两种方法处理RandⅡ型胫骨平台骨缺损全膝关节置换的对比
发布时间：2019-06-24 20:48
【摘要】：[目的]比较分析膝内翻伴胫骨内侧平台Rand Ⅱ型骨缺损病例行全膝关节置换术(total knee arthroplasty,TKA)中应用支撑螺钉联合骨水泥与自体骨移植重建骨缺损的疗效,探索更为有效的治疗方法。[方法]回顾性研究2011年10月~2015年10月,本院骨科对26例膝内翻伴胫骨内侧平台Rand Ⅱ型骨缺损患者行初次TKA,其中支撑螺钉联合骨水泥修复骨缺损13例为支撑组,自体骨移植修复骨缺损13例为植骨组。两组患者基线资料、骨缺损深度及胫骨平台受累面积比较差异无统计学意义(P0.05);观察两组患者手术前后膝关节KSS评分、膝关节活动度(ROM)、胫股角恢复情况及临床并发症。[结果]支撑组手术时间较植骨组平均缩短10 min;2例使用胫骨延长杆;术后3 d内均可扶双拐下地行走;术后即可完全负重;术后1例发生小腿肌间静脉血栓形成;1例发生切口上缘脂肪液化。植骨组7例患者应用胫骨延长杆;术后21 d内均扶双拐部分负重。术后1例发生小腿肌间静脉血栓形成;2例发生切口脂肪液化。术中失血量、术后24 h引流量与植骨组比较差异无统计学意义;两组术后内翻畸形和/或屈曲挛缩畸形均得到矫正。支撑组术后3个月1例骨与水泥界面出现约1 mm放射性透亮线,植骨组发现3例骨吸收。所有患者3个月弃拐行走。两组术后3个月膝关节KSS评分、胫股角测量结果、关节活动度(ROM)分别与术前相比差异有统计学意义,组间比较差异无统计学意义。[结论]支撑螺钉联合骨水泥及自体骨移植两种方法均能有效重建膝内翻伴胫骨内侧平台Rand Ⅱ型骨缺损,但支撑组缩短手术时间,可早期完全负重,无植骨块吸收之虑,更符合关节快速康复理念。
[Abstract]:[objective] to compare and analyze the curative effect of supporting screw combined with bone cement and autograft in total knee arthroplasty (total knee arthroplasty,TKA) in cases of knee varus with Rand type II bone defect of medial tibia plateau, and to explore a more effective method for the reconstruction of bone defect. [methods] from October 2011 to October 2015, 26 cases of knee varus with Rand type II bone defect of medial tibia plateau were treated with TKA, for the first time. 13 cases were treated with support screw combined with bone cement as support group, and 13 cases were treated with autograft to repair bone defect. There was no significant difference in baseline data, bone defect depth and tibia plateau involvement area between the two groups (P 0.05). The KSS score of knee joint, the recovery of knee motion (ROM), tibia and thigh angle and clinical complications were observed before and after operation. [results] compared with the bone grafting group, the operation time of the support group was 10 min;2 shorter than that of the bone grafting group, and the tibia lengthening rod was used within 3 days after operation; the total load could be carried after operation; 1 case had intermuscular venous thrombosis of the leg after operation; and 1 case had fat liquefaction at the upper edge of the incision. In the bone grafting group, 7 patients were treated with tibia lengthening rod, and all of them were loaded with double inflection within 21 days after operation. Postoperative intermuscular venous thrombosis occurred in 1 case and incision fat liquefaction in 2 cases. There was no significant difference in blood loss and drainage volume between the two groups at 24 hours after operation, but both groups were corrected for varus deformity and / or flexion contracture deformity. In the supporting group, 1 mm radioactive transparent line appeared at the interface between bone and cement 3 months after operation, and bone resorption was found in 3 cases in the bone grafting group. All patients abandoned crutches for 3 months. There was significant difference in knee joint KSS score, tibiofemoral angle measurement and (ROM) between the two groups at 3 months after operation, but there was no significant difference between the two groups. [conclusion] the two methods of supporting screw combined with bone cement and autograft can effectively reconstruct Rand type II bone defect of knee varus with medial tibia plateau, but the support group can shorten the operation time, can completely bear the weight at an early stage, and has no bone graft resorption, which is more in line with the idea of rapid joint rehabilitation.
【作者单位】： 福建医科大学附属闽东医院;
【分类号】：R687.4
，
本文编号：2505356
[Abstract]:[objective] to compare and analyze the curative effect of supporting screw combined with bone cement and autograft in total knee arthroplasty (total knee arthroplasty,TKA) in cases of knee varus with Rand type II bone defect of medial tibia plateau, and to explore a more effective method for the reconstruction of bone defect. [methods] from October 2011 to October 2015, 26 cases of knee varus with Rand type II bone defect of medial tibia plateau were treated with TKA, for the first time. 13 cases were treated with support screw combined with bone cement as support group, and 13 cases were treated with autograft to repair bone defect. There was no significant difference in baseline data, bone defect depth and tibia plateau involvement area between the two groups (P 0.05). The KSS score of knee joint, the recovery of knee motion (ROM), tibia and thigh angle and clinical complications were observed before and after operation. [results] compared with the bone grafting group, the operation time of the support group was 10 min;2 shorter than that of the bone grafting group, and the tibia lengthening rod was used within 3 days after operation; the total load could be carried after operation; 1 case had intermuscular venous thrombosis of the leg after operation; and 1 case had fat liquefaction at the upper edge of the incision. In the bone grafting group, 7 patients were treated with tibia lengthening rod, and all of them were loaded with double inflection within 21 days after operation. Postoperative intermuscular venous thrombosis occurred in 1 case and incision fat liquefaction in 2 cases. There was no significant difference in blood loss and drainage volume between the two groups at 24 hours after operation, but both groups were corrected for varus deformity and / or flexion contracture deformity. In the supporting group, 1 mm radioactive transparent line appeared at the interface between bone and cement 3 months after operation, and bone resorption was found in 3 cases in the bone grafting group. All patients abandoned crutches for 3 months. There was significant difference in knee joint KSS score, tibiofemoral angle measurement and (ROM) between the two groups at 3 months after operation, but there was no significant difference between the two groups. [conclusion] the two methods of supporting screw combined with bone cement and autograft can effectively reconstruct Rand type II bone defect of knee varus with medial tibia plateau, but the support group can shorten the operation time, can completely bear the weight at an early stage, and has no bone graft resorption, which is more in line with the idea of rapid joint rehabilitation.
【作者单位】： 福建医科大学附属闽东医院;
【分类号】：R687.4
，
本文编号：2505356
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