ROENTGEN STEREOPHOTOGRAMMETRIC ANALYSIS AS A PREDICTOR OF MECHANICAL LOOSENING OF KNEE PROSTHESES
ROENTGEN STEREOPHOTOGRAMMETRIC ANALYSIS AS A PREDICTOR OF MECHANICAL LOOSENING OF KNEE PROSTHESES
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DOI：
10.1302/0301-620x.77b3.7744919
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发表时间：
1995-05-01
影响因子：
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通讯作者：
TOKSVIGLARSEN, S
中科院分区：
文献类型：
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作者：
RYD, L;ALBREKTSSON, BEJ;TOKSVIGLARSEN, S
我们对1988年以前143例全膝关节置换术患者的胫骨部件进行了为期13年的微动评估，使用了伦线立体摄影分析（RSA）。在所有病例中，假体的固定在临床上保持良好，尽管有7例因其他原因需要翻修。在第二组中，从我们完整的数据库中收集到的所有RSA病例中，到1990年，15个胫骨假体从插入到首次关节置换术后1到11年，都进行了RSA手术，对胫骨假体进行了机械松动的修正；其中12个包括基础组的所有松动，因此总共有155个连续病例，而另外3个是在基础材料汇编后插入的。第一组平均每年迁移约1毫米，但随后的迁移速度较慢，在十年后达到平均约1.5毫米，约三分之一的人在整个随访期间持续迁移，而三分之二的人在一至两年后停止迁移。复习组有14个组件连续迁移，且在一年内明显多于第一组，1例复习病例缺乏关键的一年随访，无法分类。这些发现表明机械松动在术后早期就开始了。在此阶段，20%的异常移位的胫骨部件可能在手术后10年才出现需要翻修的临床症状。RSA可以在一到两年的时间里用于识别有松动风险的假体，预测率约为85%。
The tibial components in 143 patients with total knee replacements performed before 1988 were assessed for micromotion using roentgen stereophotogrammetric analysis (RSA) over a period of 13 years. The fixation of the prostheses remained clinically sound in all cases, although revision had been required for other reasons in seven.In a second group taken from all cases with RSA available on our full database to 1990, 15 tibial components had been followed by RSA from the insertion until, 1 to 11 years after the initial arthroplasty, they were revised for mechanical loosening of the tibial component; 12 of these comprised all the loosenings in the base group, thus making a total of 155 consecutive cases, while an additional three were inserted after the base material had been compiled.The mean migration in the first group was about 1 mm at one year, but subsequent migration was slower, reaching a mean of about 1.5 mm after ten years, About one-third migrated continuously throughout follow-up, while two-thirds ceased to migrate after one to two years.In the revision group, 14 components had migrated continuously and at one year significantly more than those in the first group, One revision case lacked the crucial one-year follow-up and could not be classified.These findings suggest that mechanical loosening begins early in the postoperative period. Clinical symptoms which necessitate revision, seen at this stage in 20% of abnormally migrating tibial components, may not appear until up to ten years after the operation. RSA can be used at one to two years to identify prostheses 'at risk' of loosening with predictive power of about 85%.