种新颖的徒手磨削技术而非空心扩髓进行骨准备。我们报告了针对亚洲人骨骼测量的手术技术的短期结果。
方法
我们进行了一项病例系列研究，连续招募了13名女性和12名男性患者（涉及25个膝关节），平均年龄71岁（范围54 - 88岁）。这些患者在2017年4月至2022年6月期间接受了翻修全膝关节置换术。使用徒手磨削技术植入了23个胫骨锥体和4个股骨锥体。平均随访时间为51个月（范围18 - 80个月）。由于亚洲人膝关节的骨尺寸相对较小以及干骺端中心不匹配，在准备锥体植入时采用了徒手磨削技术而非空心扩髓技术。临床结果包括膝关节活动范围、膝关节协会膝关节评分（KSS）、柄端疼痛、感染以及翻修手术需求。放射学结果包括骨整合、骨折和松动。
结果
膝关节平均活动范围从术前的83度（范围0° - 120°）改善到术后的106度（范围60° - 125°）（P < 0.001）。平均KSS从29（范围0 - 70）显著提高到69（范围5 - 100）（P < 0.001）。所有锥体均实现骨整合。1例出现短暂的柄端疼痛，2例术中发生轻微股骨骨折，1例发生反复感染但无需锥体翻修。无锥体翻修的生存率为100%。没有无菌性松动。
结论
采用徒手磨削骨准备植入的第二代锥体在亚洲人膝关节中产生了良好的短期结果。
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