Hak D J, Lieberman J R, Finerman G A
University of California Los Angeles, Department of Orthopaedic Surgery, USA.
Clin Orthop Relat Res. 1995 Jul(316):134-44.
Thirty-six knee arthrodeses performed using an external fixator with an average followup of 48 months were reviewed retrospectively. A single plane fixator was used in 19 cases and a biplane fixator in 17 cases. The reasons for fusion included an infected total knee arthroplasty (21 cases), aseptic loosening of a total knee arthroplasty (9 cases), posttraumatic osteoarthritis (3 cases), and a neuropathic joint, an infected unicondylar knee arthroplasty, and a tuberculous joint (1 case each). A fusion was obtained after the initial procedure in 22 patients (61%). With additional procedures, a fusion was obtained eventually in 27 patients (75%). The fusion rate decreased with an increasing number of prior knee procedures. Single and biplane external fixator designs had similar initial fusion rates (single 58%, biplane 65%). Complications included 14 nonunions (5 fused with additional procedures), 6 pin tract infections, 5 delayed unions, 1 stress fracture through a pin site, and 1 persistent infection resulting in an above-knee amputation. Despite biomechanical advances in external fixator design, knee arthrodesis remains difficult to achieve in patients who have had multiple previous procedures, a failed total knee arthroplasty, or an infected total knee arthroplasty with significant bone loss.
回顾性分析了36例采用外固定器进行膝关节融合术的病例，平均随访时间为48个月。19例使用单平面固定器，17例使用双平面固定器。融合的原因包括感染性全膝关节置换术（21例）、全膝关节置换术无菌性松动（9例）、创伤后骨关节炎（3例）以及神经性关节、感染性单髁膝关节置换术和结核性关节（各1例）。22例患者（61%）在初次手术后获得融合。经过额外手术，最终27例患者（75%）获得融合。融合率随着先前膝关节手术次数的增加而降低。单平面和双平面外固定器设计的初始融合率相似（单平面58%，双平面65%）。并发症包括14例骨不连（5例经额外手术融合）、6例针道感染、5例延迟愈合、1例通过针道的应力性骨折以及1例持续性感染导致膝上截肢。尽管外固定器设计在生物力学方面取得了进展，但对于先前接受过多次手术、全膝关节置换失败或伴有严重骨丢失的感染性全膝关节置换患者，膝关节融合术仍难以实现。
