自体骨植骨修复膝关节置换术中胫骨平台骨缺损

Autologous bone graft for tibial plateau bone defects in total knee arthroplasty

目的观察全膝关节置换术中利用截骨获得的自体骨植骨的方式修复胫骨平台骨缺损的近期疗效。方法从2008年11月至2011年3月,对10例(15膝)有胫骨平台骨缺损的膝关节行全膝关节置换术。术中测量胫骨平台平均缺损深度15.6 mm,平均截骨10.0 mm,截骨后残余骨缺损平均深度7.68 mm,使用摆锯或磨钻打磨清除缺损表面硬化骨壳达松质骨,同时修整成台阶状水平形骨缺损。采用截骨获得的松质骨片,修整后厚度和形状与缺损处相匹配,覆盖植骨后的缺损处截骨面,形成与胫骨截骨面一致的平面,打实,并用松质骨螺钉或门型钉载桩固定,常规安装胫骨假体,缺损植骨部位完全覆盖于假体下。结果术中胫骨平台骨缺损可有效修复,承载假体可靠;术后X线片显示胫骨假体下方无骨质缺损表现,假体位置良好。术前美国膝关节学会(KSS)评分平均33.9分,术后随访1个月至3年,平均随访1.8年,KSS评分平均87.6分。X线示植骨处无骨质吸收和假体松动现象。结论使用自体骨植骨修复全膝关节置换术中胫骨平台骨缺损,可合理利用截骨获得的自体骨,达到缺损部位的理想修复,既最大限度地保留了胫骨平台的骨量,又重建了胫骨假体的均衡力学支撑。

Objective To observe the short-term effect of autologous bone graft on tibial plateau bone defects in total knee arthroplasty（TKA）.Methods From November 2008 to March 2011,10 patients（15 knees）with tibial plateau bone defects including 3 men（5 knees） and 7 women（10 knees） underwent total knee arthroplasty.The average age of the patients was 72.4 years old ranging from 60 to 75 years.The diagnoses of the patients were osteoarthritis in 8 cases（12 knees） and rheumatoid arthritis in 2 cases（3 knees）.In addition,genu varum was found in 8 cases（12 knees） and genu valgum in 2 cases（3 knees）.During operation,the bone defect of tibial plateau was repaired into steping bone defect by osteotomy and fixed by screw.Results The patients were followed up 1 month to 3 years with the average of 1.8 months.The HSS knee score increased from preoperative 33.9 to postoperative 87.6.Nonunion,displacement,bone absorption of the autograft or loosening of the prostheses were not found in cases at final follow-up.Conclusion In total knee arthroplasty with autograft for tibial plateau bone defects,rational use of autologous bone by osteotomy may perfectly repair tibial plateau bone defects,reserve knee bone,and reconstruct initial stability of the protheses of tibial plateau.