S&H_no 5

LIFESTYLE ORTHOPEDIC QUARTERLY

SHCAAMLMPEELR&
2017
20
05No.
TM 20 Years Special Report

Voyage

Romantic River Cruise
Specialty Focus



2016 2017 ( Tr a b e c u l a r
2017 Metal) 20

Hammer & Hammer Scalpel

Scalpel &

TM cone

TM cup

TM cage

Letter From the

Editor
Scalpel & Hammer

Zimmer Biomet Scalpel & Hammer

11 35 7

| LIFESTYLE ORTHOPEDIC QUARTERLY
51 15

02-2732-8899
02-2739-0075

Happy Spring 2017 !

1

Content2017 Spring Issue

04 20 TM 20 Years Special Report
06
Reveal the Technology of Trabecular Metal
10
黑科技揭秘：淺談TM的原理及應用
12
Large Acetabular Bone Defect: Synergy of TM cup and Allograft

神骨交鋒：骨小樑髖臼杯與異體植骨的協力演出

林口長庚醫院 施信農教授 張智翔醫師

Spine Solutions with Trabecular Metal

鉭無虛發：骨小樑支架與脊椎手術的攻守同盟

振興醫院 周溫祥主任

The Management of Bone Defects in Revision Knee Arthroplasty
人工膝關節翻修手術合併骨缺損的治療策略
林口長庚醫院 張毓翰教授

Specialty Focus

16 Dealing with Traumatic OA Knee – Experience of Total Knee Arthroplasty with
Accelerometer – Based Navigation
20
24 以微型導航輔助進行全人工膝關節置換術之經驗
26
亞洲大學附設醫院 王大翊主任

Recalcitrant Distal Femoral Nonunion

頑固性遠端股骨骨折不癒合 顯微植骨重建
光田綜合醫院 楊鎮源醫師

Easy Steps to Optimal Femur Alignment

找尋股骨植入物最佳擺放位置

Clinical Trends

臨床趨勢

Out of OR

28 Romantic River Cruise
32
36 徜徉藍色多瑙河 圓一場浪漫河輪夢

Less for Luxury

減法奢華

The Delicacy in the Ally

巷弄尋香

邁入第20年的黑科技 LIFESTYLE ORTHOPEDIC QUARTERLY

立體多孔鉭金屬

TM 20 Years Special Report

鉭（Tantalum）是一種很特別的金屬材質，生物
相容性非常好，長期使用不會引起人體不良反應 1
，而且有絕佳的抗腐蝕特性，在高酸度環境下比
其他材質更不會耗損 2，以鉭為原料的「立體多孔
鉭金屬（Trabecular Metal, TM）」從 1997 年開始
應用在人工關節植入物和替代移植骨，迄今已逾
20 年，已被廣泛使用於脊椎以及關節置換手術，
並且持續帶來令人驚艷的療效。

TRABECMUELTAARL

3

立體多孔鉭金屬20週年特輯
TM 20 Years Special Report

Reveal the Technology of
Trabecular Metal

黑科技揭秘：

淺談TM的原理及應用

高摩擦力 3 0.88

TM

高開孔率 5 4
4
70%~80%

6

彈性模量 3

TM TM

3

抗菌新論

In Vitro TM
7 In Vivo

TM
8 NJR

TM Cup

9

TM

10 TM

7

EFFECTIVE TRABECULAR METAL LIFESTYLEORTHOPEDICQUARTERLY

◇脊椎 11

• 左圖：取出的頸椎融合TM Cage，可看出骨頭已確實長好
TM Cage 長滿 （植入28個月）13

• 右圖：組織染色證明骨頭與組織往內長入，並與深部表面
完全結合（粉紫色的區域代表骨頭；橘黃色為纖維
PEEK 組織；黑色為TM）13
•
FAST
TM Cage

12

◇髖膝 15 14-16, 19 左圖：術後X光片顯示圓頂處的空洞42
14, 15 右圖：術後12週發現骨頭已開始生長填補42
• TM Cup
12 RELIABLE

• TM Cup

8, 14, 17

40% 18

• 50%

TM Cup

19-37

• 左圖：因反覆脫臼而取出的TM Cup（植入50個月）42

38 右圖：表面全部被新生骨長滿覆蓋，肉眼即可看出超優異的
骨生長能力42

• TM Cone

39-41

參考資料

5

立體多孔鉭金屬20週年特輯
TM 20 Years Special Report

L arge Acetabular Bone Defect:
Synergy of TM cup and Allograft
/

(Aseptic loosening) (morselized bone chip) (TM cup) TRABECULAR METAL LIFESTYLEORTHOPEDICQUARTERLY
(Osteolysis) [7]

(mechanical support) (Hip 1. (Arthrotomy)
center) (upper
migration)

(metal mesh and bone (pelvis discontinuity)
(ideal hip center)
graft) (structural allograft)
(posterior column or anterior column)
(cemented cup) (cage,

reinforcement ring) (oblong cup)

(high hip center)

(trabecular metal, TM) (osteophyte)

trial

(cementless cup) 2.
2~3

50% (segmental
(shelf, superior segmental or minor
defect)
column defect)
10 L

20~30%[1,2]
50%

[3]

( 3~7 )
[4,5]

(Bone ingrowth)

7

立體多孔鉭金屬20週年特輯
TM 20 Years Special Report

calcar 1

70 10

X

press-fit ()
(reaming)
3~4 (4 or 6.5mm) X
3.
(reverse reaming) (superior segmental defect)

Paprosky IIA (migation <3cm, up and in) AAOS III

(medial cavitary and superior segmental)

X

30% (Gross IV, <50%)

(TM cup)

() X

()

2 ingrowth) (bone remodeling) TRABECULAR METAL LIFESTYLEORTHOPEDICQUARTERLY

75 20

X

() Reference:

X 1. Sporer SM, O'Rourke M, Chong P, et al. The use of
structural distal femoral allografts for acetabular
(superior segmental defect) Paprosky IIIA reconstruction. Average ten-year follow-up. J Bone
Joint Surg Am. 2005;87:760-765.
(migration >3cm, up and out) AAOS III (medial
2. Lee PT, Raz G, Safir OA, et al. Long-term results for
cavitary and superior segmental) minor column allografts in revision hip arthroplasty. Clin
Orthop Relat Res. 2010;468:3295-3303.
X
3. Garcia-Cimbrelo E. Porous-coated cementless
25% (Gross IV, <50%) acetabular cups in revision surgery: a 6- to 11-year
follow-up study. J Arthroplasty. 1999;14:397-406.
(TM cup) ()
X 4. Gerber A, Pisan M, Zurakowski D, et al. Ganz
reinforcement ring for reconstruction of acetabular
() defects in revision total hip arthroplasty. J Bone Joint
Surg Am. 2003; 85-A:2358-2364.
cup) (TM
50% 5. Callaghan JJ, Salvati EA, Pellicci PM, et al. Results of
90%[6] 2 revision for mechanical failure after cemented total hip
replacement, 1979 to 1982. A two to five-year follow-
(subchrondral bone) up. J Bone Joint Surg Am. 1985;67:1074-1085.
(bone
6. Lakstein D, Backstein D, Safir O, et al. Trabecular Metal
cups for acetabular defects with 50% or less host bone
contact. Clin Orthop Relat Res. 2009;467:2318-2324.

7. Bobyn JD, Stackpool GJ, Hacking SA, et al. Characteristics
of bone ingrowth and interface mechanics of a new
porous tantalum biomaterial. J Bone Joint Surg Br.
1999;81:907-914.

9

立體多孔鉭金屬20週年特輯
TM 20 Years Special Report

Spine Solutions
with Trabecular Metal

Q Trabecular Metal Q TM ?
(TM) A level ACDF
?

A 89

THA

TM cup 1.

2.
3. TM cage

ant. Plate TLIF TM cage TRABECULAR METAL LIFESTYLEORTHOPEDICQUARTERLY

Q TM cage ?

A ACDF

cage stand-alone

2-3 2-3

Q TM cage ?
cage + bone
A TM TLIF
3-4
1. 6-8

2.

3.

4. TM cage Q TM cage
?
graft
A TM cage

Q PEEK Titanium cage

TM cage ?

A cage TM
TM
PEEK

PEEK PEEK

DBM

TM

Q TM cage ?

A TM spine RA
TM cage
500

53 y/o, F, C4/5,C5/6 disc herniation ACDF with TM cages stand-alone
+ stenosis with neck pain and Rt s/p Op. for 3 years
upper limb pain for 6 months

Q TM
cage ?

A Mis TLIF Mini-open
PEEK
cage
Mini-open

TM

X-RAY 63 y/o, F, L4/5, L5/S1 deg. Unilateral TLIF with TM cages s/p Op. for 3
spondylolisthesis and years
stenosis, low back pain and
Lt leg pain for one year

11

立體多孔鉭金屬20週年特輯
TM 20 Years Special Report

/

The Management of Bone Defects
in Revision Knee Arthroplasty

septic loosening Anderson
bone quality Orthopaedic Research Institute (AORI) [1]
bone stock
contained bone defects
metal augments wedges
joint line

[2]

modular system joint line fibula head

joint line

flexion gap extension gap

strut allograft boneTRABECULAR METAL LIFESTYLEORTHOPEDICQUARTERLY

allograft bone

[3, 4]

2007 1 2012 1

2024 fresh frozen

allograft bone

24 (surgical side

infection) 1.2% (24 / 2024)

fresh frozen

allograft bone

[5]

Modular metal augment

modular metal augment metal

augment

metal augment allograft

AORI Type I cement bone metal augment
screw
metal augment

AORI Type I failure rate 48% allograft
morsellised bone graft
screw cement cement bone metal augment 19.2% failure rate
50% bone defect
5 mm [6] metal augment
bone cement
low activity

demand life expectancy

10 allograft bone

AORI Type II non-contained
bone defects morsellised bone graft

AORI Type II Fresh Frozen Strut Allograft bone

13

立體多孔鉭金屬20週年特輯
TM 20 Years Special Report

AORI Type III Fresh Frozen Strut Allograft bone

AORI Type III metal augment allograft bone
metal augment

hinged prosthesis metaphyseal bone defect TM

tumor prosthesis cones

AORI Type III

structural allograft cones Reference:

metaphyseal sleeves 1. Engh, G.A. and D.J. Ammeen, Bone loss with revision
total knee arthroplasty: defect classification and
metaphyseal bone defect alternatives for reconstruction. Instr Course Lect,
cones metaphyseal sleeves 1999. 48: p. 167-75.

Trabecular metal revision knee cones 2. Innocenti, M., et al., Joint line position in revision
total knee arthroplasty: the role of posterior femoral
trabecular metal osteoconduction off-set stems. Knee, 2013. 20(6): p. 447-50.

bone healing rate 3. Tomford, W.W., et al., Frozen musculoskeletal allografts.
A study of the clinical incidence and causes of
bone graft infection associated with their use. J Bone Joint
Surg Am, 1990. 72(8): p. 1137-43.
extension stem
4. Hart, M.M., E.D. Campbell, Jr., and M.G. Kartub,
extension stem Bone banking. A cost effective method for
establishing a community hospital bone bank. Clin
isthmus Orthop Relat Res, 1986(206): p. 295-300.

34 partial weight 5. Wu, C., et al., A positive bacterial culture from allograft
bone at implantation does not correlate with
bearing subsequent surgical site infection. Bone Joint J,
2015. 97-B(3): p. 427-31.
bone
6. Hockman, D.E., D. Ammeen, and G.A. Engh, Augments
graft and allografts in revision total knee arthroplasty:
Fresh frozen allograft bone usage and outcome using one modular revision
prosthesis. J Arthroplasty, 2005. 20(1): p. 35-41.



專題報導
Specialty Focus

D ealing with Traumatic OA
Knee – Experience of Total Knee
Arthroplasty with Accelerometer –
Based Navigation

interlocking nail

cannulated screw

dynamic hip

screw locking plate IM alignment

guide distal femoral cutting

femoral component rotation

traumatic OA knee

IM alignment

long stem THR guide

LIFESTYLE ORTHOPEDIC QUARTERLY

17

專題報導
Specialty Focus

total hip replacement long stem IM alignment guide
IM alignment guide long stem
free femoral canal
hand cutting free

hand cutting

0.5 femur tibia
femoral mechanical axis 0.4o 0.95o
tibial mechanical axis
0.7o 1.07o tibial

slope -0.05o 0.78o guiding

component

15 90% 10 98% alignment

varus deformity alignment
bowing femoral shaft tibial shaft

traumatic OA knee

LIFESTYLE ORTHOPEDIC QUARTERLY

19

專題報導
Specialty Focus

(/ )

R ecalcitrant Distal Femoral
Nonunion

[1] mechanical
28
(biological) nonunion autograft
(mechanical) [2]

() allograft

strut bone cortical

bone cancellous

[4] bone[5]

( tricortical bone / cancellous bone / strut bone
)
(BMI>30) non- (intramedullary)

locking plate

(structure bone (extramedullary)

loss)[4] strut bone fibula recalcitrant

X-ray case

distal femur medial cortex structure bone loss [6]
intramedullary free vascularized fibula graft

bone graft biological nonunion site
Bone graft

LIFESTYLE ORTHOPEDIC QUARTERLY

21

專題報導
Specialty Focus

descending genicular femoral nonunion

artery/vein recipient vessel defect Reference:

size 8 free vascularized 1. Kregor PJ, Stannard JA, Zlowodzki M, Cole PA: Treatment of distal
femur fractures using the less invasive stabilization system: Surgical
fibula graft locking plate experience and early clinical results in 103 fractures. J Orthop Trauma
2004;18(8):509-520
pedicle
2. Ebraheim NA1, Martin A, Sochacki KR, Liu J. Nonunion of distal femoral
cancellous bone graft locking plate fractures: a systematic review. Orthop Surg. 2013 Feb;5(1):46-50.

polyaxial screw fibula interlock 3. Rodriguez EK, Boulton C, Weaver MJ, Herder LM, Morgan JH, Chacko AT,
Appleton PT, Zurakowski D, Vrahas MS. Predictive factors of distal femoral
fibula graft pedicle fracture nonunion after lateral locked plating: a retrospective multicenter
case-control study of 283 fractures. Injury. 2014 Mar;45(3):554-9.
graft consolidation bone
/ bridging callus formation 4. Ricci WM, Streubel PN, Morshed S, Collinge CA, Nork SE, Gardner MJ.
Risk factors for failure of locked plate fixation of distal femur fractures: an
0-120 analysis of 335 cases. J Orthop Trauma. 2014 Feb;28(2):83-9.

the orthopedic surgeon should behave more like a 5. Al-Zahrani S, Harding MG, Kremli M, Khan FA, Ikram A, Takroni T. Free
fibular graft still has a place in the treatment of bone defects. Injury. 1993
gardener than a carpenter Sep;24(8):551-4.

6. Beris AE, Lykissas MG, Korompilias AV, Vekris MD, Mitsionis GI, Malizos KN,
Soucacos PN. Vascularized fibula transfer for lower limb reconstruction.
Microsurgery. 2011 Mar;31(3):205-11.

structure bone loss recalcitrant distal

LIFESTYLE ORTHOPEDIC QUARTERLY 23

專題報導
Specialty Focus

LIFESTYLE ORTHOPEDIC QUARTERLY 25

臨床趨勢
Clinical Trends

LIFESTYLE ORTHOPEDIC QUARTERLY 27

春季生活特輯
Out of OR

Romantic
River
Cruise
徜徉藍色多瑙河
圓一場浪漫河輪夢

Text MANSION Photo

1

1

LIFESTYLE ORTHOPEDIC QUARTERLY 29

AVALON
Patrick

2

1.
2.

春季生活特輯
Out of OR

奢華的河上時光

May : 4.
AVALON
5.
AVALON

6.

7.
May

Lounge VIP

AVALON

4

舒適深入的玩法 6 5
7
Melk Wachau
Sofitel
Ale 31

Four Seasons

LIFESTYLE ORTHOPEDIC QUARTERLY

春季生活特輯
Out of OR

LessLfourxury
Text MANSION Photography (ianwed.com)

Place Le Fumoir(02-27382786)

Liquor EDRINGTON TAIWAN LTD. Pernod Ricard Taiwan

Glass Iittala

Wallpaper Urban Trace

BEEFEATER 24 Martell Noblige Cognac Snow Leopard Vodka SHIN BRANDY UMESHE Shin Classic Blended Whisky Highland Park 12Y

Bar 12
Tequila
Gin Whisky Brandy Vodka Rum
Spirit
Sake

2013 Heering Sling Award

Bar 20 Arman

Arman 5

Arman

Arman Mansion 6

Le Fumoir Arman LIFESTYLE ORTHOPEDIC QUARTERLY

33

春季生活特輯 Snow Leopard Vodka
Out of OR

Highland Park 12Y

Highland Park

Sparrow Stephen
Grain Spelt

1800

Highland Park

Recipe & Made Recipe & Made

BEEFEATER 24 Snow Leopard Vodka
3oz
highland park 12Y 2oz
6
1 dash 1 dash
Snow Leopard Vodka

1 dash 1 dash

vermouth rosso 1 ml

Highland Park Arman
Leopard Vodka
12Y Snow

Arman
shake

Highland Park 12Y

Martell Noblige Cognac Shin Classic Blended Whisky

Shin

Classic Blended Whisky

2

Recipe & Made Recipe & Made

Martell Noblige Cognac 2oz Shin Classic Blended Whisky 2oz
1 1
1 dash
1dash
1dash Bitters 1 dash
vermouth rosso 1 dash

Martell Noblige Cognac Arman Shin Classic Blended Whisky
Sazerac
Arman

Betters
Arman

Sazerac Bitters

LIFESTYLE ORTHOPEDIC QUARTERLY

35

春季生活特輯
Out of OR

The Delicacy
in the Ally
巷弄尋香

Text Photography MANSION

LIFESTYLE ORTHOPEDIC QUARTERLY

37

春季生活特輯
Out of OR

1 34

2

瑞典設計美學
揭露神秘面紗

Villa Ollila

Villa Ollila 與瑞典建築師的結緣故事
Villa Ollila

Polous

Villa Ollila Le Moût
Villa Ollila

Mr. Ollila

Polous

Villa Ollila Dennis Lai Villa Ollila 7
Polous
Dennis

1

可過夜的斯堪地那維亞式私人招待所 2
Villa Ollila

Mr. Ollila Polous
Mr. Ollila

Polous Villa Ollila

5 1980 Bang & Olufsen
Jaeger LeCoultre Atom 561
1.2. Villa Ollila Smeg
3. 54
4. Mr. Ollila LIFESTYLE ORTHOPEDIC QUARTERLY
5. 15

39

春季生活特輯 Villa Ollila 6.
Out of OR Polous 7. 25
8.
山海饗宴 Dennis
舌尖上的法國

7 Dennis

注入濃郁情感的當季絕美菜式
Dennis

Dennis
25

15 Dennis

54

6

78