中国修复重建外科杂志

中国修复重建外科杂志

Sleeve 金属袖套联合 MBT 假体行膝关节翻修术的早期疗效

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目的探讨应用 Sleeve 金属袖套联合 MBT 假体行膝关节翻修术的早期疗效。方法回顾分析 2015 年 3 月—2017 年 4 月,应用 Sleeve 金属袖套联合 MBT 假体行膝关节翻修术的 23 例(24 膝)患者临床资料。男 8 例(8 膝),女 15 例(16 膝);年龄 48~85 岁,平均 65.4 岁。翻修原因:关节置换术后感染 14 膝,假体松动 8 膝,术后僵直 1 膝,术后关节不稳 1 膝。按照 Anderson 骨科研究所骨缺损分型标准(AORI):股骨侧ⅡA 型 5 膝、ⅡB 型 17 膝、Ⅲ型 2 膝;胫骨侧ⅡA 型 2 膝、ⅡB 型 20 膝、Ⅲ型 2 膝。初次人工全膝关节置换术至该次翻修术时间为 6~86 个月,平均 30.6 个月。膝关节活动度为(56.0±24.9)°;美国特种外科医院(HSS)评分总分为(41.9±14.2)分,疼痛及功能评分分别为(8.5±5.2)、(33.4±13.5)分。结果患者均获随访,随访时间 12~39 个月,平均 25.6 个月。手术时间 1.6~2.9 h,平均 2.2 h;术中出血量 400~1 000 mL,平均 580 mL。2 膝(8.3%)术中发生胫骨内侧轻微纵行劈裂,1 膝(4.2%)术后 25 d 出现急性感染。术后切口均Ⅰ期愈合,无下肢深静脉血栓形成发生。X 线片复查示假体稳定、无松动。末次随访时,4 膝(16.7%)活动后稍有不适,1 膝(4.2%)发生胫骨远端痛。末次随访时,膝关节活动度达(114.6±5.1)°,较术前明显改善(t=11.698,P=0.000)。HSS 总分、疼痛及功能评分分别为(89.0±10.9)、(26.9±6.6)、(62.1±5.8)分,均较术前显著提高(t=15.616,P=0.000;t=12.522,P=0.000;t=10.076,P=0.000)。结论膝关节翻修术中应用 Sleeve 金属袖套修复干骺端骨缺损,联合 MBT 假体可获得较好早期疗效。

ObjectiveTo evaluate short-term effectiveness of revision total knee arthroplasty (TKA) with porous-coated metaphyseal Sleeve and MBT implant.MethodsA clinical data of 23 patients (24 knees) who underwent revision TKA by using porous-coated metaphyseal Sleeve combined with MBT implant between March 2015 and April 2017 was retrospectively analyzed. There were 8 males (8 knees) and 15 females (16 knees). The age ranged from 48 to 85 years (mean, 65.4 years). The cause of revision TKA included infection in 14 knees, aseptic loosening in 8 knees, instability in 1 knee, and stiff knee in 1 knee. Bone defects were classified according to the Anderson Orthopaedic Research Institute (AORI) bone defect classification. The femoral defect was rated as type ⅡA in 5 knees, type ⅡB in 17 knees, and type Ⅲ in 2 knees; the tibial defect was rated as type ⅡA in 2 knees, type ⅡB in 20 knees, and type Ⅲ in 2 knees. The mean time between primary TKA and revision TKA was 30.6 months (range, 6-86 months). The preoperative range of motion (ROM) was (56.0±24.9)°. The preoperative Hospital for Special Surgery (HSS) total score was 41.9±14.2; and the pain and function scores were 8.5±5.2 and 33.4±13.5, respectively.ResultsAll patients were followed up 12-39 months (mean, 25.6 months). The mean operation time was 2.2 hours (range, 1.6-2.9 hours). The mean intraoperative blood loss was 580 mL (range, 400-1 000 mL). There were 2 knees (8.3%) of intraoperative fracture associated with Sleeve insertion and 1 knee (4.2%) of acute postoperative infection at 25 days after revision TKA. All incisions healed by first intention. No deep venous thrombosis of lower extremity occurred. X-ray film showed that all implants were stable. At last follow-up, slight discomfort after exercise occurred in 4 knees (16.7%); end-of-stem pain in the tibia occurred in 1 knee (4.2%). The ROM was (114.6±5.1)°, which had significant improvement compared with the preoperative result (t=11.698, P=0.000). The HSS total score (89.0±10.9), pain score (26.9±6.6), and function score (62.1±5.8) also had significant improvement compared with the preoperative results (t=15.616, P=0.000; t=12.522, P=0.000; t=10.076, P=0.000).ConclusionThe porous-coated metaphyseal Sleeve combined with MBT implant in revision TKA has a significant improvement in short-term effectiveness and no signs of implant loosening.

关键词: 人工全膝关节置换术; 翻修术; Sleeve 金属袖套; MBT 假体; 干骺端骨缺损

Key words: Total knee arthroplasty; revision; Sleeve; MBT implant; metaphyseal bone defect

引用本文: 郭凌飞, 杜银桥, 张明超, 孙菁阳, 金志刚, 彭亚文, 沈俊民, 周勇刚. Sleeve 金属袖套联合 MBT 假体行膝关节翻修术的早期疗效. 中国修复重建外科杂志, 2019, 33(3): 302-306. doi: 10.7507/1002-1892.201810026 复制

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1. 贾承奇, 倪明, 付君, 等. 人工全膝关节置换术中髌骨置换对疗效影响的比较研究. 中国修复重建外科杂志, 2018, 32(4): 394-399.
2. Kurtz S, Ong K, Lau E, et al. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg (Am), 2007, 89(4): 780-785.
3. Kurtz SM, Ong KL, Schmire J, et al. Future clinical and economic impact of revision total hip and knee arthroplasty. J Bone Joint Surg (Am), 2007, 89 Suppl 3: 144-151.
4. Engh GA, Ammeen DJ. Bone loss with revision total knee arthroplasty: defect classification and alternatives for reconstruction. Instr Course Lect, 1999, 48: 167-175.
5. Whittaker JP, Dharmarajan R, Toms AD. The management of bone loss in revision total knee replacement. J Bone Joint Surg (Br), 2008, 90(8): 981-987.
6. Agarwal S, Neogi DS, Morgan-Jones R. Metaphyseal sleeves in revision total knee arthroplasty: Minimum seven-year follow-up study. Knee, 2018, 25(6): 1299-1307.
7. Awadalla M, Al-Dirini RMA, O’Rourke D, et al. Influence of varying stem and metaphyseal sleeve size on the primary stability of cementless revision tibial trays used to reconstruct AORI ⅡA defects. A simulation study. J Orthop Res, 2018, 36(7): 1876-1886.
8. Zanirato A, Cavagnaro L, Basso M, et al. Metaphyseal sleeves in total knee arthroplasty revision: complications, clinical and radiological results. A systematic review of the literature. Arch Orthop Trauma Surg, 2018, 138(7): 993-1001.
9. Thorsell M, Hedström M, Wick MC, et al. Good clinical and radiographic outcome of cementless metal metaphyseal sleeves in total knee arthroplasty. Acta Orthop, 2018, 89(1): 84-88.
10. Stefani G, Mattiuzzo V, Prestini G. Revision total knee arthroplasty with metaphyseal sleeves without stem: short-term results. Joints, 2017, 5(4): 207-211.
11. Klim SM, Amerstorfer F, Bernhardt GA, et al. Septic revision total knee arthroplasty: treatment of metaphyseal bone defects using metaphyseal sleeves. J Arthroplasty, 2018, 33(12): 3734-3738.
12. Fedorka CJ, Chen AF, Pagnotto MR, et al. Revision total knee arthroplasty with porous-coated metaphyseal sleeves provides radiographic ingrowth and stable fixation. Knee Surg Sports Traumatol Arthrosc, 2018, 26(5): 1500-1505.
13. Chalmers BP, Desy NM, Pagnano MW, et al. Survivorship of metaphyseal sleeves in revision total knee arthroplasty. J Arthroplasty, 2017, 32(5): 1565-1570.
14. Watters TS, Martin JR, Levy DL, et al. Porous-coated metaphyseal sleeves for severe femoral and tibial bone loss in revision TKA. J Arthroplasty, 2017, 32(11): 3468-3473.
15. Leopold SS, Berger RA, Rosenberg AG, et al. Impaction allografting with cement for revision of the femoral component. A minimum four-year follow-up study with use of a precoated femoral stem. J Bone Joint Surg (Am), 1999, 81(8): 1080-1092.
16. Alexander GE, Bernasek TL, Crank RL, et al. Cementless metaphyseal sleeves used for large tibial defects in revision total knee arthroplasty. J Arthroplasty, 2013, 28(4): 604-607.
17. Hilgen V, Citak M, Vettorazzi E, et al. 10-year results following impaction bone grafting of major bone defects in 29 rotational and hinged knee revision arthroplasties: a follow-up of a previous report. Acta Orthop, 2013, 84(4): 387-391.
18. Bauman RD, Lewallen DG, Hanssen AD. Limitations of structural allograft in revision total knee arthroplasty. Clin Orthop Relat Res, 2009, 467(3): 818-824.
19. Beckmann NA, Mueller S, Gondan M, et al. Treatment of severe bone defects during revision total knee arthroplasty with structural allografts and porous metal cones—a systematic review. J Arthroplasty, 2015, 30(2): 249-253.
20. McNamara CA, Gösthe RG, Patel PD, et al. Revision total knee arthroplasty using a custom tantalum implant in a patient following multiple failed revisions. Arthroplast Today, 2017, 3(1): 13-17.
21. Morgan-Jones R, Oussedik SI, Graichen H, et al. Zonal fixation in revision total knee arthroplasty. Bone Joint J, 2015, 97-B(2): 147-149.