一期全膝关节置换术联合骨折切开复位内固定治疗膝关节骨关节炎合并胫骨应力性骨折的疗效分析

One-stage total knee arthroplasty combined with open reduction and internal fixation for knee osteoarthritis complicated with tibial stress fracture

目的探讨一期全膝关节置换术(TKA)联合骨折切开复位内固定治疗膝关节骨关节炎合并胫骨应力性骨折患者的疗效分析。方法回顾性分析2018年3月至2020年3月甘州区人民医院骨科收治的3例膝关节骨关节炎合并胫骨应力性骨折患者资料。3例均为女性;年龄54~76岁,平均66岁;2例为横形骨折,1例为短斜形骨折,且均为膝关节内翻畸形。美国特种外科医院(HSS)评分左侧平均37.6分(28~50分),右侧平均28.3分(22~39分)。患者均行一期关节表面置换术+右侧胫骨应力性骨折切开复位内固定术,记录患者骨折愈合时间、HSS评分、关节活动度等。结果3例患者术后随访25~44个月,平均32个月;骨折愈合时间为4~7月,平均5个月。末次随访时均无假体松动及假体周围骨溶解、关节不稳定等并发症发生。膝关节内翻畸形纠正,末次随访时膝关节HSS评分:左侧平均89.6分(88~91分),右侧88.3分(85~90分)。结论一期全膝关节置换术联合骨折切开复位内固定可恢复膝关节的功能,疗效良好。

Objective To explore one-stage total knee arthroplasty(TKA)combined with open reduction and internal fixation(ORIF)for knee osteoarthritis complicated with tibial stress fracture.Methods The 3 patients were retrospectively analyzed who had been treated for knee osteoarthritis complicated with tibial stress fracture at Department of Orthopedics,Ganzhou District People's Hospital from March 2018 to March 2020.They were all female,aged from 54 to 76 years(average,66 years).There were 2 transverse fractures and one short oblique fracture;all of them had knee varus deformity.The Hospital for Special Surgery(HSS)scores averaged 37.6(from 28 to 50)for the left knee and 28.3(from 22 to 39)for the right knee.One-stage TKA was performed for the articular surface while ORIF for the right tibial stress fracture for all patients.Recorded were fracture union time,HSS knee score and range of articular motion.Results The 3 patients were followed up for 25 to 44 months(average,32 months).The fracture union time ranged from 4 to 7 months(average,5 months).The last follow-ups revealed no such complications as prosthesis loosening,peri-prosthesis osteolysis or joint instability.Knee varus deformity was corrected in all patients.The HSS knee scores at the last follow-up averaged 89.6(from 88 to 91)for the left knee and 88.3(from 85 to 90)for the right knee.Conclusion In the treatment of knee osteoarthritis complicated with tibial stress fracture,one-stage TKA combined with ORIF can restore the function of knee joint,leading to fine curative effects.