膝关节炎伴关节外胫骨应力性骨折个体化手术的分型与治疗  

Individualized staging and treatment of knee osteoarthritis with extra-articular tibial stress fracture

作　　者：宇文星 鲁超 许珂 侯卫坤 彭侃 刘林[1] 许鹏[1] YU Wen-xing;LU Chao;XU Ke;HOU Wei-kun;PENG Kan;LIU Lin;XU Peng(Osteonecrosis and Joint Reconstruction Ward,Department of Joint Surgery,HongHui Hospital,Xi’an Jiaotong University Health Science Center.Xi’an,Shaanxi,710054,China)

机构地区：[1]西安交通大学附属红会医院骨坏死与关节重建病区,陕西710054

出　　处：《中国骨与关节杂志》2022年第10期725-730,共6页Chinese Journal of Bone and Joint

基　　金：陕西省重点研发计划(2022SF-352);陕西省科技厅高校联合项目(2020GXLH-Y-007)。

摘　　要：目的报告我院用一种新分型方法,个体化治疗膝关节炎伴关节外胫骨应力性骨折随访结果。方法分析2015年1月至2021年12月我院收治的14例膝关节炎伴关节外胫骨应力性骨折患者,骨折形成机制及不同手术方式治疗的随访结果。结果14例膝关节炎伴关节外胫骨应力性骨折患者,男4例,女10例;年龄42~87岁,平均61岁;14例中疲劳性应力性骨折4例,其中2例使用单纯钢板加植骨固定治疗,2例使用单纯全膝关节置换术(total knee arthroplasty,TKA)治疗;低骨强度应力性骨折患者共10例,其中8例使用TKA加胫骨延长杆治疗,2例使用TKA加胫骨延长杆加钢板治疗。14例均获得了Ⅰ期愈合。随访6~72个月,平均39个月。所有患者X线复查显示胫骨均已愈合,愈合时间3~4个月,假体位置良好,无松动及感染迹象。膝关节协会(Knee Society Score,KSS)评分从术前的23.86提高至87.29,平均功能得分由18.75提高至77.50。结论对膝关节炎伴关节外胫骨应力性骨折患者,应根据其骨折的发生机制和膝关节退变的程度,选择不同的治疗方式。Objective To analyze the individualized treatment of knee arthritis with extraarticular tibial stress fracture by a new classification method.Methods A total of 14 patients with knee arthritis complicated with extraarticular tibial stress fracture were selected.All were admitted to the Joint Hospital of Red Union Hospital affiliated to Xi’an Jiaotong University from January 2015 to December 2021.Individualized treatment results and fracture mechanisms were analyzed.Results There were 4 males and 10 females.The average age was 61 years(range:42-87 years).Among the 14 patients,there were 4 cases of fatigue stress fracture(2 cases were treated with plate and bone graft fixation;2 cases were treated with TKA).There were 10 patients with low bone strength stress fracture,among whom 8 were treated with TKA plus tibial extension rod,and 2 were treated with TKA plus tibial extension rod plus steel plate.All patients achieved stage I healing after treatment.Follow-up ranged from 6 months to 72 months,with a mean of 39 months.X-ray reexamination of all patients showed that tibia had healed 3-4 months,and the prosthesis was in good position with no signs of loosening or infection.KSS score increased from 23.86 preoperatively to 87.29,and the mean functional score increased from 18.75 preoperatively to 77.50.Conclusions Different treatment methods should be selected according to the mechanism of fracture and the degree of knee degeneration in patients with knee arthritis and extrarticular tibial stress fracture.

关 键 词：膝关节 关节炎 胫骨 骨折 应力性 

分 类 号：R684.3[医药卫生—骨科学] R683.4[医药卫生—外科学]