目的:全膝关节置换术(TKA)后的伸展机制病变是灾难性的并发症。伸肌机构同种异体移植(EMA)的重建已被描述为一种合理的抢救程序。其在长期和败血症病例中的有效性仍在审查中。已分析了无菌和败血症翻修TKA后慢性伸肌机制衰竭的EMA重建的长期结果。
方法:从机构数据库,回顾性分析了2005年至2015年进行EMA重建的35例翻修TKA(RevTKA)患者。在13例(37%)患者中发现了假体周围感染(PJI)的病史。平均随访81.2个月(±34.7,范围3-120)。EMA故障被认为是滞后超过20°,膝关节社会得分(KSS)低于60分,和/或在同种异体移植物修正的情况下。
结果:无菌组的平均KSS从35.9(±16.9,范围0-54)提高到86.6(±10.4,范围54-99)分(p<0.001),败血症组的平均KSS从27.5(±11.6,范围10-44)提高到79.4(±16.3,范围48-94)分(p<0.001)。无菌组的伸肌滞后从48.4°(±14.5,范围30-90)变为4.6°(±10.8,范围0-50)(p<0.001),败血症组的伸肌滞后从56.5°(±20.8,范围30-90)变为6.1°(±6.8,范围0-20)(p<0.001)。无菌组术后平均屈曲为105.2°(±13.2,范围75-130),脓毒症组为102.7°(±12.5,范围80-120)(p=0.32)。无菌组发生了3次失败(占病例的14%),败血症组发生了5次失败(占病例的38%)。10年总生存率为83.3%(22例,CI9594.2-121.7)vs58%(13例,CI9567.2-111.7)在无菌和脓毒症组中,分别(p=0.01)。
结论:TKA中伸肌机制破坏后的EMA重建是一种可靠的抢救程序。翻修的败血症性质降低了EMA后膝关节的功能,但它并不代表感染再破裂或复发的危险因素.
方法:三级。
OBJECTIVE: Extensor mechanism lesion after total knee arthroplasty (TKA) is a catastrophic complication. Reconstruction with extensor mechanism allograft (EMA) has been described as a sound salvage procedure. Its effectiveness at long term and in septic cases is still under scrutiny. The long-term results of EMA reconstruction for chronic extensor mechanism failures following aseptic and septic revision TKA have been analysed.
METHODS: From the institutional database, 35 patients with a revision TKA (RevTKA) undergoing EMA reconstruction from 2005 to 2015 have been retrospectively identified. A history of periprosthetic joint infection (PJI) was found in 13 (37%) patients. The mean follow-up was 81.2 months (± 34.7, range 3-120). EMA failures were considered for lag more than 20°, Knee Society Score (KSS) less than 60 points, and/or in the case of revision of the allograft.
RESULTS: The mean KSS improved from 35.9 (± 16.9, range 0-54) to 86.6 (± 10.4, range 54-99) points in the aseptic group (p < 0.001) and from 27.5 (± 11.6, range 10-44) to 79.4 (± 16.3, range 48-94) points in the septic group (p < 0.001). The extensor lag changed from 48.4° (± 14.5, range 30-90) to 4.6° (± 10.8, range 0-50) in the aseptic group (p < 0.001) and from 56.5° (± 20.8, range 30-90) to 6.1° (± 6.8, range 0-20) in the septic group (p < 0.001). The mean postoperative flexion was 105.2° (± 13.2, range 75-130) in the aseptic group and 102.7° (± 12.5, range 80-120) in the septic group (p = 0.32). Three failures (14% of the cases) occurred in the aseptic group and five in the septic group (38% of the cases). The overall survivorship at 10 years was 83.3% (22 cases, CI95 94.2-121.7) vs 58% (13 cases, CI95 67.2-111.7) in the aseptic and septic group, respectively (p = 0.01).
CONCLUSIONS: EMA reconstruction after extensor mechanism disruptions in TKA is a reliable salvage procedure. The septic nature of the revision decreased the functionality of the knee joint after EMA, but it did not represent a risk factor for re-ruptures or recurrence of infection.
METHODS: Level III.