膝关节置换对骨关节炎并内翻胫骨内侧骨缺损的处理及疗效

发布时间：2018-05-18 23:37

本文选题：膝内翻 + 膝关节置换术　；参考：《吉林大学》2015年硕士论文

【摘要】：目的探讨膝关节置换对骨关节炎并内翻胫骨内侧骨缺损的修复方法及临床疗效。材料与方法 1.临床资料：吉林大学中日联谊医院关节外科2012年11月至2014年11月资料较完整的膝骨关节炎并内翻畸形患者39例（53膝），其中男13例（17膝），女26例（36膝）；年龄53岁-79岁，平均68.25岁。所有患者均存在胫骨内侧骨缺损，依据Rand分型，a型34膝，b型19膝。术中分别采用单纯骨水泥（A组）、骨水泥加螺钉（B组）、结构植骨加螺钉（C组）重建胫骨平台。对术中情况、术后影像学、术后并发症、关节活动度及KSS评分进行分析，以了解患膝预后状况。 2.方法：术前所有患者进行患膝功能、畸形的评估，通过X线评定骨缺损及骨质条件，必要时行骨密度测定，常规进行KSS评分。术中a型34膝采用单纯骨水泥修复骨缺损，b型19膝，其中11膝采用骨水泥加螺钉修复，8膝采用结构植骨加螺钉。54膝均采用表面膝关节置换。术后随访常规拍摄膝关节正侧位片了解假体、植骨块、骨水泥情况，通过查体评定膝关节术后膝关节活动度，同样进行KSS评分，并使用SPSS17.0软件对比术前及术后随访过程的KSS评分。结果： 53膝均获完整随访，，随访6~48个月，平均22.6个月，未发现植骨不愈合、骨吸收等情况，1例出现骨水泥断裂，1例出现深静脉血栓，1例术后感染，2例出现假体周围透亮带，但未呈进行性进展。A组KSS评分由术前（45.15±5.84）分提高至末次随访时的（94.25±5.02）分，优良率达96.5%；B组KSS评分由术前（26.34±6.27）分提高至末次随访时的（92.02±4.45）分，优良率达94.6%；C组KSS评分由术前（29.27±5.42）分提高至末次随访时的（90.96±3.79）分，优良率达93.7%，术前与术后KSS评分比较具有明显的统计学意义（P＜0.05）。单纯骨水泥填充（A组）、骨水泥充填螺钉加强（B组）、结构植骨加螺钉（C组）三种方法在初次TKA中修复膝内翻胫骨内侧骨缺损效果良好，术后并发症少。结论： 1.胫骨内侧骨缺损Rand分型有助于合理制定手术方案。 2.骨水泥填充、骨水泥充填螺钉加强、结构植骨加螺钉修复膝骨关节炎并内翻畸形胫骨近端内侧骨缺损近期疗效满意。 ①年老体弱患者采用单纯骨水泥修复疗效满意； ②骨质疏松患者采用骨水泥修复螺钉加强疗效满意； ③年轻骨质条件良好的患者采用结构植骨加螺钉修复疗效满意。 3.术前X线及骨密度评估骨质条件对选择何种方式很有意义。
[Abstract]:Purpose

To investigate the repair method and clinical curative effect of knee joint replacement on the internal bone defect of tibia .

Materials and Methods

1 . Clinical data : From November 2012 to November 2014 , 39 cases ( 53 knees ) of knee osteoarthritis complicated with endogenic deformity of the joint surgery department of Jilin University between November 2012 and November 2014 , including 13 males ( 17 knees ) and 26 females ( 36 knees ) ;
Age 53 - 79 years , mean 68.25 years . All patients had medial tibial defects . According to Rand ' s classification , type a 34 knees and type b 19 knees , the tibial plateau was reconstructed by using bone cement alone ( group A ) , bone cement plus screw ( group B ) , structural bone grafting and screw ( group C ) .

Methods : Before operation , all patients were evaluated for knee function and deformity . The bone defect and bone condition were assessed by X - ray . Bone density measurement was performed .

Results :

All of the 53 knees were followed up for 6 - 48 months , average 22.6 months , no graft union , bone resorption were found , 1 case had bone cement fracture , 1 case had deep vein thrombosis , 1 case had postoperative infection , 2 cases had periprosthetic transmission , but did not show progressive progress .
The KSS score of group B increased from ( 26.34 卤 6.27 ) preoperatively to ( 92.02 卤 4.45 ) at the last follow - up , with a good rate of 94.6 % .
In group C , KSS score increased from 29.27 卤 5.42 to 90.96 卤 3.79 , and the excellent rate reached 93.7 % . There was significant difference between preoperative and postoperative KSS scores ( P & lt ; 0.05 ) .

Conclusion :

1 . The Rand classification of medial tibial defect can help to establish the surgical plan .

2 . Bone cement filling , bone cement packing screw strengthening , structural bone grafting and screw fixation for the treatment of knee osteoarthritis .

( 1 ) The elderly patients were satisfied with the curative effect of bone cement alone .

( 2 ) bone cement repairing screw is adopted to strengthen the curative effect satisfaction in patients with osteoporosis ;

( 3 ) The patients with good young bone condition were satisfied with the curative effect of structural bone grafting and screw repair .

3 . The preoperative X - ray and bone mineral density evaluated the way the bone condition was chosen .
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

【参考文献】