自体结构植骨结合钢板固定治疗初次全膝关节置换胫骨内侧严重骨缺损  

Treatment of severe medial tibial bone defect in primary total knee arthroplasty with autogenous bone graft and plate fixation

作　　者：王旭春 姜斌方 武中庆 陈闽昌 张占丰[2] WANG Xu-chun;JIANG Pin-fang;WU Zhong-qing;CHEN Min-chang;ZHANG Zhan-feng(Department of Orthopaedics,the People’s Hospital of Wuxing District,Huzhou 313000,Zhejiang,China)

机构地区：[1]湖州市吴兴区人民医院骨科,浙江湖州313000 [2]湖州市第一人民医院,浙江湖州313000

出　　处：《中国骨伤》2022年第11期1048-1052,共5页China Journal of Orthopaedics and Traumatology

基　　金：浙江省医药卫生科技计划项目(编号:2021KY346)。

摘　　要：目的:探讨自体结构植骨结合钢板固定这一技术在伴随胫骨近端内侧严重骨缺损的初次全膝置换术(total knee arthroplasty,TKA)中的应用技巧及其价值。方法:自2012年3月至2018年10月采用自体结构植骨结合钢板固定处理初次全膝置换术中胫骨近端内侧严重骨缺损患者21例,男9例,女12例,年龄61~77(69.6±9.1)岁,病程64~257(73.6±170.7)个月。根据Rand分型:Ⅲb型13例,Ⅳb型8例。术后观察并发症发生情况,以美国特种外科医院(Hospital for Special Surgery,HSS)评分,SF-36生活质量评分进行膝关节功能评价。结果:21例患者均获得随访,时间37~64(49.5±13.7)个月。所有患者切口顺利愈合,术后2例患者出现下肢肌间静脉丛血栓,无假体周围感染、假体松动等其他并发症出现。所有患者在术后X线随访时自体植骨块均获得骨性愈合,愈合时间8~13(10.1±2.3)个月。患者HSS评分由术前30~48(53.4±4.2)分升高至末次随访时75~92(81.2±8.4)分(P<0.05)。患者术后SF-36生活质量评分与术前比较差异有统计学意义(P<0.05)。结论:自体结构植骨结合钢板固定这一技术应用于初次膝关节置换中胫骨近端严重骨缺损能获得满意的骨整合效果,并发症少,对膝关节功能改善效果明显。Objective:To explore the technique of autogenous bone graft combined with plate fixation in total knee arthroplasty(TKA)with severe proximal medial tibial bone defect.Methods:From March 2012 to October 2018,21 patients(9 males and 12 females)with severe bone defects in the proximal medial tibia during primary total knee arthroplasty were treated with autogenous structural bone grafting and steel plate fixation,with an age of 61 to 77 years old with an average of(69.6±9.1)years and a course of 64 to 257 months with an average of(73.6±170.7)months.According to Rand classification,there were 13 cases of typeⅢb and 8 cases of typeⅣb.Postoperative complications were observed,and knee joint function was evaluated by the Hospital for Special Surgery(HSS)score and SF-36 quality of life score.Results:All 21 patients were followed up for 37 to 64 months with an average of(49.5±13.7)months.The incisions of all patients healed smoothly,and 2 patients developed lower limb intermuscular venous plexus thrombosis after operation.There were no periprosthetic infection,loosening of prosthesis and other complications.The autogenous bone grafts of all patients achieved bony healing during postoperative X-ray follow-up,and the healing time was 8 to 13 months with an average of(10.1±2.3)months.The HSS score of patients increased significantly from 30 to 48 with an average of(53.4±4.2)before operation to 75 to 92 with an average of(81.2±8.4)at the final follow-up(P<0.05).The SF-36 quality of life score of patients after operation was significantly different from that before operation(P<0.05).Conclusion:The technique of autogenous bone graft combined with steel plate fixation can achieve satisfactory osseointegration effect in the treatment of severe proximal tibial bone defects in primary knee arthroplasty,with less complications and obvious improvement in knee function.

关 键 词：关节成形术 置换 膝 骨关节炎 膝 胫骨 骨缺损 

分 类 号：R687.4[医药卫生—骨科学]