人工全膝关节置换术治疗胫骨平台骨折内固定术后创伤性关节炎回顾性研究

Total knee arthroplasty for post-traumatic osteoarthritis secondary to internal fracture fixation of tibial plateau fracture: a retrospective study

目的探讨胫骨平台骨折内固定术后创伤性骨关节炎的人工全膝关节置换术及其临床疗效。方法北京积水潭医院矫形骨科自2003年1月至2015年1月,收治12例（12膝）胫骨平台骨折术后创伤性关节炎患者。所有患者骨折后均曾行切开复位内固定术治疗。应用KSS评分和功能评分术前和术后随访评估。术前膝关节屈伸活动度（80.0°±34.9°）。膝关节学会KSS评分（62.7±11.1）分,功能评分（61.7±10.7）分。12例患者均行全膝关节置换术。9例患者选择后稳定型假体,2例患者选择限制性LCCK假体,1例患者选择旋转铰链膝关节假体。结果本组共12例患者,1例患者出现伤口并发症和浅表感染,1例患者术中内侧副韧带部分撕脱。术后随访1~13年（平均4.3年）,无晚期并发症出现。末次随访时,KSS评分（80.5±10.4）分,功能评分（82.5±16.6）分,膝关节屈伸活动度（101.7°±16.0°）,均较术前显著改善（P〈0.05）。结论胫骨平台骨折内固定术后创伤性骨关节炎的人工全膝关节置换术可以显著改善患者的关节功能,但易出现感染及伤口并发症,具有较高的技术要求。

Objective To investigate the outcomes of total knee arthroplasty（ TKA） for post-traumatic osteoarthritis secondary to inter-nal fracture fixation of the tibial plateau treated with open reduction and internal fixation（ORIF）. Methods From January 2003 to January 2015,12 consecutive patients underwent TKA at a mean of 7. 6 years（1 to 25）after tibial plateau fracture. All of these cases had undergone ORIF. Patients were assessed pre-operatively and post-operatively using Knee Society Score （ KSS ） and function score. The KSS score was（62. 7 ± 11. 1）,function score was（61. 7 ± 10. 7）,and the flexion and extension ROM of the knee joint was （80. 0° ± 34. 9°） pre-operatively. TKA was performed in all cases. Posterior stabilize prosthesis were used in 9 cases,condylar con-strained prosthesis in 2 cases,and rotational hinged prosthesis in one case. Results Complications included wound complication and superficial infection in one case,and partial avulsion of medial collateral ligament in one case. Patients were followed up for 4. 3 years on average（1-13 years）,and no late complication was found. At last follow-up,the KSS score was（80. 5 ± 10. 4）and function score was （82. 5 ± 16. 6）,the flexion and extension ROM of the knee joint was（101. 7° ± 16. 0°）,and all showing significant differences when compared with preoperative values（P〈0. 05）. Conclusion TKA is technically demanded for post-traumatic osteoarthritis secondary to tibial plateau treated fracture with ORIF. Improvement of joint function can be achieved significantly with caution of infection and wound complication.