本文選題：膝內(nèi)翻 + 膝關(guān)節(jié)置換術(shù)��； 參考：《吉林大學(xué)》2015年碩士論文

【摘要】：目的 探討膝關(guān)節(jié)置換對(duì)骨關(guān)節(jié)炎并內(nèi)翻脛骨內(nèi)側(cè)骨缺損的修復(fù)方法及臨床療效。 材料與方法 1.臨床資料：吉林大學(xué)中日聯(lián)誼醫(yī)院關(guān)節(jié)外科2012年11月至2014年11月資料較完整的膝骨關(guān)節(jié)炎并內(nèi)翻畸形患者39例（53膝），其中男13例（17膝），女26例（36膝）；年齡53歲-79歲，平均68.25歲。所有患者均存在脛骨內(nèi)側(cè)骨缺損，依據(jù)Rand分型，a型34膝，b型19膝。術(shù)中分別采用單純骨水泥（A組）、骨水泥加螺釘（B組）、結(jié)構(gòu)植骨加螺釘（C組）重建脛骨平臺(tái)。對(duì)術(shù)中情況、術(shù)后影像學(xué)、術(shù)后并發(fā)癥、關(guān)節(jié)活動(dòng)度及KSS評(píng)分進(jìn)行分析，以了解患膝預(yù)后狀況。 2.方法：術(shù)前所有患者進(jìn)行患膝功能、畸形的評(píng)估，通過(guò)X線評(píng)定骨缺損及骨質(zhì)條件，必要時(shí)行骨密度測(cè)定，常規(guī)進(jìn)行KSS評(píng)分。術(shù)中a型34膝采用單純骨水泥修復(fù)骨缺損，b型19膝，其中11膝采用骨水泥加螺釘修復(fù)，8膝采用結(jié)構(gòu)植骨加螺釘。54膝均采用表面膝關(guān)節(jié)置換。術(shù)后隨訪常規(guī)拍攝膝關(guān)節(jié)正側(cè)位片了解假體、植骨塊、骨水泥情況，通過(guò)查體評(píng)定膝關(guān)節(jié)術(shù)后膝關(guān)節(jié)活動(dòng)度，同樣進(jìn)行KSS評(píng)分，并使用SPSS17.0軟件對(duì)比術(shù)前及術(shù)后隨訪過(guò)程的KSS評(píng)分。 結(jié)果： 53膝均獲完整隨訪，，隨訪6~48個(gè)月，平均22.6個(gè)月，未發(fā)現(xiàn)植骨不愈合、骨吸收等情況，1例出現(xiàn)骨水泥斷裂，1例出現(xiàn)深靜脈血栓，1例術(shù)后感染，2例出現(xiàn)假體周?chē)噶翈�，但未呈進(jìn)行性進(jìn)展。A組KSS評(píng)分由術(shù)前（45.15±5.84）分提高至末次隨訪時(shí)的（94.25±5.02）分，優(yōu)良率達(dá)96.5%；B組KSS評(píng)分由術(shù)前（26.34±6.27）分提高至末次隨訪時(shí)的（92.02±4.45）分，優(yōu)良率達(dá)94.6%；C組KSS評(píng)分由術(shù)前（29.27±5.42）分提高至末次隨訪時(shí)的（90.96±3.79）分，優(yōu)良率達(dá)93.7%，術(shù)前與術(shù)后KSS評(píng)分比較具有明顯的統(tǒng)計(jì)學(xué)意義（P＜0.05）。單純骨水泥填充（A組）、骨水泥充填螺釘加強(qiáng)（B組）、結(jié)構(gòu)植骨加螺釘（C組）三種方法在初次TKA中修復(fù)膝內(nèi)翻脛骨內(nèi)側(cè)骨缺損效果良好，術(shù)后并發(fā)癥少。 結(jié)論： 1.脛骨內(nèi)側(cè)骨缺損Rand分型有助于合理制定手術(shù)方案。 2.骨水泥填充、骨水泥充填螺釘加強(qiáng)、結(jié)構(gòu)植骨加螺釘修復(fù)膝骨關(guān)節(jié)炎并內(nèi)翻畸形脛骨近端內(nèi)側(cè)骨缺損近期療效滿意。 ①年老體弱患者采用單純骨水泥修復(fù)療效滿意； ②骨質(zhì)疏松患者采用骨水泥修復(fù)螺釘加強(qiáng)療效滿意； ③年輕骨質(zhì)條件良好的患者采用結(jié)構(gòu)植骨加螺釘修復(fù)療效滿意。 3.術(shù)前X線及骨密度評(píng)估骨質(zhì)條件對(duì)選擇何種方式很有意義。
[Abstract]:Purpose

To investigate the repair method and clinical curative effect of knee joint replacement on the internal bone defect of tibia .

Materials and Methods

1 . Clinical data : From November 2012 to November 2014 , 39 cases ( 53 knees ) of knee osteoarthritis complicated with endogenic deformity of the joint surgery department of Jilin University between November 2012 and November 2014 , including 13 males ( 17 knees ) and 26 females ( 36 knees ) ;
Age 53 - 79 years , mean 68.25 years . All patients had medial tibial defects . According to Rand ' s classification , type a 34 knees and type b 19 knees , the tibial plateau was reconstructed by using bone cement alone ( group A ) , bone cement plus screw ( group B ) , structural bone grafting and screw ( group C ) .

Methods : Before operation , all patients were evaluated for knee function and deformity . The bone defect and bone condition were assessed by X - ray . Bone density measurement was performed .

Results :

All of the 53 knees were followed up for 6 - 48 months , average 22.6 months , no graft union , bone resorption were found , 1 case had bone cement fracture , 1 case had deep vein thrombosis , 1 case had postoperative infection , 2 cases had periprosthetic transmission , but did not show progressive progress .
The KSS score of group B increased from ( 26.34 鹵 6.27 ) preoperatively to ( 92.02 鹵 4.45 ) at the last follow - up , with a good rate of 94.6 % .
In group C , KSS score increased from 29.27 鹵 5.42 to 90.96 鹵 3.79 , and the excellent rate reached 93.7 % . There was significant difference between preoperative and postoperative KSS scores ( P & lt ; 0.05 ) .

Conclusion :

1 . The Rand classification of medial tibial defect can help to establish the surgical plan .

2 . Bone cement filling , bone cement packing screw strengthening , structural bone grafting and screw fixation for the treatment of knee osteoarthritis .

( 1 ) The elderly patients were satisfied with the curative effect of bone cement alone .


( 2 ) bone cement repairing screw is adopted to strengthen the curative effect satisfaction in patients with osteoporosis ;


( 3 ) The patients with good young bone condition were satisfied with the curative effect of structural bone grafting and screw repair .

3 . The preoperative X - ray and bone mineral density evaluated the way the bone condition was chosen .
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.3

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