Shih L Y, Sim F H, Pritchard D J, Rock M G, Chao E Y
Department of Orthopedics, Mayo Clinic/Mayo Foundation, Rochester, MN 55905.
Clin Orthop Relat Res. 1993 Jul(292):269-81.
Sixty-one patients treated with custom-made segmental total knee reconstruction after resection of a primary tumor of the distal femur were reviewed retrospectively. Two types of implants were used: the Walldius hinge prosthesis (Walldius Group, n = 45) and the Kinematic rotating hinge prosthesis (Kinematic Group, n = 16). The mean periods of follow-up observation were 6.4 years for the Walldius Group and 2.3 years for the Kinematic Group. The overall functional results in the Walldius Group were excellent in 7%, good in 26%, fair in 25%, and poor in 42% of the patients. Roentgenographic analyses showed that 50% of the patients had bony resorption, 33% had interface loosening, and 10% had prosthetic stems that were broken at the time of last follow-up evaluation. Forty-two complications occurred in 34 patients who needed additional surgical treatment. Nine of the prostheses in the Walldius Group failed (20%), and 27 of the complications (64%) associated with the use of the Walldius prosthesis occurred in the first three years after implantation. Nineteen Walldius prostheses (42%) were revised or removed for reasons other than local recurrence. The overall functional results of the Kinematic Group were as follows: excellent in 25%, good in 44%, fair in 25%, and poor in 6% of the patients. Roentgenographic analysis showed that there was no change in bone on 81% of the discharge roentgenograms, that there were no radiolucent lines in 87% of the prosthetic replacements, and that there were no radiolucent lines less than 2 mm thick on the roentgenograms. None of the Kinematic rotating hinge prostheses required revision, except one with a patellar button fracture, which was revised without compromising the functional results. Four complications occurred in three patients in the Kinematic Group, and two of them required surgical treatment. The patients with the Kinematic rotating hinge prosthesis had better early functional and roentgenographic results and fewer complications.
对61例在股骨远端原发性肿瘤切除后接受定制节段性全膝关节重建治疗的患者进行了回顾性研究。使用了两种类型的植入物：瓦尔迪厄斯铰链假体（瓦尔迪厄斯组，n = 45）和运动旋转铰链假体（运动组，n = 16）。瓦尔迪厄斯组的平均随访时间为6.4年，运动组为2.3年。瓦尔迪厄斯组患者的总体功能结果为：7%为优，26%为良，25%为中，42%为差。X线分析显示，50%的患者有骨质吸收，33%有界面松动，10%的患者在最后一次随访评估时假体柄断裂。34例患者出现42例并发症，需要额外的手术治疗。瓦尔迪厄斯组有9个假体失败（20%），与使用瓦尔迪厄斯假体相关的并发症中有27例（64%）发生在植入后的前三年。19个瓦尔迪厄斯假体（42%）因局部复发以外的原因进行了翻修或取出。运动组患者的总体功能结果如下：25%为优，44%为良，25%为中，6%为差。X线分析显示，81%的出院X线片上骨无变化，87%的假体置换处无透光线，X线片上无厚度小于2 mm的透光线。除1例髌骨纽扣骨折的运动旋转铰链假体进行了翻修且未影响功能结果外，其他运动旋转铰链假体均无需翻修。运动组3例患者出现4例并发症，其中2例需要手术治疗。使用运动旋转铰链假体的患者早期功能和X线结果更好，并发症更少。
