金属填充物重建全膝关节翻修术中严重骨缺损的研究进展  

The application of metal fillers in the reconstruction of severe bone defects in revision total knee arthroplasty

作　　者：黄超 王浩洋[1] 曾伟南[1] 周宗科[1] Huang Chao;Wang Haoyang;Zeng Weinan;Zhou Zongke(Department of Orthopaedics,West China Hospital of Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院骨科,成都610041

出　　处：《中华骨科杂志》2024年第4期270-278,共9页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金(82172394)。

摘　　要：随着全膝关节置换术(total knee arthroplasty,TKA)的广泛开展,因各种原因需行膝关节翻修术的患者数量也逐渐增加。严重骨缺损的重建是膝关节翻修术的一大挑战。近年来,骨缺损的重建方法不断发展,基于骨缺损的大小和部位出现了多种翻修策略。严重骨缺损的重建需要诸如自体骨移植、同种异体骨移植或金属填充物等进行重建。然而,骨移植面临来源受限、吸收塌陷或疾病传播等风险,临床应用受限;而金属填充物因其来源广、可定制、安全性高等优点在实际应用中受到广泛关注,可避免骨移植的各种弊端。金属垫块的优势在于可提供即时支撑、无需加固、不会发生骨坏死和吸收塌陷,然而金属与骨之间的弹性模量差异可能会导致应力遮挡,增加潜在的骨质丢失风险。Cone和Sleeve均可实现干骺端骨的生物固定,但出现假体周围感染时,由于假体骨长入和骨整合,很难轻易取出。本文对金属填充物在全膝关节翻修严重骨缺损重建中的应用进行综述,将有助于评估各种重建方案,提高为患者制定高性能翻修策略的能力。With the increasing prevalence of total knee arthroplasty(TKA),there is a corresponding rise in the number of patients requiring revision of total knee arthroplasty(R-TKA)for various reasons.R-TKA presents several complex challenges,with severe bone defect reconstruction being a critical obstacle to securing favorable long-term outcomes.Recently,the approach to managing bone defects has seen significant advancements,with a range of techniques proposed contingent on the defect's size and location.Severe bone defects require reconstruction with autologous or allogeneic bone grafts or metal fillers.However,bone grafts have their usage constrained by limited availability,risks of resorption and collapse,and the potential for disease transmission.Consequently,metal fillers have received widespread attention in practical applications due to their advantages,such as comprehensive source,customizability,and safety.The advantages of metal augment are that they provide immediate support without reinforcement and are not subject to necrosis and resorptive collapse.However,the difference in elastic modulus between metal and bone may lead to stress shielding and increase the risk of potential bone loss.Both Cone and Sleeve can achieve biological fixation of metaphyseal bone;however,in cases of periprosthetic infections,it is generally difficult to remove them easily due to the prosthetic bone in-growth and osseointegration.This study aims to provide a comprehensive review of the use of metal fillers to reconstruct bone defects during R-TKA.It is intended to aid orthopedic surgeons in understanding the spectrum of reconstructive possibilities and provide high-performance revision strategies for their patients.

关 键 词：膝关节 再手术 内固定器 骨缺损 

分 类 号：R687.4[医药卫生—骨科学]