Cameron H U, Jung Y B
Orthopaedic & Arthritic Hospital, University of Toronto, Ont.
Can J Surg. 1993 Dec;36(6):555-9.
To determine if the addition of a stem to the tibial component in noncemented total knee replacement affects sinkage of that component or micromotion.
A cohort of 176 consecutive cases with no exclusions. Follow-up ranged from 2 to 6 years.
A university-affiliated institution specializing in elective orthopedic surgery.
All 176 patients had arthritis of the knee, mainly osteoarthritis. All agreed preoperatively to prolonged postoperative follow-up.
Noncemented total knee replacement with the Tricon M long-stem tibial component.
Hospital for Special Surgery rating system for clinical results and degree of tibial sinkage and stem lucency seen radiologically.
Eight (4.5%) of the 176 prostheses required revision, none for sinkage. Of the remaining 168 knees, 156 (92.9%) scored good or excellent, 6% fair and 1.2% poor. Sinkage occurred in 3%, but was not of sufficient severity to require revision. No lucency was visible in 33.8% of stems, partial lucency in 62%, complete lucency with the lines being parallel to the stem in 3.5% and complete lucency with divergent lines, indicating a loose implant, in 1.7%. Lucency, when present, was seen mainly in the lateral view, seldom in the anteroposterior view. There was no correlation between radiologic results and clinical results.
The addition of a metaphyseal stem reduces the incidence of sinkage of the tibial component in total knee replacement. The stem largely solves the problem of mediolateral micromotion but does not completely prevent anteroposterior micromotion.
确定在非骨水泥型全膝关节置换术中，胫骨假体增加柄部是否会影响该假体的下沉或微动。
176例连续病例组成的队列，无排除标准。随访时间为2至6年。
一所大学附属的专门从事择期骨科手术的机构。
176例患者均患有膝关节关节炎，主要为骨关节炎。所有患者术前均同意进行长期术后随访。
使用Tricon M长柄胫骨假体进行非骨水泥型全膝关节置换。
采用特殊外科医院评分系统评估临床结果，以及通过放射学检查观察胫骨下沉程度和柄部透亮情况。
176个假体中有8个（4.5%）需要翻修，均非因下沉。在其余168个膝关节中，156个（92.9%）评分良好或优秀，6%为中等，1.2%为差。3%出现下沉，但严重程度不足以需要翻修。33.8%的柄部未见透亮，62%有部分透亮，3.5%完全透亮且透亮线与柄部平行，1.7%完全透亮且线发散，提示假体松动。透亮情况若存在，主要见于侧位片，很少见于前后位片。放射学结果与临床结果之间无相关性。
增加干骺端柄部可降低全膝关节置换术中胫骨假体下沉的发生率。柄部在很大程度上解决了内外侧微动问题，但不能完全防止前后位微动。
