全膝关节置换术治疗骨关节炎合并股骨远端畸形短缩

TKA in the Treatment of Osteoarthritis with Severe Deformity and Shortening in Distal Femoral

目的:探讨RT-PLUS MODULAR组配式人工膝关节假体治疗膝关节骨关节炎合并股骨远端严重畸形短缩的可行性及其疗效。方法2010年3月~2013年2月对9例膝关节骨关节炎合并股骨远端严重畸形短缩患者一期行 RT-PLUS MODULAR组配式人工膝关节假体全膝关节置换,男3例,女6例;年龄(5l±6.8)岁。关节外截骨髓腔延长杆纠正下肢力线和长度,金属垫块修复股骨远端缺损。采用HSS评分标准对手术疗效进行评价。结果手术切口均一期愈合,无感染、无下肢深静脉血栓,肢体短缩内外翻畸形纠正。1例腓总神经出现不完全麻痹,给予神经营养药物对症治疗后症状逐渐缓解。患者均获得随访,术后随访7~16个月,1例患者骨折延迟愈合。末次随访时,本组患者未见假体松动、下沉、再骨折等迹象,关节稳定性好,关节活动度为(102.1±20.6)°,HSS评分为(85.3±8.8)分,与术前比较差异有统计学意义(P<0.05)。结论 RT-PLUS MODULAR组配式膝关节假体系统提供了金属垫块和髓腔延长杆等简便、可靠的工具,提高了膝关节骨关节炎合并股骨远端严重畸形短缩全膝关节置换的手术的疗效。

Objective The purpose of the present study was to investigate the clinical result of RT-PLUS MODULAR prosthesis in the treatment of osteoarthritis with severe deformity and shortening in distal femoral.Method From March 2010 to February 2013,Nine patients with severe deformity and shortening in distal femoral were selected for total knee arthorplasty using RT-PLUS MODULAR prosthesis.The average age was 51 years.Metal augmentation was used for uncontained bone defects and soft tissue balance combined with intramedul ary stem was feasible to accomplish.Result Al the patients were evaluated by HSS score were fol owed up 7-16 months(mean,13 months).During fol ow-up,1 case was found delayed union.At last fol ow-up,the ROM of knee was(102.1±20.6)°and the HSS score was85.3±8.8,there were significant dif erences when compared with preoperative values(P<0.05),X-ray films showed good position of the prosthesis with no loosening,subsidence or displacement.Conclusion RT-PLUS MODULAR prosthesis is an ef ective and reliable prosthesis for severe knee deformity with metal augmentation for bone defects and intramedul ary stem for limb long,it reduce the dif icult of the operation,and enhance success rate of knee arthroplasty of osteoarthritis with severe deformity and shorting in distal femoral.