初次全膝置换自体骨移植修复胫骨平台骨缺损
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王振虎,主任医师,研究方向:人工关节外科及运动医学,(电话)18931258651,(电子信箱)wzh_0312@sina.com

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R683.42

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Bone autografting for repairing tibial plateau defect in primary total knee arthroplasty
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    摘要:

    目的]探讨初次行全膝置换术中采用自体骨移植修复严重膝内翻胫骨内侧平台骨缺损的疗效。[方法]回顾性分析 2006 年 2 月—2019 年 3 月收治的行初次膝关节表面置换术 180 例严重膝内翻患者的临床资料,其中 86 例胫骨截骨后仍存在内侧平台骨缺损、行自体骨移植修复。总结 86 例患者的临床与影像结果。[结果] 86 例患者均顺利完成手术,无血管、神经损伤等严重并发症。86 例患者均获随访 2 年以上,除第 1 例于术后 2 年出现患膝疼痛加重,影像证实胫骨假体松动,行翻修术外,其余患者膝关节功能良好,无翻修。与术前相比,末次随访时,86 例患者的 VAS 评分显著减少 (P<0.05),而 ROM 和 HSS 评分显著增加(P<0.05)。影像方面,与术前相比,末次随访时 86 例患者 FTA 和 MPTA 显著改善(P<0.05),而 PTS 无显著改变 (P>0.05)。[结论] 全膝置换术中对胫骨内侧平台 RandⅡ、Ⅲ型骨缺损采用自体骨移植修复骨缺损可降低费用、最大限度的保存骨量,临床效果满意。

    Abstract:

    [Objective] To explore the clinical outcomes of bone autografting for repairing medial tibial plateau defect in primary total knee arthroplasty (TKA) . [Methods] A retrospective study was conducted on total of 180 patients who underwent primary total knee arthro- plasty from February 2006 to March 2019. Among them, 86 patients remained defect of the medial tibial plateau after tibial osteotomy, and then underwent bone autografting to repair the bone defect. The clinical and radiographic consequences of 86 patients were summarized. [Results] All the 86 patients were operated on successfully, without serious complications such as vascular and nerve injury. The 86 pa- tients were followed up for more than 2 years. All the patients got good function of the knee without revision performed except the first case who received revision TKA for knee pain aggravating 2 years after primary operation, which was caused by tibial prosthetic loosening con- firmed by imaging. The VAS scores were significantly decreased (P<0.05) , whereas the ROM and HSS scores were significantly increased at the latest follow-up compared with those preoperatively (P<0.05) . In terms of imaging, the femorotibial angle (FTA) and medial proximal tibial angle (MPTA) significantly improved (P<0.05) , whereas the posterior tibial slope (PTS) remained unchanged (P>0.05) at the latest fol- low up compared with those before operation. [Conclusion] Bone autografting has advantages of preserving bone stock maximally, better cost efficiency and achieving satisfactory clinical outcomes for Rand type II and III bone defects of the medial tibial plateau in the primary TKA.

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王振虎,于洋,龚龙,等. 初次全膝置换自体骨移植修复胫骨平台骨缺损[J]. 中国矫形外科杂志, 2022, 30 (2): 181-183. DOI:10.3977/j. issn.1005-8478.2022.02.19.
WANG Zhen-hu, YU Yang, GONG Long, et al. Bone autografting for repairing tibial plateau defect in primary total knee arthroplasty[J]. Orthopedic Journal of China , 2022, 30 (2): 181-183. DOI:10.3977/j. issn.1005-8478.2022.02.19.

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  • 收稿日期:October 13,2021
  • 最后修改日期:October 26,2021
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  • 在线发布日期: June 10,2023
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