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山东大学学报(医学版) ›› 2016, Vol. 54 ›› Issue (6): 35-38.doi: 10.6040/j.issn.1671-7554.0.2015.809

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初次全膝关节置换术中胫骨近端骨缺损的处理及疗效

周垂宝1,马良2,李明2,张元凯2   

  1. 1. 青岛市胶州中心医院关节创伤科, 山东 青岛 266300;2. 山东大学齐鲁医院关节外科, 山东 济南 250012
  • 收稿日期:2015-08-25 出版日期:2016-06-20 发布日期:2016-06-20
  • 通讯作者: 张元凯. E-mail:drzhangyk@163.com E-mail:drzhangyk@163.com

Reconstruction of proximal tibial bone defect during primary total knee arthroplasty and its clinical efficacy

ZHOU Chuibao1, MA Liang2, LI Ming2, ZHANG Yuankai2   

  1. 1. Department of Joint and Traumatic Orthopedics, Central Hospital of Jiaozhou, Qingdao 266300, Shandong, China;
    2. Department of Joint Orthopedics, Qilu Hospital of Shandong University, Jinan 250012, Shandong, China
  • Received:2015-08-25 Online:2016-06-20 Published:2016-06-20

摘要: 目的 探讨初次全膝关节置换术中胫骨近端骨缺损的处理方法和临床疗效。 方法 选取2009年1月至2014年1月接受初次全膝关节置换术患者14例(14膝),其中男3例,女11例,51~80岁,平均59.3岁。重度骨性关节炎伴膝内翻畸形6例,伴外翻畸形1例,类风湿膝关节炎5例,创伤后膝骨性关节炎2例。非包容性骨缺损8例,包容性骨缺损6例。采用组配式金属垫块矫正骨缺损9例,采用骨水泥螺钉充填骨缺损5例。 结果 所有患者均获得完整随访。随访12~48个月,平均26.3个月;术后下肢力线恢复良好,假体位置准确。术前膝关节功能评分(HSS评分)平均46.23分,末次随访评分平均82.5分。2例出现刀口愈合延迟,经加强换药后痊愈。所有患者围手术期无心肺脑、深静脉血栓等严重并发症。随访当中未见浅深部位感染、假体松动、断裂、骨吸收等情况。 结论 初次全膝关节置换术中针对胫骨近端骨缺损的类型,选择骨水泥螺钉或组配式金属垫块等重建方法可以提供假体良好稳定性,获得满意的手术效果。

关键词: 膝关节置换, 重建, 胫骨, 金属垫块, 骨缺损

Abstract: Objective To investigate the efficacy of proximal tibial bone defect reconstruction during primary total knee arthroplasty(TKA). Methods A total of 14 cases(14 knees)with proximal tibial bone defect who underwent primary TKA during Jan. 2009 and Jan. 2014 were enrolled, including 3 males and 11 females. The average age of patients was 59.3 years, ranging from 51 to 80 years. The diagnoses were severe osteoarthritis(6 cases of varus deformity and 1 case of valgus deformity), rheumatoid arthritis(5 cases), and post-traumatic osteoarthritis(2 cases). Bone cement was used in 5 cases, and prosthetic augments was adopted in 9 cases. Results All patients were followed up for an average of 26 months, ranging from 12 to 48 months. The postoperative mechanical alignment and competent position were satisfactory. The knee function scores rose from 46.23 before operation to 82.5 on average. No severe complications occurred. Conclusion The reconstruction technique including bone cement and modular augment is effective in the treatment of proximal tibia bone defect.

Key words: Knee arthroplasty, Reconstruction, Modular augment, Tibia, Bone defect

中图分类号: 

  • R687.4
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