TKA术中自体骨移植联合螺钉固定重建内侧平台骨缺损

目的 探讨全膝关节置换(TKA)术中自体骨移植联合螺钉固定重建内侧平台骨缺损的疗效.方法 2001年11月至2004年11月,46例(50膝)伴内侧胫骨平台骨缺损患者行TKA手术,男16例(16膝),女30例(34)膝,骨性关节炎组(OA)35例(38膝),类风湿性关节炎组(RA)11例(12膝).46例患者术前常规采用三维CT重建估计胫骨平台截骨后骨缺损范围和深度,术中采用单块或内外髁双侧截骨块重叠填充骨缺损并采用空心钉固定.另随机抽取TKA患者80例(86膝)作为对照组.对手术情况、胫骨基座外移、关节线高度改变等比较分析,随访并记录KSS评分.结果 随访6～9年,46例患者中2例失访,1例术后5年死于心肌梗死,末次随访除深部感染1例外无假体松动发生;1例(1膝)楔形植骨术后8年出现骨质吸收,其余植骨块均愈合,无骨质吸收改变.OA组术中平台劈裂骨折3例(3膝),股骨远端截骨量、聚乙烯垫片厚度、胫骨假体型号、关节线抬高、胫骨基座外移均大于其他两组(q检验,P＜0.05).各组手术前后KSS评分差异均有统计学意义(F检验,P＜O.05),术后优于术前,同组术后6、9年比较差异无统计学意义(q检验,P＞0.05.结论 自体骨移植联合螺钉固定重建内侧平台骨缺损操作简单,能有效重建骨缺损、恢复关节稳定性,但OA硬化型骨缺损植骨时易出现胫骨假体外移、关节线抬高、术中胫骨劈裂骨折等并发症.

Abstract：

Objective To investigate the efficacy of autologous bone grafting plus screw fixation to reconstruct the medial tibial defects in total knee arthroplasty (TKA). Methods From November 2001 to November 2004, 46 patients (50 knees) with medial tibial bone defects underwent TKA at our hospital.There were 16 males (16 knees) and 30 females (34 knees). They included osteoarthritis (OA) (n = 35,38 knees) and rheumatoid arthritis (RA) (n = 11, 12 knees). A total of 46 patients underwent three-dimensional CT (computed tomography) reconstruction to evaluate the tibial plateau defects after osteotomy.Single or double distal femoral osteotomic bone was used to reconstruct the bone defects with the hollow nail internal fixation. Another 80 TKA patients (86 knees) were randomly selected as the control group. The surgical outcome, lateral migration of tibial component and joint line elevation, etc. were analyzed and the follow-up knee society scores recorded. Results The patients were followed up for 6 to 9 years. Two patients were lost to follow-up and 1 died of myocardial infarction at 5 years post-TKA in the test group. In the last follow-up, 1 case suffered deep infections and all others had no prosthetic loosening. One case ( 1 knee) had resorption of wedge-shaped bone graft after 8 years. The remaining graft healed and there was no screw displacement. Medial platform split fracture occurred in 3 patients (3 knees) in the OA group. The quantity of distal femoral osteotomy, thickness of polyethylene insert, tibial implant size, joint line elevation and lateral migration of tibial base were greater than the other two groups (q test, P ＜0. 05). The pre- and post-operative KSS scores had significant differences in each group ( F test, P ＜ 0. 05). But the same group showed no significant difference at 6, 9 years ( q test, P ＞ 0. 05). Conclusion As an easy and effective way of reconstructing the medial tibial bone defects, autologous bone grafting plus screw fixation can restore knee mechanical axis and stability. But in OA patients with tibial sclerosis, the complications of tibial component lateral migration, joint line elevation and splitting tibia fractures should be avoided during the reconstruction     

保留股骨颈短柄假体在治疗晚期股骨头坏死中的应用

目的 观察保留股骨颈短柄股骨假体全髋关节置换术(THA)治疗晚期股骨头坏死的短期疗效.方法 2008年6月至2009年12月,采用保留股骨颈短柄股骨假体全髋关节置换术治疗晚期股骨头坏死8例(9髋),平均年龄24.1 (20～36)岁.酒精性者3例(3髋),激素性者5例(6髋).按照世界骨循环研究学会(ARCO)分期,Ⅲ-C期7髋,Ⅳ期2髋.通过Harris评分及X线片评价临床效果.结果 平均随访18.1(12 ～30)个月,术前Harris评分平均为(42.8±8.6)(21～52)分,终末随访时平均(92.8±6.1)(80 ～ 100)分,优7髋,良2髋.X线片上髋臼和股骨无骨吸收或骨溶解,假体无松动征象.疼痛解除,无并发症发生.结论 使用保留股骨颈短柄股骨假体全髋关节置换术治疗年轻患者晚期股骨头坏死的短期效果满意.     

固定平台型和旋转平台型假体全膝关节置换术后早期疗效的随机对照研究

目的 随机对照试验比较固定平台型和旋转平台型假体在人工全膝关节置换术后的早期临床疗效.方法 将2008年1至10月新疆医科大学第一附属医院关节外科诊断为膝骨性关节炎的患者,连续随机分配至固定平台组和旋转平台组行全膝关节表面置换术,记录术前及术后6个月,1、2年时术膝的膝关节评分(KSS评分、HSS评分)、WOMAC骨关节炎评分、疼痛评分、功能评分以及膝关节最大屈曲度(ROM)等指标,进行统计学分析.结果 比较两组病人术前及术后6个月,1、2年时KSS膝评分P值分别为0.754、0.802、0.561、0.764,HSS评分P值分别为0.737、0.361、0.254、0.330,WOMAc骨关节炎评分P值分别为0.976、0.557、0.946、0.818,ROM随访P值分别为0.519、0.646、0.175、0.276,差异均无统计学意义.结论 固定平台型和旋转型膝假体TKA术后早期临床疗效差异无统计学意义.

Abstract：

Objective To compare the early clinical outcomes of primary total knee arthroplasty by a fixed-bearing versus mobile-beating prosthesis.Methods A total of 80 patients with osteoarthritis at our hospital from January 2008 to October 2008 were sequentially and randomly assigned into Group A (fixedbearing prosthesis) (40 knees) and Group B (mobile-bearing prosthesis) (40 knees).And the data of the range of motion (ROM),Knee Society Score (KSS) and Western Ontario MacMaster (WOMAC) were collected at pre-operation and 6,12 and 24 months post-operation respectively.Results The P values were as follows:KSS:0.754,0.802,0.561,0.764;HSS (Hospital for Special Surgery):0.737,0.361,0.254,0.330;WOMAC (Western Ontario and McMaster Universities) osteoarthritis index :0.976,0.557,0.946,0.818;ROM follow-up:0.519,0.646,0.175,0.276.No significant differences were found in clinical outcomes between two groups.Conclusion The fixed-bearing and mobile-bearing prostheses show no difference in clinical outcomes.     

氧化铝全陶瓷内衬对陶瓷头界面全髋置换的临床疗效分析

目的 分析第三代氧化铝全陶瓷内衬对陶瓷头界面在初次全髋关节置换术的中期临床疗效.方法 回顾性收集1999年1月至2005年10月135例患者临床资料,共获得有效随访患者119例,共146例髋.其中髋臼侧均为羟基磷灰石(HA)涂层压配固定臼杯,股骨侧123例为非骨水泥HA近端涂层压配固定,23例为锥形光面骨水泥固定,所有假体的头臼界面均为氧化铝陶瓷头对全陶瓷内衬.进行最短时间5年以上,平均(72.9±10.9)个月的随访,对其进行临床和影像学检查评估疗效.结果 髋关节功能Harris评分从术前平均(49.6±7.9)分提高到术后末次随访(91.7±3.0)分(P＜0.05).以翻修作为终点的假体5年生存率为96.6％.1例因髋臼杯移位松动而翻修;1例出现外伤性股骨假体周围骨折,行翻修术;1例患者因轻微外伤后并发陶瓷内衬破损行翻修术;另2例因感染而翻修.此外,16例术中并发股骨侧截骨面皮质劈裂,延迟负重后无假体松动下沉;1例髋术中并发髋臼骨折,行保守治疗后髋臼无松动;2例术后出现脱位,保守治疗成功;2例出现非典型性关节异响,非手术治疗后消失.其余无论是骨水泥或非骨水泥假体,假体髋臼侧和股骨侧均固定稳定,假体周围无骨溶解,假体无明显松动和下沉.结论 第三代氧化铝全陶瓷内衬对陶瓷头界面假体用于初次全髋置换中期临床随访结果满意,但需要避免陶瓷界面特有的并发症,假体使用需要注意良好的临床技术.