结构性植骨修复膝关节翻修术中严重骨缺损的临床效果及相关分析(英文)

Structural bone grafts in the repair of major bone defects in revision total knee arthroplasty performed using total Condylar Ⅲ System

目的探讨同种异体结构性植骨在膝关节翻修术中大块骨缺损中应用的临床效果和意义。方法1994～2001年芬兰坦佩雷大学医院应用单一翻修假体及同种异体骨结构性植骨治疗膝关节置换术大块骨缺损患者10例（膝），男1例，女9例，平均年龄70岁（61—77岁），平均随访5年（1～8年），所有手术均由两名高年资专科医师执行，采取KSS评分评估术前术后膝关节功能。结果最后随访时，患者膝关节KSS评分由术前的平均39分（4～51分）提高至81分（28—102分；P〈0．05）；疼痛评分由术前的18分（0—30分）提高至42分（10—50分；P〈0．05）。2例出现假体周围透亮线（〈1mm），但没有任何松动症状；所有结构性植骨均获得满意的愈合，最后随访时没有出现吸收征象，1例患者术后出现膝前疼痛，经髌骨表面置换后症状消失。结论同种异体骨结构性植骨应用在膝关节翻修术中大块骨缺损中可取得满意的临床效果，重建下肢力线、第三代骨水泥技术的应用及有由专科医师实施手术是获得良好临床效果的保证。

Objective To assess the results of revision total knee arthroplasty in patients with major bone defects using Total Condylar Ⅲ revision prosthesis and structural bone allografts. Methods A consecutive series of 10 revision total knee arthroplasties using a structural bone graft and modular revision prosthesis（Total Condylar Ⅲ system）operated between 1994 and 2001 in our institution were analysed. Patients（9 women, 1 man, mean age 70 years, range 61 -77）were followed up for 5（range 1 -8）years. Results The mean preoperative Knee Society Score 39 （ range 4 - 51 ） improved to 81 （ range 28 - 102 ） points at the follow-up（ P 〈 0. 05）indicating good overall results. Knee Society pain score improved from 18 （ range 0 - 30 ） to 42 （ range 10 - 50 ; P 〈 0. 05 ）. Two knees had asymptomatic radiolucent lines （ 〈 1 mm）. All structural allografts had definite unions without any signs of resorption. One case was complicated by patellar pain which was successfully treated with patellar resurfacing. Conclusions These results suggest that the Total Condylar Ⅲ system can be used successfully for revision total knee arthroplasty in patients with major bone defects if structural bone graft is used to repair these defects.