骨小梁金属Cone重建膝关节翻修术中干骺端骨缺损的临床疗效

The efficacy of trabecular metal Cones in reconstructing metaphyseal bone defects during revision total knee arthroplasty

目的探讨膝关节翻修术中应用骨小梁金属Cone重建干骺端骨缺损的临床疗效。方法回顾性分析2015年7月至2023年8月于新疆医科大学第一附属医院接受膝关节翻修术中应用骨小梁金属Cone重建干骺端骨缺损患者46例(47膝)的病历资料,男12例、女34例,年龄为(68.65±9.09)岁(范围41~83岁),体质指数(body mass index,BMI)为(27.20±4.50)kg/m2(范围19.5~36.0 kg/m2)。股骨侧及胫骨侧骨缺损安德森骨科研究所(Anderson orthopedic research institute,AORI)分型为T2B型20侧、T3型16侧、F2B型11侧、F3型17侧,64侧共置入骨小梁金属Cone 67个。临床评价指标包括膝关节活动度(range of motion,ROM)、疼痛视觉模拟评分(visual analogue scale,VAS)及美国膝关节学会评分(Knee Society score,KSS)。拍摄双下肢全长X线片和膝关节正侧位X线片,测量患肢膝关节胫股角(femorotibial angle,FTA),观察膝关节力线的改善情况及骨小梁金属Cone骨长入程度,记录并发症发生情况。结果46例患者均获得随访,随访时间为(46.22±26.55)个月(范围6~103个月)。KSS膝评分由术前(29.22±19.79)分提高至术后3个月的(72.46±6.55)分,末次随访为(88.22±6.01)分,差异有统计学意义(F=258.118,P<0.001);KSS功能评分由术前(7.65±8.21)分提高至术后3个月的(40.00±9.49)分,末次随访为(56.30±6.10)分,差异有统计学意义(F=354.711,P<0.001)。VAS评分由术前(5.35±1.50)分降低至术后3个月的(1.91±0.59)分,末次随访为(0.28±0.50)分,差异有统计学意义(F=300.934,P<0.001);ROM由术前67.72°±34.62°改善至术后3个月的80.33°±10.51°,末次随访为85.33°±9.15°,差异有统计学意义(F=7.798,P<0.001)。FTA由术前179.24°±10.30°改善至出院时的174.61°±2.11°,末次随访为174.39°±1.69°,差异有统计学意义(F=9.123,P<0.001)。末次随访时64个骨小梁金属Cone(95.5%,64/67)X线片提示有良好的骨长入,未见假体周围骨溶解,假体均牢固固定。1例患者术后第20天发生股骨干中段骨折,次日行股骨记忆合金环抱钢板内固定术,术后6个月复查骨折线已完全闭合,可扶助行器行走;其余患者均无假体周围感染、松动、脱位及周围骨折等并发症。结论膝关节翻修术中应用骨小梁金属Cone可有效重建严重的干骺端骨缺损,加强膝关节假体的稳定性,重建相对正常的膝关节下肢力线,Cone内骨长入趋势良好,膝关节功能明显改善。

Objective To investigate the clinical outcomes and efficacy of trabecular metal(TM)cones for the reconstruction of metaphyseal bone defects in revision total knee arthroplasty.Methods A retrospective analysis was conducted on 46 patients(47 knees),who underwent revision total knee arthroplasty with TM cones for metaphyseal defect reconstruction from July 2015 to August 2023.The cohort comprised 12 males and 34 females,ranging from 41 to 83 years of age,with a mean of 68.65±9.09 years.Body mass index(BMI)ranged from 19.5 to 36.0 kg/m^(2),averaging 27.20±4.50 kg/m^(2).Bone defects were stratified according to the Anderson Orthopedic Research Institute(AORI)classification,including 64 sides(AORI T2B type 20 sides,T3 type 16 sides,F2B type 11 sides,F3 type 17 sides)which were addressed with 67 cones.Evaluations during follow-up included range of motion(ROM),visual analogue scale(VAS)for pain,and the American Knee Society Score(KSS).Long leg radiographs and knee X-rays were reassessed for femorotibial angle(FTA)and joint alignment,osseointegration of the TM cones,and any complications were documented.Results The average follow-up duration was 46.22±26.55 months(range 16-103 months).The KSS knee score significantly improved from 29.22±19.79 preoperatively to 88.22±6.01 at the final follow-up(F=258.118,P<0.001).Similarly,the KSS function score saw a marked increase from a preoperative average of 7.65±8.21 to 56.30±6.10 at the final follow-up(F=354.711,P<0.001).VAS scores significantly decreased from 5.35±1.50 preoperatively to 0.28±0.50 at the final follow-up(F=300.934,P<0.001).ROM improved from 67.72°±34.62°preoperatively to 85.33°±9.15°at the final follow-up(F=7.798,P<0.001),and the FTA improved from 179.24°±10.30°preoperatively to 174.39°±1.69°at the final follow-up,a statistically significant enhancement(F=9.123,P<0.001).Osseointegration was observed in 95.5%of the cases(64/67 cones).There were no instances of osteolysis or aseptic loosening observed,indicating stable prosthetic fixation.Complications were minimal,with one reported case of a femoral shaft fracture,which was successfully treated with internal fixation,resulting in satisfactory healing at 6 months.At the last follow-up(3 years after operation),the patient could walk at home with a walker and the other patients had no complications such as periprosthetic joint infection,dislocation and periprosthetic fracture.Conclusion The application of trabecular metal cones in revision total knee arthroplasty provides an effective solution for the reconstruction of severe metaphyseal bone defects,enhancing prosthetic stability and restoring the knee joint's mechanical alignment.The trend towards successful osseointegration in the TM cones is promising,and a significant improvement in knee joint function has been observed.