重度膝内翻伴骨缺损的全膝表面置换术中的自体骨移植治疗  

Autogeneous bone graft in the treatment of total knee arthroplasty for severe genu varus with tibial plateau bone defect

作　　者：裴征[1] 关振鹏[1] 张绍龙[1] 李云鹏[1] 张卓[1] 

机构地区：[1]北京大学人民医院,关节病诊疗研究中心,北京100044

出　　处：《北京大学学报（医学版）》2011年第5期707-713,共7页Journal of Peking University:Health Sciences

摘　　要：目的:通过对全膝表面置换术中严重内翻畸形伴内侧骨缺损的处理,介绍应用自体骨移植术进行胫骨平台重建的方法和效果。方法:本研究组2007年4月至2011年3月共对16例(19膝)有重度内翻畸形伴内侧骨缺损的膝骨关节炎患者进行初次关节置换术,平均内翻32°(25°～45°),平均年龄66±8岁(52～77岁)。术前膝关节功能:平均活动范围为62°(37°～90°),平均KSS(knee society scure)评分为18分(-24～41分),平均功能评分为13分(-21～43分)。术中将胫骨内侧平台倾斜型骨缺损修整成台阶状水平型骨缺损;将截下的外侧胫骨平台骨块修整后使其厚度和形状与缺损处匹配,并将带有皮质骨的部分尽量放置在台阶状缺损的外缘,以承受平台的压力;置入假体时,在植骨块侧方加压至骨水泥固化。16例中3例(3膝)使用了胫骨平台侧延长柄假体,所有膝关节假体均采用抗生素骨水泥固定。结果:术后平均随访25个月(3～50个月),患肢畸形得到矫正,术后3个月均可弃拐行走,生活自理;术后膝关节活动范围(range of motion,ROM)平均为112°(95°～125°);术后随访KSS膝关节评分平均为86分(71～93分)、膝关节功能评分平均为88分(74～96分);尚未发现有自体移植骨的不愈合、移位、骨折和胫骨假体松动者,同时也未见因术后迟发性感染或植骨吸收再次出现膝内翻畸形和假体松动而行翻修手术的患者。结论:在重度膝内翻伴骨缺损的全膝关节表面置换术中,有多种重建方式以恢复胫骨平台的稳定性,本研究采用了台阶状胫骨平台重建自体骨移植的方法,该方法不仅可以恢复胫骨平台的完整性,提供了良好的初始稳定性,较其他方法减少了内置物,同时具有可靠的相容性,减少了术后感染的可能,获得了满意的初期治疗效果。Objective：To introduce the method and experience of autogeneous bone graft for tibial pla-teau reconstruction during the procedure of total knee arthroplasty for severe varus knees with bone defect in the medial tibial plateau.Methods： From April 2007 to March 2011,19 knees of 16 osteoarthritic patients who had serious genu varus with bone defect in medial tibial plateau underwent primary total knee arthroplasty,their mean varus degree being 32°（25°to 45°）,and average age 66±8 years（52 to 77 years）.Their preoperative knee functions are as follows： the average range of motion（ROM） was 62°（37°to 90°）;average knee society scure（KSS） knee score was 18 points（-24 to 41 points）;average function score was 13 points（-21 to 43 points）.During operation,the slope bone defect of the medial tibial plateau was dressed into step-shape horizontal bone defect by osteotomy,and then the defect was restored with the resected tibial plateau autograft whose thickness and shape were matched in advance;and the high-intensity cortical part of the autograft was placed on the rim,to sustain the tibial prosthesis;and a lateral pressure from the rim had to be maintained to the autograft until the cement under tibial prosthesis solidified.The long-stem tibial prostheses were used in 3 patients（3 knees）.All knee prostheses were fixed using antibiotic bone cements.Results： The average follow-up after TKR was 25 months（3 to 50 months）,the average ROM was 112°（95° to 125°）;average KSS score 86 points（71 to 93 points）,and knee function score 88 points（74 to 96 points）.The nonunion,shift,fracture of the autologous graft bone were not found;no tibial prosthesis became loose,either;no knee was revised for delayed infection or recurrent varus due to autologous graft bone absorption.Conclusion： In TKA for severe varus osteoarthritic patients with bone defect in the tibial plateau,there are various ways to regain its stability,and reconstruction is adopted by using step-shape allograft

关 键 词：膝关节 关节成形术 置换 膝 骨移植 移植 自体 骨重建 

分 类 号：R684[医药卫生—骨科学]