市售金属小梁胫骨锥结合逆行锁定髓内钉治疗胫骨-踝关节置换术骨缺损的初步经验。

Michael S Pinzur, Adam P Schiff, Kamran Hamid, Ryan LeDuc
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引用次数: 0

摘要

在接受胫骨踝关节置换术的肢体重建患者中,踝关节严重骨缺损的情况越来越常见。长期以来,大块异体移植的效果并不理想。有零星的初步报道称使用定制脊柱笼或三维打印钛植入物来解决关键的骨缺损问题;然而,这些装置的成本在许多临床实践环境中令人望而却步。本研究旨在报告使用市售金属骨架(Zimmer-Biomet)胫骨骺锥与逆行锁定髓内钉结合解决这一难题的初步经验。连续八名患者接受了胫骨踝关节置换术,使用的是市售的金属骨骺锥和逆行锁定髓内钉。5名患者因神经性(Charcot)骨吸收而出现骨质流失,3名患者因全踝关节置换术失败而接受了手术。所有 8 位患者最终都实现了临床和影像学愈合,并能穿标准鞋行走。一名患者术后在小腿骨锁定螺钉部位出现伤口感染,经过清创和肠外抗生素治疗后,感染痊愈。定制的三维钛植入物成功解决了踝关节的严重骨缺损问题。这组小型病例表明,使用从我们的关节置换同事那里借来的市售多孔钽骺垫片,并结合使用逆行锁定髓内钉,也能取得类似的临床效果:4级:回顾性病例系列。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Preliminary Experience With Commercially Available Trabecular Metal Tibial Cones Combined With a Retrograde Locked Intramedullary Nail for Bony Defects in Tibiotalocalcaneal Arthrodesis.

Critical sized bone defects in the ankle are becoming increasingly more common in patients undergoing limb reconstruction with tibiotalocalcaneal arthrodesis. Bulk allografts have not fared well over time. There have been scattered preliminary reports using custom spinal cages or 3D-printed Titanium Implants to address the critical bony defect; however, the cost of these devices is prohibitive in many clinical practice settings. The purpose of this investigation is to report the preliminary experience using a commercially available Trabecular Metal (Zimmer-Biomet) tibial metaphyseal cone combined with a retrograde locked intramedullary nail to address this challenging problem. Eight consecutive patients underwent tibiotalocalcaneal arthrodesis using a commercially available Trabecular Metal tibial metaphyseal cone combined with a retrograde locked intramedullary nail. Five developed bone loss secondary to neuropathic (Charcot) bony resorption and 3 underwent surgery for failed total ankle arthroplasty. All 8 patients eventually achieved clinical and radiographic healing and were able to ambulate with standard footwear. One patient developed a postoperative wound infection at the site of calcaneal locking screws, which resolved with debridement and parenteral antibiotic therapy. Critical bone defects about the ankle have successfully addressed with custom 3D titanium implants. This small series suggests that similar clinical outcomes can be achieved with the use of a commercially available porous tantalum metaphyseal spacer borrowed from our arthroplasty colleagues, combined with the use of a retrograde locked intramedullary nail.Levels of Evidence: Level 4: Retrospective case series.

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