初次全膝关节置换术中自体骨修复胫骨平台骨缺损的近期疗效

Short-term curative effect of primary total knee arthroplasty in repairing bone defect of tibial plateau using the autologous bone

目的观察初次全膝关节置换术中利用自体骨植骨的方式修复胫骨平台骨缺损的近期疗效。方法选择重庆市南川区人民医院2010年1月～2013年1月有胫骨平台骨缺损的膝关节行初次全膝关节置换术患者10例(12膝)。观察术后患者疼痛、关节活动范围、畸形矫正程度及关节功能改善情况,并对患者手术并发症进行统计分析。结果 10例患者术中胫骨平台骨缺损有效修复,承载假体可靠;术后载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HSS评分平均为(19.0±4.0)分,术后HSS评分平均为(87.6±12.5)分,差异有高度统计学意义(P<0.01)。术前HSS疼痛评分为(14.8±3.6)分,术后为(25.4±4.2)分,差异有统计学意义(P<0.05)。术前膝关节平均活动范围为(61.0±14.7)°,术后平均为(107.3±11.8)°,差异有统计学意义(P<0.05)。术前平均胫股角(FTA)为(182.1±10.7)°,术后平均FTA为(176.4±9.1)°,差异有统计学意义(P<0.05)。术后未见严重并发症。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 curative effect of primary total knee arthroplasty in repairing bone defect of tibial plateau using the autologous bone.Methods 10 patients with tibial bone defect of knee joint （12 knees）from January 2010 to January 2013 in People＇s Hospital of Nanchuan District in Chongqing City were selected.The pain,range of motion,the degree of deformity correction,joint function improvement after the operation were observed,operative complications were analyzed.Results Tibial plateau bone defect were repaired in 10 patients,bearing prosthesis were reliable; bone defect performance was not found under the tibial prosthesis load according to the postoperative X-ray films,location of the prosthesis were good.Preoperative HSS score was （19.0±4.0） points,postoperative HSS score were （87.6±12.5） points,the differences was statistically significant （P ＜ 0.01）.Preoperative HSS pain score was （14.8±3.6） points,postoperative HSS pain score was （25.4±4.2） points,the difference was statistically significant （P＜ 0.05）.Preoperative knee average motion range was （61.0±14.7）°,postoperative knee average motion range was （107.3±11.8）°,the difference was statistically significant （P ＜ 0.05）.Preoperative FIA was （182.1±10.7）°,postoperative FTA was （176.4±9.1）°,the difference was statistically significant （P ＜ 0.05）.Serious complications was not found after the operation.Conclusion Primary total knee arthroplasty in repairing bone defect of tibial plateau using the autologous bone can make rational utilization in autologous bone,make graft repair of tibial plateau bone defect,can maximize the retention of the tibial plateau bone,and reconstruct the tibial prosthesis balanced mechanical support.