全膝关节翻修术中采用金属垫片结合髓内延长杆重建骨缺损和关节稳定性的早期临床疗效

Early clinical effect of metal augmentation and intramedullary stem for reconstruction of major bone defects and joint stability in revision total knee arthroplasty

目的探讨全膝关节翻修术中采用金属垫片结合髓内延长杆重建非包容性骨缺损和关节稳定性的早期临床疗效。方法笔者自2013-12—2015—06对17例（17膝）AORI11型非包容性骨缺损患者进行全膝关节翻修术，采用金属垫片重建骨缺损，恢复关节线水平，联合使用髓内延长杆加强翻修假体的稳定性。结果所有患者获得平均30．5（6—45）个月随访，无髌骨脱位、伸膝迟滞及膝关节前方疼痛等。术前膝关节KSS临床评分（24．5±7．9）分，功能评分（33．8±8．9）分，术后膝关节KSS临床评分（82．2±6．8）分，功能评分（85．5±8．1）分，术后KSS评分较术前明显提高，差异有统计学意义（t=41．328，P〈0．001；t=31．116，P〈0．001）；膝关节活动度术前（63．9±9．9）°，术后（100．0±9．5）°，术后较术前明显提高，差异有统计学意义（t=8．512，P〈0．001）；术后复查X线示假体位置及力线良好，假体周围未发现透亮带。结论全膝关节翻修术中采用金属垫块结合髓内延长柄能重建非包容性骨缺损及增加膝关节稳定性，恢复关节线水平，重建软组织平衡，简化手术操作，膝关节稳定性好，翻修成功率高，早期临床疗效满意。

Objective To observe the early clinical effect of metal augmentation and intramedullary stem for reconstruction of noncontained bone defects and joint stability in revision total knee arthroplasty. Methods From Dec. 2013 to Jun. 2015, 17 patients（17 knees） with AORI-type Ⅱ noncontained bone defects underwent revision total knee arthroplasty. During operation, the metal augmentation was used to repair AORI-type Ⅱ uncontained bone defect and restore the joint line level, and the intramedullary stem was used to increase the stability of prosthesis due to the lateral instability. Results All the cases were followed up for 30.5 months （range, 6 to 45 months）. There were no pateUar dislocation and extension lag and anterior knee pain. Preoperative KSS clinical score of knee was （24.5±7.9） and functional score was （33.8±8.9） while the postoperative KSS clinical score of knee score was （82.2±6.8） and functional score was （85.5±8.1）, the scores increased significantly after operation （t =41.328, P 〈0.001; t =31.116, P 〈0.001）. The preoperative range of movement （ROM） was （63.9±9.9）° and postoperative ROM was （100.0±9.5）°, the ROM significantly improved（t =8.512, P 〈0.001）. In the final follow-up through the X-ray measurement, the position and alignment of the prosthesis were good, and there were no radiolucent lines between the metal augment and the host bone at the contact interface. Conclusion Total knee arthroplasty revision is effective to solve the failure of total knee arthroplasty after surgery. The metal augmentation for reconstruction of uncontained bone defects and soft tissue balance combined with intramedullary stem is feasible to accomplish, it can provide immediate secure fixation to host bone, and enhance success rate of knee arthroplasty revision, simplify operation, with early clinical efficacy satisfaction.