發(fā)布時間：2019-06-24 20:48

【摘要】：[目的]比較分析膝內(nèi)翻伴脛骨內(nèi)側(cè)平臺Rand Ⅱ型骨缺損病例行全膝關(guān)節(jié)置換術(shù)(total knee arthroplasty,TKA)中應(yīng)用支撐螺釘聯(lián)合骨水泥與自體骨移植重建骨缺損的療效,探索更為有效的治療方法。[方法]回顧性研究2011年10月~2015年10月,本院骨科對26例膝內(nèi)翻伴脛骨內(nèi)側(cè)平臺Rand Ⅱ型骨缺損患者行初次TKA,其中支撐螺釘聯(lián)合骨水泥修復(fù)骨缺損13例為支撐組,自體骨移植修復(fù)骨缺損13例為植骨組。兩組患者基線資料、骨缺損深度及脛骨平臺受累面積比較差異無統(tǒng)計(jì)學(xué)意義(P0.05);觀察兩組患者手術(shù)前后膝關(guān)節(jié)KSS評分、膝關(guān)節(jié)活動度(ROM)、脛股角恢復(fù)情況及臨床并發(fā)癥。[結(jié)果]支撐組手術(shù)時間較植骨組平均縮短10 min;2例使用脛骨延長桿;術(shù)后3 d內(nèi)均可扶雙拐下地行走;術(shù)后即可完全負(fù)重;術(shù)后1例發(fā)生小腿肌間靜脈血栓形成;1例發(fā)生切口上緣脂肪液化。植骨組7例患者應(yīng)用脛骨延長桿;術(shù)后21 d內(nèi)均扶雙拐部分負(fù)重。術(shù)后1例發(fā)生小腿肌間靜脈血栓形成;2例發(fā)生切口脂肪液化。術(shù)中失血量、術(shù)后24 h引流量與植骨組比較差異無統(tǒng)計(jì)學(xué)意義;兩組術(shù)后內(nèi)翻畸形和/或屈曲攣縮畸形均得到矯正。支撐組術(shù)后3個月1例骨與水泥界面出現(xiàn)約1 mm放射性透亮線,植骨組發(fā)現(xiàn)3例骨吸收。所有患者3個月棄拐行走。兩組術(shù)后3個月膝關(guān)節(jié)KSS評分、脛股角測量結(jié)果、關(guān)節(jié)活動度(ROM)分別與術(shù)前相比差異有統(tǒng)計(jì)學(xué)意義,組間比較差異無統(tǒng)計(jì)學(xué)意義。[結(jié)論]支撐螺釘聯(lián)合骨水泥及自體骨移植兩種方法均能有效重建膝內(nèi)翻伴脛骨內(nèi)側(cè)平臺Rand Ⅱ型骨缺損,但支撐組縮短手術(shù)時間,可早期完全負(fù)重,無植骨塊吸收之慮,更符合關(guān)節(jié)快速康復(fù)理念。
[Abstract]:[objective] to compare and analyze the curative effect of supporting screw combined with bone cement and autograft in total knee arthroplasty (total knee arthroplasty,TKA) in cases of knee varus with Rand type II bone defect of medial tibia plateau, and to explore a more effective method for the reconstruction of bone defect. [methods] from October 2011 to October 2015, 26 cases of knee varus with Rand type II bone defect of medial tibia plateau were treated with TKA, for the first time. 13 cases were treated with support screw combined with bone cement as support group, and 13 cases were treated with autograft to repair bone defect. There was no significant difference in baseline data, bone defect depth and tibia plateau involvement area between the two groups (P 0.05). The KSS score of knee joint, the recovery of knee motion (ROM), tibia and thigh angle and clinical complications were observed before and after operation. [results] compared with the bone grafting group, the operation time of the support group was 10 min;2 shorter than that of the bone grafting group, and the tibia lengthening rod was used within 3 days after operation; the total load could be carried after operation; 1 case had intermuscular venous thrombosis of the leg after operation; and 1 case had fat liquefaction at the upper edge of the incision. In the bone grafting group, 7 patients were treated with tibia lengthening rod, and all of them were loaded with double inflection within 21 days after operation. Postoperative intermuscular venous thrombosis occurred in 1 case and incision fat liquefaction in 2 cases. There was no significant difference in blood loss and drainage volume between the two groups at 24 hours after operation, but both groups were corrected for varus deformity and / or flexion contracture deformity. In the supporting group, 1 mm radioactive transparent line appeared at the interface between bone and cement 3 months after operation, and bone resorption was found in 3 cases in the bone grafting group. All patients abandoned crutches for 3 months. There was significant difference in knee joint KSS score, tibiofemoral angle measurement and (ROM) between the two groups at 3 months after operation, but there was no significant difference between the two groups. [conclusion] the two methods of supporting screw combined with bone cement and autograft can effectively reconstruct Rand type II bone defect of knee varus with medial tibia plateau, but the support group can shorten the operation time, can completely bear the weight at an early stage, and has no bone graft resorption, which is more in line with the idea of rapid joint rehabilitation.
【作者單位】： 福建醫(yī)科大學(xué)附屬閩東醫(yī)院;
【分類號】：R687.4
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本文編號：2505356