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Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction

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Published on: December 3, 2017

切除压式骨整合植入物的技术

Germane Ong¹, Jason Shih Hoellwarth², Kevin Testworth³

¹Limb Reconstruction Centre, Macquarie University Hospital, Macquarie University, Macquarie Park, New South Wales, Australia.

JBJS essential surgical techniques

|March 7, 2024

概括

截肢者切除的穿皮骨整合 (TOFA) 由于骨的整合性强,可能具有挑战性. 本文详细介绍了安全有效的技术,在必要时去除压贴骨整合植入物.

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科学领域:

整形外科手术整形外科手术
生物医学工程生物医学工程
康复医学康复医学康复医学

背景情况:

截肢者的皮肤穿越骨整合 (TOFA) 与插座假肢相比,显著改善了生活质量和流动性.
由于感染,无菌松动或骨折,可能需要移除植入物,尽管骨整合植入物很少被移除用于周围假肢骨折.
移除深度集成的TOFA植入物可能具有挑战性,即使部分松动或植入物破裂.

研究的目的:

展示安全和有效的技术,以移除压装骨整合植入物.
为管理与骨整合植入物相关的并发症提供指导.
突出保护骨库的重要性,并尽量减少植入物切除期间的阳性损伤.

主要方法:

患者躺卧时进行手术,并仔细考虑使用带以尽量减少骨的热暴露.
根据需要,植入物去除技术从保守 (子,电线辅助) 发展到积极 (扩展骨切除术).
由于潜在的骨损伤和难以移除双接口,不建议使用三氨酸;骨切除术是首选的.

主要成果:

大多数与TOFA相关的感染不需要移除植入物,通常通过抗生素或有限的脱bridement解决.
修复性骨整合在恢复运动方面通常是成功的,患者经常在修复后达到类似的性能水平.
再植入通常在6-12周的消毒期后可行,涉及抗生素.

结论:

压骨整合植入物切除需要谨慎的技术来保持骨完整性,并促进潜在的修复手术.
对于感染,非手术治疗或更少的侵入性手术是首选的,除非严重和反复性.
在切除过程中最大限度地减少热损伤和骨损失对于成功的结果至关重要,无论是修复骨整合还是转换为插座假肢.