一期人工全膝关节置换术治疗股骨髁上骨折合并膝骨关节炎

One-stage total knee arthroplasty for femoral supracondylar fracture combined with knee osteoarthritis

目的探讨一期人工全膝关节置换术(total knee arthroplasty,TKA)治疗股骨髁上骨折合并膝骨关节炎的临床疗效。方法 2012年1月—2015年3月,采用一期TKA治疗股骨髁上骨折合并膝骨关节炎患者19例(19膝)。其中,男8例,女11例;年龄60~85岁,平均69.6岁。体质量指数22.0~27.5 kg/m^2,平均22.6 kg/m^2。左膝13例,右膝6例。股骨髁上骨折原因:摔伤10例,交通事故伤8例,其他伤1例;骨折按AO/ASIF分型均为A型。受伤至手术时间为4~13 d,平均8.6 d。骨关节炎病程30~90个月,平均52.6个月。术后采用膝关节学会评分系统(KSS)并测量膝关节活动度(range of motion,ROM),评估膝关节功能;摄膝关节正侧位X线片,了解假体在位情况。结果术后切口均Ⅰ期愈合,无肺部感染、压疮及泌尿系统感染等早期并发症发生。19例患者均获随访,随访时间2~4年,平均2.6年。术后15 d及2年时患膝关节ROM及KSS功能评分、临床评分均较术前明显改善(P<0.05);术后两时间点间比较差异亦有统计学意义(P<0.05)。膝关节X线片复查示,下肢力线良好,2年时骨折均达骨性愈合,假体对位良好,无松动现象。结论一期TKA治疗股骨髁上骨折合并膝骨关节炎,在重建关节功能同时治疗骨关节炎及骨折,缩短了康复时间,降低并发症发生率,能够获得良好的临床疗效。

Objective To evaluate the effectiveness of one-stage total knee arthroplasty （TKA） for femoral supracondylar fracture combined with knee osteoarthritis. Methods Between January 2012 and March 2015, a total of 19 patients （19 knees） with femoral supracondylar fracture and knee osteoarthritis were treated with one-stage TKA. Of 19 cases, 8 were male and 11 were female with an average age of 69.6 years （range, 60-85 years）. The mean body mass index was 22.6 kg/m2 （range, 22.0-27.5 kg/m2）. The left knee was involved in 13 cases, and the right knee in 6 cases. The causes of femoral supracondylar fracture were falls in 10 cases, traffic accidents in 8 cases, and other injury in 1 case. All fractures were classified as type A according to AO/Association for the Study of Internal Fixation （AO/ASIF） classi- fication. The interval of injury and operation was 4-13 days （mean, 8.6 days）. The disease duration of osteoarthritis ranged from 30 to 90 months （mean, 52.6 months）. During follow-up, the knee society score （KSS） and the range of motion （ROM） were used to evaluate the knee function; anteroposterior and lateral X-ray films of the knee were used to observe the position of the prosthesis. Results All the incisions healed at the first stage, and there was no early complication such as pulmonary infection, pressure ulcer, and urinary tract infection. All patients were followed up 2-4 years with an average of 2.6 years. The ROM and KSS functional scores and clinical scores were significantly improved at 15 days and 2 years afteroperation, showing significant differences when compared with those before operation （P〈0.05）. There were significant differences in the ROM and KSS functional scores and clinical scores between two time points after operation （P〈0.05）. X- ray films showed the fracture bone healing, good alignment, no loosening of prosthesis at 2 years after operarion. Conclusion One-stage TKA for femoral supracondylar fracture combined with knee osteoarthritis can achieve good effectiveness. It can not only reconstruct joint function, but also cure osteoarthritis and fracture at the same time, shorten the healing time, reduce the incidence of related complications.