复杂性陈旧性胫骨平台骨折治疗失败患者的全膝关节置换七例报告

Total knee arthroplasty after the failed treatment of complex obsolete tibia plateau fractures: 7 cases report

目的报告7例复杂的陈旧性胫骨平台骨折治疗失败患者全膝关节置换的临床疗效。方法对陈旧性胫骨平台骨折7例在骨折治疗失败后出现创伤性关节炎,平均12个月内进行全膝关节置换术。术前术后进行KSS(knee society score)评分、膝关节功能评分和膝关节活动度评分,评价功能恢复情况。术前膝关节屈伸活动度(65.0±36.5)°。膝关节学会KSS评分(63.5±12.1)分,功能评分(62.7±11.6)分。结果7例均获得至少2年的随访,平均30个月。6例未出现伤口并发症和浅表感染,但均未出现术中副韧带部分撕脱及发生假体周围骨折、骨溶解、假体松动等情况,1例因为术后皮缘坏死,而并发感染而手术失败,行二次手术翻修术;末次随访时,KSS评分(85.5±11.4)分,功能评分(87.5±15.6)分,膝关节屈伸活动度(100.7±10.0)°,术后应用方差分析,均较术前显著改善(P<0.05)。结论复杂陈旧性胫骨平台骨折治疗失败患者全膝关节置换,术后生存质量及膝关节功能明显改善。

Objective To explore the feasibility, safety and effectiveness of total knee arthroplasty after the failed treatment of complex obsolete tibia plateau fractures. Methods Seven cases of obsolete tibial plateau fractures underwent total knee arthroplasty within 12 months on average. Knee Society score （ KSS ） was applied to observe the knee function, range of motion. Preoperative flexion and extension of the knee was （ 65.0 ± 36.5 ） ＆#176;. KSS score：（ 63.5 ± 12.1 ）. Functional score： （ 62.7 ± 11.6 ）. Results Seven patients were followed-up for more than 2 years, 30 months on average. No wound complication, superficial infection, accessory ligament avulsion, periprosthetic fracture, osteolysis, or prosthesis loosening occurred in 6 cases. One surgery failed because of the postoperative skin necrosis and infection. Revision was conducted. In the latest follow-up： KSS scores （ 85.5 ± 11.4 ）, functional score （ 87.5 ± 15.6 ）, flexion and extension of the knee （ 100.7 ± 10.0 ）°. According to postoperative variance analysis, all results were significantly improved after the surgery （ P 〈 0.05 ）. Conclusions Treatment of complex obsolete tibial plateau fractures with internal fixation is difficult. Recovery of postoperative function and quality of life are not always satisfactory. Total knee arthroplasty can achieve good results, and postoperative life quality and knee function are significantly improved. However, indications need to be strictly mastered and long term follow-up is needed.