初次全膝关节置换术中胫骨近端骨缺损植骨术

The operation of bone graft of bone defects in proximal tibia during initial total knee arthroplasty

目的:探讨初次全膝关节置换术中胫骨近端骨缺损植骨技术的方法和疗效。方法:2001年10月~2006年3月,在23例(42膝)初次全膝关节置换术中,采用自体或异体骨移植的方法修复胫骨近端骨缺损,男5例(9膝),女18例(33膝);年龄51~80岁,平均66.2岁;体重68~93kg,平均77.2kg;身高156~178cm,平均170.3cm。术前诊断:骨关节炎19例(35膝),类风湿关节炎2例(4膝),大骨节病1例(2膝),关节结核1例(1膝)。分为包容型和非包容型两类。非包容型22例40膝,包容型1例2膝。膝关节结核1例(1膝)同时合并股骨外髁骨缺损。植骨种类:自体髂骨2例3膝,1例2膝为类风湿关节炎,包容型,骨移植起填充作用,另1例1膝为左膝骨关节炎,非包容型;异体冷冻骨1例1膝为膝关节结核,同时股骨外髁和胫骨内侧平台骨缺损,行大块骨移植,螺钉固定;自体股骨内髁加异体冻干骨移植修复胫骨内侧平台骨缺损1例1膝;其余19例37膝均为自体股骨内髁或胫骨外侧平台修整后移植,修复胫骨内侧平台骨缺损,其中螺钉固定14膝。结果:术后随访3~56个月,平均38.2个月。所有患者术前均有内或外翻畸形和屈曲挛缩畸形,术后畸形得到矫正,疼痛消失,3个月后均可弃拐行走,生活可以自理。膝关节HSS评分由术前15.3(10~26)分提高到术后86(79~95)分。膝关节活动范围由术前74.4°(0°~90°)提高到术后109.4°(80°—135°)。1例于术后3年死于心肺功能衰竭。无感染、腓总神经损伤、骨折或肺脑栓塞等并发症患者。X线复查时未见假体松动或感染征象,无明显的植骨块移位、骨折、骨吸收、不愈合或胫骨平台塌陷。结论:骨移植技术尤其是自体骨移植在初次全膝人工关节置换术中,可以恢复胫骨近端的完整性,为胫骨假体提供初始稳定性,具有简便、实用、经济实惠等优点。

Objective:The method and curative effect of bone graft of bone defects in proximal tibia is approached during initial total knee arthroplasty. Method:From Octomber 2001 to March 2006, 23 cases (42 knees) were treated by auto or xenogenic bone graft to repair their bone defects in proximal tibia during initial total knee arthrolasty. There are 5 males with 9 knees and 18 females with 33 knees, the average age of the patients was 66.2 years ranging from 51 to 80 years, the average weight was 77.2 kg ranging from 68 kg to 93 kg.and the average body height was 170.3cm ranging from 156cm to 178cm. The diagnosises of the patients were osteoarthritis in 19 cases (35 knees),rheumatoid arthritis 2 case(4 knees),Kashin-Bek syndrome in 1 case(2 knees),and tuberculosis of knee joint in 1case(1 knee). 22 cases (40 knees) of 23 cases belong to uncontained type and 1 case (2 knees) belong to contained type.The categories of bone graft consisted of autograft of ilium used in 2cases (3 knees), xenogenic used in 1case (1 knee), autograft of femur medial condyles and xenogenic used in 1case (1 knee) and autograft of femur medial condyles or tibia lateral condyles plateaus used in the rest 19cases (37knees),screw fixing 14 knees. Result:The patients were followed up 3 to 56 months with the average of 38.2months.All of the patients can walk without crutch and self-care 3 months after operation, who all had enstrophe or ecstrophy or contraction anisotrophy before operation,which were rectified right after operation. The HSS knee score improved from preoperative 15.3(10～26)to postoperative 86(79～95). The range of movement improved from preoperative 74.4°(0°—90°) to postoperative 109.4°(80°—135°). 1 case died of cardiorespiratory nonfunction 3 years after operation. There are no complications such as infection, injure of common peroneal nerve, fracture or pulmonary or cerebral embolism etc. There is no loosening of the prostheses, infection, obvious displacement fracture, bone absorption, nonunion and collapse of the tibia plateau found in x-ray recheck of the patients as well.Conclusion In initial total knee arthroplasty the bonegraft,especially the autograft can reconstruct the integrity of proximal tibia and can provide a initial stability for the protheses. Those procedures can predominate with fortes of convenient, utility, and economics etc.