髁限制性假体联合金属垫块治疗伴AORIⅡ型胫骨缺损的严重膝骨关节炎的早期疗效  

The early clinical outcomes of condylar-constrained prosthesis combined with a metal block for the treatment of severe knee osteoarthritis with AORI typeⅡtibial defects

作　　者：郝鑫 贾健[2] 成凯[2] 徐克钢 王小虎[3] HAO Xin;JIA Jian;CHENG Kai;XU Ke-gang;WANG Xiao-hu(Shanxi Medical University,Taiyuan,Shanxi,030000,China)

机构地区：[1]山西医科大学,太原030000 [2]临汾市人民医院关节外科,山西省041000 [3]山西医科大学第二医院创伤骨科,太原030000

出　　处：《中国骨与关节杂志》2024年第7期516-521,共6页Chinese Journal of Bone and Joint

基　　金：山西省卫生健康委员会“四个一批”创新计划(2020TD18);山西省自然科学基金(20210302123298)。

摘　　要：目的探讨采用髁限制性假体(constrained condylar knee,CCK)联合金属垫块治疗伴有AORIⅡ型胫骨缺损的严重膝骨关节炎(knee osteoarthritis,KOA)患者的临床效果。方法回顾分析2018年1月至2019年12月,于我院行的全膝关节置换术(total knee arthroplasty,TKA)中使用CCK假体联合金属垫块治疗伴有AORIⅡ型胫骨缺损的严重KOA患者,共纳入49例患者(60膝),其中男16例,女33例;年龄48~81岁,平均(64.06±6.12)岁。记录平均手术时间、平均出血量和手术并发症情况。在术前和最后一次随访时测量膝关节活动度(range of motion,ROM),并评估膝关节美国纽约特种外科医院(Hospital for Special Surgery,HSS)评分和美国膝关节协会评分(Knee Society score,KSS)。结果平均手术时间为100.9 min,切口平均长度为14.5 cm,术中平均失血量为194.8 ml,术后平均引流量为237.1 ml。术后,平均胫骨近端内侧角由80.0°升高至87.3°,平均股胫角由186.0°降至175.0°。平均随访时间为49.1个月,在随访期间没有出现血管神经损伤、假体周围骨折、骨溶解、假体松动或关节不稳等并发症。仅有1例患者在术后6个月出现假体周围感染并接受了翻修治疗,假体生存率为98.3%。在末次随访时,膝关节的屈伸活动度由术前(62.80±24.09)°升至(109.25±6.16)°,HSS评分由术前(36.03±12.20)分升至(89.02±9.58)分,KSS临床评分由术前(35.55±11.41)分升至(88.12±8.97)分,KSS功能评分由术前(36.67±11.71)分升至(86.67±8.57)分,差异均有统计学意义(P<0.05)。结论对于伴有AORIⅡ型骨缺损的KOA患者,CCK假体联合金属垫块技术是一种有效重建骨缺损的方法。该方法能够恢复关节线水平,平衡屈伸间隙,增强关节稳定性,有利于提高患者的生活质量和关节功能,临床疗效和早期生存率满意。Objective The early clinical outcomes using condylar-constrained prosthesis combined with a metal block for the treatment of severe knee osteoarthritis with AORI typeⅡtibial defects were investigated.Methods A retrospective analysis was conducted on 49 patients(60 knees)with severe knee osteoarthritis and AORI typeⅡtibial defects.All underwent total knee arthroplasty(TKA)with condylar-constrained prosthesis and metal block from January 2018 to December 2019 in our hospital.There were 16 males and 33 females,with an age range of 48 to 81 years(mean:64.06±6.12 years).The average operation time,blood loss,and surgical complications were recorded.Knee joint range of motion(ROM)was measured before surgery and at the last follow-up.Hospital for Special Surgery(HSS)score and Knee Society score(KSS)were evaluated.Results The average operation time was 100.9 minutes,incision length 14.5 cm,intraoperative blood loss 194.8 ml,and postoperative drainage 237.1 ml.After surgery,the average proximal medial tibial angle increased from 80.0°to 87.3°,and the average femorotibial angle decreased from 186.0°to 175.0°.The average follow-up was 49.1 months with no vascular and nerve injuries,periprosthetic fractures,osteolysis,prosthesis loosening,or joint instability occurred during the follow-up.Only one patient developed periprosthetic infection at 6 months postoperatively and underwent revision treatment,resulting in a prosthetic survival rate of 98.3%.At the last follow-up,the knee joint flexion-extension range of motion increased from(62.80±24.09)°preoperatively to(109.25±6.16)°;the HSS score increased from(36.03±12.20)to(89.02±9.58);the KSS clinical score increased from(35.55±11.41)to(88.12±8.97),and the KSS functional score increased from(36.67±11.71)to(86.67±8.57);all were with statistical significance(P<0.05).Conclusions The combination of constrained condylar prosthesis and metal block augmentation is an effective method to reconstruct bone defects in knee osteoarthritis patients with AORIⅡtibial defect

关 键 词：关节成形术 置换 膝 假体和植入物 骨缺损 

分 类 号：R684.3[医药卫生—骨科学]