骨水泥螺钉技术与术前预康复在胫骨平台骨缺损初次全膝关节置换术中应用的效果观察  

Observation of effects of cement-screw technique and preoperative prehabilitation in primary total knee arthroplasty for tibial plateau bone defects

作　　者：郑伟坤[1] 汤俊芬[2] 王新亮[1] 肖文德[1] ZHENG Weikun;TANG Junfen;WANG Xinliang;XIAO Wende(*Department of Orthopedics,Guangzhou First People’s Hospital,Guangzhou,Guangdong 511457,China)

机构地区：[1]广州市第一人民医院骨科,广东511457 [2]广州市第一人民医院神经内科,广东511457

出　　处：《中国骨与关节损伤杂志》2024年第10期1028-1033,共6页Chinese Journal of Bone and Joint Injury

基　　金：广东省中医药局科研项目(20222156);广州市南沙区民生科技计划项目(2023MS011)。

摘　　要：目的评估骨水泥螺钉技术与术前预康复在胫骨平台骨缺损初次全膝关节置换术中应用的临床效果。方法纳入自2022-01—2023-06完成的51例(64膝)初次全膝关节置换术,胫骨平台骨缺损采用骨水泥螺钉技术修复。对照组22例(28膝)按共识进行术前健康教育,观察组29例(36膝)在对照组基础上完成标准化预康复训练4周。比较两组手术时间、螺钉使用数量、术后引流量、术后至开始下床时间、股四头肌力量恢复时间、助行器使用时间,以及术前1 d、术后3个月疼痛VAS评分、膝关节活动度、膝关节功能HSS评分。结果51例均获得随访,随访时间12~32个月,平均24.2个月。随访期间未出现深部感染、下肢深静脉血栓形成、骨吸收、假体松动、假体周围骨折、螺钉断裂等并发症。观察组与对照组手术时间、螺钉使用数量、术后引流量差异无统计学意义(P>0.05);而观察组术后至开始下床时间、股四头肌力量恢复时间、助行器使用时间均短于对照组,差异有统计学意义(P<0.05)。观察组术前1 d、术后3个月疼痛VAS评分低于对照组,术前1 d、术后3个月膝关节活动度、膝关节功能HSS评分高于对照组,差异有统计学意义(P<0.05)。结论复杂初次全膝关节置换术中采用骨水泥螺钉技术修复胫骨平台骨缺损安全、可靠,合理、有效的术前预康复训练可以加速患者术后康复进程,提高术后近期疗效。Objective To assess the clinical effects of the cement-screw technique and preoperative prehabilitation in primary total knee arthroplasty for tibial plateau bone defects.Methods A total of 51 patients(64 knees)who underwent primary total knee arthroplasty from January 2022 to June 2023 were included.The tibial plateau bone defects were repaired using the ce⁃ment-screw technique.The control group consisted of 22 patients(28 knees)who received preoperative health education accord⁃ing to consensus guidelines,while the observation group included 29 patients(36 knees)who completed a standardized prehabili⁃tation program for 4 weeks in addition to the control group’s education.The operation time,number of screws used,postoperative drainage volume,time to first mobilization,recovery time of quadriceps strength,duration of walker use,as well as visual analog scale(VAS)pain scores,range of motion(ROM)of the knee joint,and hospital for special surgery(HSS)knee function scores 1 day and 3 months postoperatively were compared between the two groups.Results All 51 patients were followed up for a peri⁃od of 12 to 32 months,with an average follow-up of 24.2 months.No complications such as deep infection,deep vein thrombo⁃sis,bone resorption,prosthetic loosening,periprosthetic fracture,or screw breakage occurred during the follow-up period.There were no statistically significant differences in operation time,number of screws used,and post-operative drainage volumes be⁃tween the observation and control groups(P>0.05).However,the observation group had a shorter time to first mobilization,re⁃covery time of quadriceps strength,and duration of walker use compared to the control group,with statistically significant differ⁃ences(P<0.05).The VAS pain scores on the day before surgery and at 3 months after surgery in the observation group were low⁃er than those in the control group,while the knee ROM and HSS knee function scores on the day before surgery and at 3 months after surgery were higher in the observation gro

关 键 词：全膝关节置换术 胫骨平台骨缺损 骨水泥 螺钉 预康复 

分 类 号：R687.42[医药卫生—骨科学]