梯形自体植骨在全膝关节置换术骨缺损修复中的应用

Application of trapezidal autologous bone graft for the repair bone defects in total knee arthroplasty

目的 评价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临床疗效.方法 2011年3月-2015年3月,对20例（28膝）有胫骨内侧平台骨缺损的患者膝关节行全膝关节置换术,修整骨缺损为水平阶梯状,采用截骨获得的松质骨片,行自体梯形植骨.结果 术中胫骨平台骨缺损可有效修复,承载假体可靠;术后门诊随访1～4年,平均随访2.6年,HSS评分由术前（20.9±1.2）分提高到术后（87.6±1.6）分,应用配对t检验,差异有统计学意义（P＜0.05）;X线片显示胫骨假体下方无骨质缺损表现,假体位置良好,植骨处无骨质吸收和假体松动现象.结论 修复全膝关节置换术中胫骨内侧平台骨缺损,可合理利用截骨获得的自体骨,达到缺损部位的良好修复,最大程度地保留了胫骨平台的骨量,重建了胫骨假体的均衡力学支撑.

Objective To evaluate the clinical effect of tibial plateau bone defects repair using osteotomy and bone grafting with autogenous bone gain way in total knee arthroplasty.Methods From Mar.2011 to Mar.2015,28 knees of 20 patients with bone defects in medial tibial plateau were in total knee arthroplasty,the bone defects were repaired into horizontal steps,then with autogenous bone grafting by osteotomy.Results The bone defects could be repaired effectively to support the knee joint prosthesis,all the patients were followed-up through outpatient from 1 year to 4 years with the average of 2.6 years,the HSS kness score increased from （20.9 ± 1.2） before opearation to （87.6 ± 1.6） after operation.Hss score were paired t test,there was statistically significant difference （P 〈 0.05）.The location was good and there was no bone defect image,no bone resorption and no joint dislocation under X-ray.Conclusions To repair the bone defects in total nkee arthroplasty,it can use the autogenous bone by osteotomy reasonably,achieve good repair defect site,reserve the bone mass maxium,reconstrust the balanced mechanical support of tibia.