Notch现象对初次全膝关节置换术后股骨侧假体周围骨折的影响

目的:探讨Notch对初次全膝关节置换术（total knee arthroplasty,TKA）后股骨侧假体周围骨折（periprosthetic fracture,PPF）的影响。方法:回顾性收集2013年1月至2020年12月在西安市红会医院收治股骨侧PPF 34例患者的病历资料,男4例,女30例;年龄（69.2...     

全膝关节置换术后KimⅠB型股骨侧假体周围骨折的手术治疗

目的 探讨膝关节表面置换术后股骨假体周围骨折的手术方法及临床疗效.方法 回顾性分析2015年7月至2019年7月采用手术治疗的9例股骨假体周围骨折患者,女性8例,男性1例,年龄65～92岁,平均(75.3±8.7)岁.所有病例均为初次膝关节表面置换术后,假体为骨水泥型.Kim分型均为ⅠB型.骨折发生时间为术后3个月至1...     

不同手术入路的双钢板技术在全膝关节置换术后股骨假体周围骨折中的应用

目的:探讨采用不同手术入路的股骨远端双钢板技术治疗粉碎性、骨质疏松明显的全膝关节置换术后股骨假体周围骨折的临床疗效。方法:自2010年7月至2017年6月,将收治的全膝关节置换术后股骨侧假体周围骨折患者21例根据不同手术入路分为2组。内外侧双入路组(双入路组)15例,男5例,女10例;年龄63～79(67.2±5.9)岁;骨折根据AO-OTA分型,33-A2型11例,33-A3型4例;摔伤12例,交通伤3例;采用双钢板技术固定治疗。髌旁内侧入路组(单入路组)6例,男3例,女3例;年龄61～74(64.6±6.0)岁;骨折按照AO-OTA分型,33-A2型3例,33-A3型3例;摔伤5例,交通伤1例;采用双钢板技术固定。比较两组患者的手术时间、术中出血量、术后引流量、骨折愈合时间,并于术后3、12个月比较两组膝关节HSS评分和影像学表现。结果:所有患者获得随访,双入路组随访时间12～18(14.2±2.6)个月,单入路组随访时间12～16(12.6±2.5)个月;两组比较差异无统计学意义。双入路组手术时间、术后引流量分别为(107.2±10.4) min、(213.9±30.4) ml,单入路组手术时间、术后引流量分别为(95.4±12.8) min、(256.8±34.2) ml,两组比较差异有统计学意义(P0.05);两组患者术中出血量、骨折愈合时间比较差异无统计学意义(P0.05)。术后3、12个月时双入路组HSS评分分别为82.9±5.7、84.8±7.1,单入路组HSS分别为83.6±6.1、86.3±6.8,两组比较差异无统计学意义(P0.05)。术后12个月根据HSS评分,双入路组优2例,良13例;单入路组优1例,良4例,中1例;两组比较差异无统计学意义(χ~2=2.625,P=0.105)。术后12个月随访时,双入路组2例出现并发症,单入路组1例出现并发症,两组比较差异无统计学意义(P0.05)。结论:对于粉碎性、骨质疏松明显的全膝关节置换术后股骨侧假体周围骨折,采用双钢板技术固定能获得较好的膝关节功能,髌旁内侧入路手术时间更短,内外侧双入路术后引流量更少。     

可旋转铰链式膝关节假体在膝关节严重畸形治疗中的应用研究

[目的]探讨可旋转铰链式膝关节假体在膝关节严重畸形治疗中的应用效果.[方法]膝关节严重畸形病例22例(24膝),男10例,女12例,平均年龄56.2岁,右侧12侧,左侧8例,双侧2例,应用可旋转铰链式膝关节假体行全膝关节置换术.采用HSS(hospital for special surgery)评分标准对手术疗效进行评价[2].[结果]手术切口一期愈合,畸形全部矫正,1例术后出现轻度深静脉血栓.随访6～55个月,功能良好,无感染及假体松动发生.[结论]采用可旋转铰链式膝关节假体置换术治疗膝关节严重畸形病例,手术操作简单,效果可靠.     

旋转铰链式膝关节假体重建膝部骨肿瘤切除后骨缺损

[目的]评估量体定制旋转铰链式膝关节假体重建膝部骨肿瘤切除后膝关节功能的临床疗效。[方法]自2000年3月~2008年5月对膝部骨肿瘤36例实施肿瘤切除,应用定制人工关节重建膝关节功能,男29例,女7例,年龄12~33岁,其中骨肉瘤21例,骨巨细胞瘤12例,转移性肿瘤3例,21例骨肉瘤患者术前均行新辅助化疗,所有病例均采用骨水泥型旋转铰链式膝关节假体,利用国际骨与软组织肿瘤协会(MSTS)93功能重建评分系统对患者进行术后肢体功能评定。[结果]4例患者失访,其余32例患者均获得随访,随访资料完整,随访时间1.5~6年(平均2年8个月)。按MSTS93评分标准,患肢功能评分11~28分,平均(22.28±4.33)分,其中优20例,良8例,中2例,差2例。[结论]定制旋转铰链式膝关节假体重建膝部骨肿瘤切除后骨缺损不仅可保留患肢,而且最大程度地恢复患肢功能。恶性骨肿瘤有效的化疗为保肢术提供了可靠保障。     

全膝关节置换术后假体周围骨折的研究进展

假体周围骨折是全膝关节置换术的严重并发症,是对骨科医师的挑战性难题。不同部位骨折的处理方法不同,临床上要结合患者的全身情况与骨折前的关节功能,提出个体化的治疗方案,才能促进骨折愈合,重建假体周围骨量和维持关节功能。近年来,随着内固定材料和外科技术的不断提高,全膝关节假体周围骨折的外科干预技术有了很大的进展。     

全髋关节置换术中假体周围骨折的研究进展

全髋关节置换术是一个较为成熟的手术,术中假体周围骨折是其并发症之一,假体周围骨折分为髋臼假体周围骨折和股骨假体周围骨折,危险因素包括微创技术的使用、压配式非骨水泥假体柄的使用、髋关节翻修术和骨质疏松等。本文就全髋关节置换术中假体周围骨折的分型及治疗进展进行综述。     

后稳定型全膝关节假体置换术后疗效分析

目的　分析后稳定型全膝关节假体置换术的处理方式、手术经验及疗效。方法　对 14例15膝行关节置换 ,使用Apollo后稳定型假体 ,单膝关节置换 13例 ,双膝同期置换 1例。原发疾病为类风湿性关节炎 3例 4膝 ,骨关节炎 11例 11膝。术后随访时间平均 11个月。结果　 15个膝关节术前伸曲活动度平均 75°,全膝关节置换术后 2个月关节活动度恢复至平均 10 0°。 14例患者均可自如行走、上下楼梯 ,膝关节稳定性好。 1膝术后脂肪液化致表层伤口裂开 ,清创后愈合 ,余膝术后伤口均愈合良好。结论　后稳定型假体植入的全膝关节置换手术方式简单、疗效肯定、术后并发症少。     

全膝关节置换术后股骨假体周围骨折的治疗进展

全膝关节置换(total knee arthroplasty, TKA)术后最常见股骨假体周围骨折。术后股骨假体周围骨折的危险因素包括女性、骨质疏松、类风湿关节炎、骨关节炎、神经肌肉疾病、认知障碍、药物相关(服用皮质类固醇)、肥胖、高龄、感染、假体周围骨溶解、膝关节强直、股骨前皮质切迹等。流行病学研究表明, TKA术后假体周围骨折中股骨假体周围骨折最常见, 发生率为0.3%～2.5%。Lewis和Rorabeck分型是股骨假体周围骨折最常用的分型方法, 该分型提出了假体松动的概念, 并强调了进行翻修手术的必要性。其他还有Su分型、通用分型系统以及Rhee分型, 最新的分型为2022年提出的Kim分型。TKA术后股骨假体周围骨折的治疗策略包括非手术治疗、外固定技术、单钢板固定、双钢板固定、髓内钉固定以及翻修TKA和股骨远端置换术。通过检索并分析TKA术后股骨假体周围骨折的相关文献, 以期更好地指导TKA术后股骨假体周围骨折的预防和治疗。     

The role of the rotating hinge prosthesis in the salvage arthroplasty setting

We have studied a consecutive series of 72 salvage knee procedures using a Kinematic rotating hinge prosthesis performed in a single arthroplasty unit between 1983 and 1997. Clinical and radiographic assessment of the survivorship of the Kinematic rotating hinge total knee arthroplasty (Howmedica, Rutherford, NJ) were analyzed. Survival analysis revealed a best-case 10-year implant survival of 90%. Concurrently, this group of patients exhibited a significant and sustained improvement in Knee Society Score and pain relief after implantation of a rotating hinge component. There were 10 deaths due to unrelated causes during the study period. This constrained hinged prosthesis remains a viable option in the face of gross deformity, bone loss, and failed multiple previous surgical procedures.     

Periprosthetic femoral supracondylar fracture after total knee arthroplasty with navigation system

We report 1 patient with a supracondylar periprosthetic fracture 1 month after computer-assisted total knee arthroplasty. The fracture line extended from previous anchoring pinholes into the supracondyle area. Intramedullary nailing of the left femur was performed under close reduction. The possible complication of pinhole fracture to total knee arthroplasty with navigation system should be kept in mind.     

Total knee arthroplasty using the total condylar III knee prosthesis

Twenty-seven total knee arthroplasties (TKAs) were performed in 24 patients using the total condylar III knee prosthesis (TCP III) and were evaluated clinically and radiographically with a mean follow-up period of 4 years. Eighteen were revision TKAs, and nine were primary knee arthroplasties. Evaluations were made using the Hospital for Special Surgery (HSS) knee scale as well as the Knee Society radiographic evaluation method. Clinical results for all knees were 11% (3 of 27) excellent, 70% (19 of 27) good, 15% (4 of 27) fair, and 4% (1 of 27) poor. The one poor rating resulted from an intraoperative vascular injury. The results showed no statistical difference between revision and primary TKA. After operation, pain relief, range of motion, walking, function, and activity level improved in both the primary and revision patients. Radiolucencies 2 mm or greater in width were found in 6 of the 27 tibial components, in none of the 27 femoral components, and in 1 of the 19 patellar components. Only two tibial implants showed progressive radiolucencies. No correlation was found between the radiographic position of the implants and the clinical results. The authors conclude that the TCP III is a satisfactory choice for TKA in selected knees in which there is significant instability and in which intramedullary fixation is required.     

Periprosthetic fracture of the proximal tibia after lateral unicompartmental knee arthroplasty

We report a case of periprosthetic fracture of the proximal tibia after lateral unicompartmental knee arthroplasty following a trivial fall. At the time of surgery, the components were found to be loose; and there was a large uncontained tibial defect with bone loss and communition at the fracture site. The patient was treated by revision total knee arthroplasty and proximal structural tibial allograft, with a satisfactory result at 5-year follow up. Our case illustrates that a bone-conserving unicompartmental knee arthroplasty, if complicated by a periprosthetic fracture, can also present with a difficult surgical problem. Attention to preoperative planning and to availability of structural allograft for such difficult cases is recommended.     

Follow-up of a modular rotating hinge knee system in salvage revision total knee arthroplasty

We evaluated the clinical and radiographic outcomes of salvage knee revisions using a modern-generation, modular, rotating hinge total knee prosthesis in 24 cases with a minimum follow-up of 36 months (mean, 56 months). Indications for revision included aseptic loosening, combined with bone loss and gross collateral ligament instability in all cases. Patients were evaluated clinically and radiographically (Knee Society scores). Knee Society scores improved from 25 preoperatively to 91 postoperatively, and function scores improved from 35 to 85. No loosening of implants was observed. Nonprogressive radiolucent lines were identified around 2 tibial components. One patient required a revision due to patellofemoral subluxation.     

Tibial stress fracture after computer-navigated total knee arthroplasty

A correct alignment of the tibial and femoral component is one of the most important factors determining favourable long-term results of a total knee arthroplasty (TKA). The accuracy provided by the use of the computer navigation systems has been widely described in the literature so that their use has become increasingly popular in recent years; however, unpredictable complications, such as displaced or stress femoral or tibial fractures, have been reported to occur a few weeks after the operation. We present a case of a stress tibial fracture that occurred after a TKA performed with the use of a computer navigation system. The stress fracture, which eventually healed without further complications, occurred at one of the pinhole sites used for the placement of the tibial trackers.     

国产TC-Dynamic假体全膝关节表面置换的近期疗效

目的评价应用国产后稳定型TC-Dynamic假体行人工膝关节表面置换的临床近期疗效。方法应用国产TCDynamic假体行全膝关节表面置换28例(31膝)。结果患者均获5～17个月随访,按1989年美国膝关节外科学会评分系统评分,膝关节评分平均为83分(术前平均为39分);功能评分平均为85分(术前平均为36分)。结论国产TCDynamic假体设计合理、操作便利、患者功能康复可靠,适宜推广。     

Periprosthetic femoral fracture after total hip arthroplast

Periprosthetic femoral fractures represent a significant complication in total hip arthroplasty. based on originand treatment considerations, these fractures are best considered on the basis of the proximal region, and middle region below the lesser trochanter, and distal region at the prosthetic tip and beyond. Proximal-region fractures are usually wired and treated conservatively. Middle-region fractures may require prosthetic revision in addition to fracture fixation.Distal-region fractures are most difficult and may need advanced techniques, such as distal prosthetic fixation and allograft femoral plates.     

Bilateral periprosthetic tibial stress fracture after total knee arthroplasty: A case report

IntroductionPeriprosthetic fractures around the knee after total knee arthroplasty can be seen in the femur, tibia and patella. The tibial fractures are rare cases. Our case with bilateral tibial stress fracture developed after total knee arthroplasty (TKA) is the first of its kind in the literature.Presentation of case75-year-old male patient with bilateral knee osteoarthritis had not benefited from conservative treatment methods previously applied. Left TKA was applied. In the second month postoperatively, periprosthetic tibial fracture was identified and osteosynthesis was implemented with locked tibia proximal plate-screw. Bone union in 12 weeks was observed in his follow-ups.After 15 months of his first operation, TKA was applied to the right knee. Postoperatively in the second month, as in the first operation, periprosthetic tibial fracture was detected. Osteosynthesis with locking plate-screw was applied and union in 12 weeks was observed in his follow-up.He was seen mobilized independently and without support in the last control of the case made in the 24th month after the second operation.DiscussionThe number of TKA applications is expected to increase in the future. The incidence of periprosthetic fractures should also be expected to increase in these cases. Periprosthetic tibial fractures after TKA are rarely seen. The treatment of periprosthetic fractures around the knee after TKA can be difficult.ConclusionIn the case of persistent pain in the upper end of the tibia after the surgery, stress fracture should be considered.     

Periprosthetic fractures about the knee: Clinical pearls and pitfalls

As the average age of our population advances, the demand for total knee arthroplasty (TKA) increases. Additionally, the average age of patients receiving TKA is decreasing, further augmenting the size of the recipient population and the patients’ functional demand on the implants. Concurrent with the growth of TKA performed is an increase in the overall number of adverse outcomes following TKA, one of which includes periprosthetic fracture. These injuries can be challenging to treat and, if not addressed properly, may contribute to accelerated prosthetic failure. Furthermore, these injuries impart a significant mortality risk, higher than elective arthroplasty or fracture of a native distal femur. This article will serve as a review of periprosthetic fractures of the distal femur above a TKA and the authors’ preferred management strategies with respect to fracture location and implant type.