全膝关节置换过程中骨缺损的处理策略

Management of bone defects in total knee arthroplasty

背景:全膝关节置换过程中骨缺损是手术医师经常需要面对的重要挑战之一,合理的处理方法才可以保证修复手术的效果。目的:分析关于全膝关节置换及全膝关节置换翻修骨缺损处理的文献资料,分析及总结不同类型骨缺损的最优处理策略。方法:搜索CNKI、万方、维普、Pub Med、Medline、Web of Science数据库,以"全膝关节置换,全膝关节置换翻修,骨缺损,骨丢失"、"total knee arthroplasty,total knee replacement,revision total knee arthroplasty,bone loss,bone defect,bone deficiency,management"等检索词检索,最后对所获得的文献中进行分析总结。结果与结论:(1)共纳入62篇关于全膝关节置换骨缺损的文献,针对骨缺损分型尚无公认的标准,AORI分型的使用最为广泛;(2)术前的详细评估,包括实验室及影像学检查,以及准确的诊断是手术成功的关键;(3)胫骨、股骨骨缺损的处理策略相似,髌骨骨缺损的分型及处理尚无统一标准;(4)全膝关节置换翻修术中使用延长杆效果更优;(5)结果提示,通过详细的术前评估、正确的诊断以及合理的骨缺损分型,根据不同策略的特点和患者年龄、生活需求进行选择,可获得良好的修复效果。

BACKGROUND： Bone defects are one of the most important challenges that surgeons have to manage in total knee arthroplasty. The reasonable treatment method can guarantee the effect of the repair operation. OBJECTIVE： To review the relevant literatures concerning bone defects treated by primary total knee arthroplasty and revision total knee arthroplasty, and to analyze the optimal managements for different types of bone defects. METHODS： Relevant literatures were identified in China National Knowledge Infrastructure, Wanfang data, Vip, PubMed, Medline, and Web of Science. The key words were ＂total knee arthroplasty, total knee replacement, revision total knee arthroplasty, bone loss, bone defect, bone deficiency, management＂. The included studies were analyzed and summarized. RESULTS AND CONCLUSION： （1） Sixty-two studies regarding total knee arthroplasty for bone defects were included, without recognized standards on the type of bone defects. AORI is the most widely used classification for bone defects. （2） Pre-operated detailed evaluation including laboratory and radiographic examination, and accurate diagnosis are the key to success. （3） Management of bone defect was similar in tibia and femur, but there is still no standard classification and management of patellar bone defect. （4） Using stem fixation whenever a femoral or tibial component is revised can improve clinical outcome. （5） Through detailed evaluation, accurate diagnose and appropriate classification of bone defect, selection, according to the characteristics of different strategies, the age of the patient and the needs of life, can get a good clinical result.