初次膝关节置换Rand C型胫骨缺损处理分析  

Treatment of Rand C tibial defects in primary total knee arthroplasty

作　　者：闫飞[1] 代端明[1] 王栋[1] 曹虎[1] 陈权书 熊永发[1] 秦志华[1] 周林[1] 贺家州 高登宁 杨胜龙[1] 

机构地区：[1]贵州医科大学第三附属医院骨科,贵州都匀558000

出　　处：《中国现代医学杂志》2016年第17期63-66,共4页China Journal of Modern Medicine

摘　　要：目的探讨严重膝内／外翻并骨性关节炎初次关节置换胫骨Rand C型缺损的处理措施。方法8例（13膝）严重膝内／外翻并骨性关节炎Rand C型骨缺损患者。2膝外翻，11膝内翻；男2例（3膝），女性5例（10膝）；年龄56～81岁，平均67岁。4膝自体骨移植，7膝螺钉骨水泥填充，2膝金属垫块。术后随访6～39个月，平均23个月。记录患者术前、术后3d、3个月、1年和末次随访x线平片及Lysholm评分结果。结果膝关节Lysholm评分，术前（21．150±4．059）分，术后末次随访平均（91．230±6．153）分，术后优于术前，有统计学意义（t=-56．157，P=0．000），其中优（≥90分）4例（8膝），良（80～89分）4膝，中1膝76分，优良率92．3％，术后末次随访复查x线平片可见植骨均愈合，未见移位、骨吸收、骨溶解、胫骨平台塌陷、假体松动及感染征象。结论在初次全膝关节置换胫骨近端RandC型骨缺损的治疗中，自体植骨、螺钉骨水泥、金属垫块为胫骨假体提供良好的初始稳定性和近期疗效。Objective To explore the treatment measure for Rand C tibial defects with severe genu varum or valgum and osteoarthritis in total knee arthroplasty （TKA）. Methods Eight patients （13 knees） suffered from severe genu varum or valgum and osteoarthritis and Rand C tibial defects. Two knees suffered from genu val- gum and 11 knees suffered from genu varum. There were 3 knees involved in men and 10 knees in women. The average age was 67 years （from 56 to 81 years）. Autogenous bone graft was used for 4 knees, screw bone cement filling for 7 knees and metal augmentation for 2 knees. The patients were followed up for 6-39 months （average 23 months） after operation. The X-ray and Lysholm scores were recorded before operation, 3 days, 3 months and 1 year after operation and at last follow-up. Results The Lysholm score was （21.150± 4.059） before operation, （91.230 ± 6.153） at last follow-up with significant difference （t=-56.157, P= 0.000）. Eight knees were excellent with Lysholm score more than 90, 4 knees were good with Lysholm score between 80 and 89, and 1 knee was moderate with Lysholm score 76. The excellent and good rate was 92.3%. At the last follow-up, the graft bones of all patients were healed, there was no complication as bone displacement, bone resorption, osteolysis, tibial plateau collapse, prosthesis loosening, or infection. Conclusions Autologous bone graft, compound of metal screw and bone cement, and metal augmentation can provide effective treat- ment for Rand C bone defect of proximal tibia in the primary total knee arthroplasty, achieve excellent initial stability and short-term clinical effect.

关 键 词：膝 关节置换 骨缺损 胫骨 

分 类 号：R684.2[医药卫生—骨科学]