Calton T F, Fehring T K, Griffin W L
Wasatch Orthopaedic Clinic, Ogden, UT, USA.
Clin Orthop Relat Res. 1997 Dec(345):148-54.
Twenty-five knees in 24 patients with infected total knee replacements were treated with debridement, component removal, and insertion of an antibiotic impregnated cement spacer block. Intravenous antibiotics were administered for 6 weeks during which time the patients' knees were kept in a knee immobilizer nonweightbearing. These cases were reviewed retrospectively to determine radiographically the amount of bone loss that occurred during the period before reimplantation. Tibial and femoral bone loss occurred frequently from invagination of the cement spacer block into the femoral and tibial cancellous bone. Tibial bone loss was present in 10 (40%) cases and averaged 6.2 mm. Femoral bone loss was present in 11 (44%) cases and averaged 12.8 mm. Bone loss was more common when spacer blocks were undersized. None of the 15 spacer blocks that were made with a small intramedullary stem displaced. Three of the remaining 10 spacer blocks made without an intramedullary stem did displace with associated bone loss. Antibiotic spacer blocks used in the two-stage treatment of infected total knee replacements can be associated with subsequent tibial and femoral bone loss.
24例感染性全膝关节置换患者的25个膝关节接受了清创、取出假体以及植入抗生素骨水泥间隔物的治疗。静脉使用抗生素6周，在此期间患者的膝关节使用膝关节固定器固定，不负重。对这些病例进行回顾性研究，以通过影像学确定再次植入前这段时间内发生的骨丢失量。骨水泥间隔物陷入股骨和胫骨的松质骨中常常导致胫骨和股骨骨丢失。10例（40%）出现胫骨骨丢失，平均为6.2毫米。11例（44%）出现股骨骨丢失，平均为12.8毫米。当间隔物尺寸过小时，骨丢失更为常见。15个带有小髓内柄的间隔物均未发生移位。其余10个没有髓内柄的间隔物中有3个发生了移位并伴有骨丢失。用于感染性全膝关节置换二期治疗的抗生素间隔物可能会导致随后的胫骨和股骨骨丢失。
