膝关节翻修术的现状与未来
The current status and future of knee joint revision surgery
裴福兴 1谢锦伟1
作者信息
- 1. 四川大学华西医院骨科,成都 610041
- 折叠
摘要
近十多年来,随着加速康复理念的提出、膝关节翻修假体及定制型垫块或假体的研制和应用,膝关节翻修术进入了快速发展的阶段.但关节外科医生因此面临新的临床挑战,即假体周围感染的可能.术前应全面检查排除感染,改善全身情况至最佳状态;全面评估软组织、骨缺损类型和程度;选择合适的手术入路、骨重建策略及假体类型,最终恢复膝关节的力线、稳定性及活动度.未来需要关注膝关节翻修技术团队的建立,包括术前规划、3D打印、手术技术、加速康复围手术期管理;还应加强初次膝关节置换术的高质量管理,从根本上减少膝关节翻修率;更需要加强假体周围感染的防控措施与假体周围骨折的预防,以及建立高质量的随访体系.
Abstract
With enhanced recovery after surgery(ERAS),research and application of knee revision protheses and custom-ized components or prostheses in the past decade,revision of total knee arthroplasty(TKA)is developing rapidly.However,peri-prosthetic joint infection(PJI)has always been a major clinical challenge.A comprehensive preoperative examination to find any potential infection sites should be conducted.The overall condition of the patients should be improved.Surgeons should evaluate the classification and degree of soft tissue and bone defects comprehensively and carefully select appropriate surgical approaches,bone reconstruction strategies,and revision prostheses to ultimately restore the alignment,stability,and the range of motion of the knee joint.In the future,efforts should be made to build a team of experts for the support of revisions of TKAs,including preopera-tive planning,3D printing,surgical techniques,and ERAS.Nevertheless,primary TKAs protocols should always be firmly sticked to,which are a key to a low rate of revision surgeries.Prevention of PJIs and periprosthetic fractures,as well as establishing a high-quality follow-up system are of the same importance.
关键词
假体周围骨折/假体相关感染/术后加速康复/膝关节翻修Key words
Periprosthetic fracture/Prosthesis-related infections/Enhanced recovery after surgery/Knee joint revision引用本文复制引用
出版年
2024
NETL
NSTL
万方数据