Vlasak R, Gearen P F, Petty W
University of Florida College of Medicine, Department of Orthopaedics, Gainesville, USA.
Clin Orthop Relat Res. 1995 Dec(321):138-44.
Twenty-six primary arthrodeses and 6 repeat arthrodeses were done for a total of 32 arthrodesis procedures in 26 patients, with followup from 2 to 10 years (mean, 4 years). The indications for arthrodesis were septic failure in 18 patients and aseptic loosening in 8 patients. Thirteen arthrodeses were done using external fixators, and 12 arthrodeses were done using a closed fluted intramedullary nail for fixation (1 arthrodesis was done with a custom proximal and distal interlocked nail). In addition, 6 repeat arthrodeses with intramedullary nail fixation were done for treatment of nonunions after external fixation. Five (38%) of the 13 patients who underwent arthrodesis with an external fixator had clinical and radiographic union at a mean of 5 months. All 13 patients with primary intramedullary nail arthrodesis achieved union. The knees of the 6 patients with nonunions after external fixation that were treated with repeat intramedullary nail arthrodesis achieved union. Patients with septic failure had staged debridements before intramedullary nail arthrodesis. Intramedullary nail arthrodesis can be done safely in patients with sepsis as a staged procedure. Knee arthrodesis using intramedullary nail fixation gives a much higher union rate than does external fixation and is associated with fewer complications.
对26例患者共进行了32次关节融合手术，其中包括26例初次关节融合和6例再次关节融合，随访时间为2至10年（平均4年）。关节融合的指征为18例感染性失败和8例无菌性松动。13例关节融合采用外固定器进行，12例关节融合采用闭合带槽髓内钉固定（1例关节融合使用定制的近端和远端交锁钉）。此外，6例再次关节融合采用髓内钉固定，用于治疗外固定后不愈合。13例采用外固定器进行关节融合的患者中，5例（38%）在平均5个月时达到临床和影像学愈合。所有13例初次髓内钉关节融合患者均实现愈合。6例外固定后不愈合且接受再次髓内钉关节融合治疗的患者膝关节实现愈合。感染性失败患者在髓内钉关节融合前进行了分期清创。髓内钉关节融合作为分期手术可在脓毒症患者中安全进行。使用髓内钉固定的膝关节融合术比外固定术的愈合率高得多，且并发症较少。
