MBT系统在膝关节翻修及复杂初次膝关节置换中的运用

The application of M.B.T system in knee joint revision and complex primary total knee arthroplasty

目的 探讨MBT系统在膝关节翻修及复杂初次膝关节置换中的运用价值。方法 回顾性分析2017年2月—2020年7月本院收治的采用MBT系统行翻修或复杂初次置换并获得12-54个月随访的17例患者的临床资料,男4例,女13例;年龄47-78岁,平均(66.5±8.6)岁。均为单侧,左侧9例、右侧8例。运用MBT原因:翻修4例,创伤性关节炎并骨缺损4例,严重骨质疏松3例,严重畸形并骨缺损4例,骨缺损并韧带松弛2例。7例配合运用延长杆,10例仅用袖套未加延长杆。术后6周、3个月、6个月、9个月、12个月以及以后每年定期随访,根据HSS膝关节评分和X线检查评估临床疗效,包括假体松动、假体周围透亮线、骨长入、膝关节功能和术后并发症。结果 随访12-54个月,平均(30.4±10.5)个月,术后末次随访膝关节HSS评分由术前(47.6±12.8)分增加至(86.1±6.7)分,差异有统计学意义(t=13.6,P=0.00)。17例患者膝关节活动范围由术前(66.7±13.5)°增加至(103.5±10.4)°,差异有统计学意义(t=-11.1,P=0.00)。随访期间所有病例均未发生假体相关感染、松动、垫块不稳和脱位等并发症。结论 MBT可以维持关节线,达到良好的膝关节2区固定,增加假体的稳定性,提高复杂膝关节置换和膝关节翻修的临床结果。

Objective To investigate the application value of M.B.T system in knee joint revision and complex primary total knee arthroplasty.Methods The clinical data of 17 patients,those were admitted to the hospital from February 2017 to February 2020 and underwent knee joint revision or complex primary total knee arthroplasty by using M.B.T system and were followed-up for 12 to 54 months,were retrospectively analyzed.The subjects consisted of 4 males and 13 females,with mean age of 66.5±8.6 year(range,47-78 years).All the surgery were operated on unilateral side,9 on left knees and 8 on right knees.The reasons for using MBT:4 cases of patients received revision,4 patients were suffered from traumatic knee arthritis complicated with bone defects,3 patients were suffered from severe osteoporosis,6 patients suffered from severe deformity and bone defects,2 cases with bone defect and ligament relaxation.Metaphyseal sleeves in combination with stems were used in 7 patients,10 patients were used metaphyseal sleeves alone.The 17 patients were followed-up at 6 weeks,3 months,6 months,9 months,12 months and annually until final follow-up.Score of hospital for special surgery(HSS) of the knee joint and X-rays examination was used to evaluate the clinical effect,including prosthetic loosening,periprosthesis light line,bone ingrowth,knee joint function and postoperative complications.Results The mean duration of follow-up was 30.4±10.5months(range,12-54 months);the HSS score increased from(47.6±12.8) at preoperative to 86.1±6.7) at postoperative,the difference was statistically significant(t=13.6,P=0.00).The range of motion of the 17 patients improved from(66.7±13.5)° to(103.5±10.4)°,the difference was statistically significant(t=-11.1,P=0.00).There was no periprosthetic infection,loosening,bearer instability or dislocation complications during the follow-up.Conclusions M.B.T system could maintain the joint line,achieved zone-2 fixation at knee joint,increase the stability of prosthesis,and improve the clinical outcome of revision and complex primary total knee arthroplasty.