全膝关节置换术中螺丝钉数量与骨缺损严重程度关系的临床研究  

Relationship between screw numbers and severity of tibial bone defect in primary total knee arthroplasty

作　　者：郑充 周勇刚[1] 马海洋[1] 张卓[1] 付华昊 吴文明[1] 朴尚 杜银桥 王森[1] 

机构地区：[1]解放军总医院骨关节外科,北京100853 [2]北京大学社会学系,北京100871

出　　处：《中国骨伤》2016年第5期415-420,共6页China Journal of Orthopaedics and Traumatology

摘　　要：目的 ：总结使用全膝关节置换术治疗严重膝关节内翻畸形中,应用螺丝钉骨水泥技术重建胫骨平台骨缺损的临床经验,探讨使用螺丝钉数量与骨缺损严重程度的相关性。方法：2009年4月至2015年5月,34例（40膝）接受全膝关节置换术,术中应用螺丝钉骨水泥技术重建胫骨平台内侧骨缺损。其中男8例（8膝）,女26例（32膝）;年龄55~82岁,平均（65.00±7.25）岁。每例膝关节使用的螺丝钉数为1~6枚,其中2例结合使用了延长杆（分别使用4、5枚螺丝钉）。分别测量计算每例患者胫骨平台骨缺损面积百分比、骨缺损的深度并记录使用螺丝钉数量,经过统计学分析,探讨胫骨平台不同缺损百分比与使用螺丝钉数量的关系,同时分析骨缺损深度对使用螺丝钉数量的影响。结果：所有患者获随访,时间1~72个月,平均24个月。HSS评分术前（43.33±6.11）分（32~51分）,术后改善为（92.15±4.64）分（83~96分）,各单项评分包括疼痛、功能、活动度、肌力、屈曲畸形及稳定性均较术前提高。所有患者获得稳定且力线正常的膝关节,胫股角由术前（167.00±6.39）°改善为术后（175.00±2.69）°;胫骨角由术前（78.09±4.51）°改善为术后（88.75±1.24）°。螺钉骨水泥技术使用螺丝钉数量与骨缺损的面积和深度存在相关性,可据此构建相关性直角坐标图。结论：螺钉加强骨水泥技术是一种简便、安全、有效的处理胫骨内侧平台骨缺损的方法,中短期效果可靠。临床实践中可利用缺损严重程度与使用螺丝钉数量的相关性直角坐标图,根据术中的缺损面积百分比和深度,得到推荐使用的螺丝钉数。Objective：To summarize experience of using screws and cement to rebuild tibial bone defect in primary total knee arthroplasty（TKA）,and to discuss the relationship between the number of required screws and the severity of tibial bone defects. Methods：From July 2009 to May 2015,34 patients（40 knees） with varus knees underwent TKA,and the screw and cement technique was used to rebuild medial tibia plateau during operation. There were 8 males（8 knees） and 26 females（32knees）,and the average age was（65.00±7.25） years old（ranged,55 to 82 years old）. One to 6 screws were used in each case.Extension stems were used in 2 cases（4 and 5 screws was used respectively）. The area percentages of the bone defects measured as defect area / tibia plateau area,depth of each defect,the number of screws needed in each case,were all used to determine the relationship between the number of screws and the area percentage in certain depth of bone defect by statistic methods,as well as the relationship between screw number and defect depth. Results：All the patients were followed up and the average duration was 24 months（ranged,1 to 72 months）. The average preoperative HSS score was 43.33±6.11（ranged,32 to 51scores）. Whereas the average postoperative HSS score was 92.15±4.64（ranged,83 to 96 scores）. The preoperative individual scores including pain,function,activity,muscle strength,flexion deformity and stability were all improved compared with pre operation,and the differences were statistically significant. All the patients received normal alignment postoperatively,femoraltibial angle was improved from（167.00±6.39）° preoperatively to（175.00±2.69）° postoperatively,the tibial angle was improved from（78.09±4.51）° preoperatively to（88.75±1.24）° postoperatively. Both area percentage and depth of bone defect in a fitting Ologistic model had a significant statistical relationship with the screw number,and a rectangular coordinate system could be formed according to the rela

关 键 词：骨螺丝 关节成形术 置换 膝 胫骨 骨缺损 

分 类 号：R687.4[医药卫生—骨科学]