全膝关节置换术治疗胫骨平台骨折后创伤性关节炎中期疗效  

The Mid-term Outcome of Total Knee Arthroplasty on Secondary Traumatic Arthritis After The Treatment of Tibia Plateau Fracture

作　　者：赵光辉[1] 贺强[1] 马建兵[1] 肖琳[1] Zhao Guanghui;He Qiang;Ma Jianbing(Knee Joint Surgery,Red Cross Hospital,Xi'an Jiaotong University,Xi'an 710054,China)

机构地区：[1]西安交通大学医学院附属红会医院膝关节外科

出　　处：《实用骨科杂志》2019年第9期790-794,798,共6页Journal of Practical Orthopaedics

摘　　要：目的探讨全膝关节置换术治疗胫骨平台骨折后创伤性关节炎的临床疗效。方法回顾性分析2007年1月至2017年1月,获得随访的13例全膝关节置换术治疗胫骨平台骨折后创伤性关节炎患者的临床资料,其中男9例,女4例;年龄43~75岁,平均57岁。胫骨平台骨折按Schatzker分型,Ⅰ型1例,Ⅱ型3例,Ⅲ型4例,Ⅳ型3例,Ⅴ型2例。其中骨折保守治疗3例,切开复位内固定10例。骨折至全膝置换手术的间隔时间1~14年,平均7年。应用美国膝关节协会评分(knee society score,KSS)和功能评分对全膝关节置换术(total knee arthroplasty,TKA)术前和术后随访进行评估。术前TKA膝关节屈伸活动范围(78.5±32.5)°,KSS评分(63.8±12.1)分,功能评分(62.8±9.8)分。结果根据术中情况,6例患者选择后稳定型假体;3例患者因平台骨缺损选择螺钉水泥处理;3例患者因骨缺损选择胫骨侧延长杆加垫块处理;1例患者因内侧韧带部分损伤选择限制性膝关节假体(legacy constrained condylar knee,LCCK)。本组13例患者中,1例患者术后出现伤口并发症,经治疗后痊愈;3例患者术后出现肌肉间隙静脉血栓,给予抗凝保守治疗;1例患者术后发生了僵直膝,给予麻醉下手法松解。术后随访时间12~113个月,平均68个月。末次随访时KSS评分(81.7±11.1)分,功能评分(83.5±15.4)分,膝关节屈伸活动度(105.4±18.2)°,与术前相比差异有统计学意义(P<0.05)。结论应用TKA治疗以往胫骨平台骨折后发生的创伤性关节炎,可明显改善功能,缓解疼痛,恢复肢体的下肢力线,确保假体达到软组织平衡,但手术技术要求较高,容易出现伤口并发症。Objective To investigate the clinical outcome of total knee arthroplasty on secondary traumatic arthritis after tibia plateau fracture.Methods From January 2007 to January 2017,13 consecutive patients underwent TKA after tibial plateau fracture,including 9 males and 4 females,with the average age of 57 years,ranging from 43 years to 75 years.The fracture was classified according to Schatzker.There were 1 case of type Ⅰ,3 cases of type Ⅱ,4 cases of type Ⅲ,3 cases of type Ⅳ and 2 case of type Ⅴ.The treatment method were conservative treatment in three cases,and open reduction and internal fixation in ten cases.The mean interval between fracture and knee arthroplasty was 7 years (range:1to 14 years).Patients were assessed pre-operatively and post-operatively using knee society score (KSS) and function score.The flexion and extension ROM of the knee joint was (78.5±32.5)° pre-operatively.The KSS score was (63.8±12.1),function score was(62.8±9.8) pre-operatively.Results Implant selection varied according to the pathology found at surgery.Six cases used the posterior stabilized implants.Three cases with tibia bone defect used bone and screws.In three cases,metal wedges and stem were used.Only one case used the constrained implant because of injury of medial collateral ligament.Complications included wound complication in one case,deep venous thrombosis in three cases and stiff knee in one case.Patients were followed up for 68 months on average (range:12 to 113 months).At last follow-up,the KSS score was(81.7±11.1) and function score was (83.5±15.4),the flexion and extension ROM of the knee joint was (105.4±18.2)°.No case showed significant differences when compared with preoperative values ( P < 0.05).Conclusion Patients treated with total knee arthroplasty after a previous fracture of the tibial plateau have substantial improvement in function and relief of pain,restoring the alignment of the limbs.However,these patients are at increased risk for peri-operative complications and good surgical skill i

关 键 词：胫骨平台骨折 创伤性关节炎 骨缺损 全膝关节置换术 

分 类 号：R687.42[医药卫生—骨科学]