中国修复重建外科杂志

中国修复重建外科杂志

一期带延长杆的胫骨假体人工全膝关节置换治疗膝关节炎合并胫骨应力骨折

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目的探讨一期带延长杆的胫骨假体人工全膝关节置换治疗膝关节炎合并胫骨应力骨折的早期疗效。 方法2014 年 1 月—2016 年 11 月, 采用一期带延长杆的胫骨假体行人工全膝关节置换术治疗 12 例(12 膝)膝关节炎合并胫骨应力骨折患者。男 5 例,女 7 例;年龄 60~77 岁,平均 71.5 岁。骨关节炎 8 例,类风湿性关节炎 4 例。影像学检查显示,关节内骨折 6 例;关节外骨折 6 例,均为胫骨近端 1/3 骨折(4 例为横形骨折,2 例为短斜形骨折);合并腓骨中上段骨折 2 例;12 例均为膝关节内翻畸形。术前膝关节学会评分系统(KSS)临床评分(31.5±8.4)分、功能评分(33.3±9.0)分,膝关节活动度(65.6±9.6)°。 结果术后切口均Ⅰ期愈合。患者均获随访,随访时间 6~52 个月,平均 36.5 个月。X 线片复查示,胫骨骨折均愈合,愈合时间 3~7 个月,平均 4 个月;假体位置均良好,无松动及感染征象。末次随访时,膝关节 KSS 临床评分为(90.5±8.9)分、功能评分(92.1±7.8)分,膝关节活动度(115.0±9.8)°;均较术前明显改善,比较差异有统计学意义(t=40.340,P=0.000;t=32.120,P=0.000;t=8.728,P=0.000)。 结论一期带延长杆的胫骨假体人工全膝关节置换治疗膝关节炎合并胫骨应力骨折,能够恢复下肢力线,促进骨折愈合,早期临床疗效满意。

ObjectiveTo evaluate the early effectiveness of one-stage total knee arthroplasty (TKA) with tibial stem extender for knee arthritis complicated with tibial stress fractures. MethodsBetween January 2014 and November 2016, 12 patients (12 knees) with knee arthritis and tibial stress fractures underwent one-stage TKA with tibial stem extender. There were 5 males and 7 females with an average age of 71.5 years (range, 60-77 years). There were 8 cases with osteoarthritis and 4 cases with rheumatoid arthritis. The radiographic examination showed the 6 cases of intra-articular fractures and 6 of extra-articular fractures (including transverse fractures in 4 cases and short oblique fractures in 2 cases); 2 cases complicated with middle and upper fibular fractures; 12 cases of varus deformities. Preoperative Knee Society Score (KSS) clinical score was 31.5±8.4 and functional score was 33.3±9.0. The preoperative range of motion (ROM) of the knee was (65.6±9.6)°. ResultsAll incisions healed primarily and no wound infection or skin necrosis occurred. All patients were followed up 36.5 months on average (range, 6-52 months). X-ray films showed that all fractures healed at 3-7 months (mean, 4 months); the position of the prosthesis was good, and no loosening or signs of infection occurred. At last follow-up, the KSS clinical score was 90.5±8.9 and functional score was 92.1±7.8; the ROM of the knee was (115.0±9.8)°. All indexes were significantly improved than those before operation (t=40.340, P=0.000; t=32.120, P= 0.000; t=8.728, P=0.000). ConclusionOne-stage TKA with tibial stem extender for patients with knee arthritis and tibial stress fractures can restore limb alignment, facilitate fracture healing, and obtain the satisfactory early effectiveness.

关键词: 膝关节炎; 胫骨应力骨折; 人工全膝关节置换术

Key words: Knee arthritis; tibial stress fracture; total knee arthroplasty

引用本文: 潘文杰, 贺艳, 马建兵, 肖琳, 姜扩. 一期带延长杆的胫骨假体人工全膝关节置换治疗膝关节炎合并胫骨应力骨折. 中国修复重建外科杂志, 2018, 32(9): 1177-1180. doi: 10.7507/1002-1892.201802047 复制

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