初次全膝置换术中非包容性骨缺损的处理

目的：通过对初次全膝关节置换术中非包容型骨缺损的重建，介绍自体或异体骨移植重建的方法和体会。方法：对16例（20膝）非包容性骨缺损的膝关节行全膝关节置换及自体或同种异体移植术。其中13例（17膝）为自体股骨髁或胫骨平台修整后移植，2例为股骨远端冻干异体半关节骨移植，1例为胫骨近端冻干异体半关节骨移植；螺钉固定4膝，钢板固定16膝。结果：术后随访1—8a，平均3．7a。所有患者术后均弃拐行走，术后疼痛完全消失，下肢畸形及关节功能明显改善，HSS膝关节评分由术前17．2（11～29分）提高到术后85．2（76～94）分。1例股骨远端异体半关节移植患者术后1a出现异体骨骨折。其他患者经X线复查时未见假体松动和感染征象，无明显的植骨块移位、骨折、骨吸收、不愈合。结论：在非包容型骨缺损的初次全膝关节置换术中，采用自体或异体骨移植重建可保持假体的长期稳定性，同时为较年轻的患者将来翻修而保存骨量。

The Treatment of Uncontained Bone Defect in Primal Total Knee Arthroplasty

Objective：To introduce the method and experiences of reconstructing uncontained bone defect in primary total knee arthroplasty with autograft and allograft. Methods：Sixteen（20 knees）cases with uncontained knee joint bone defect were in this study. In 13 cases （ 17 knees）, the bone defect was restored with the resected tibial plateau and femoral condyles. 2 cases were distal femur reconstructions and 1 cases was proximal tibia reconstruction with freeze dry allograft-prosthesis composites. 4 knees were fixed by screws and 16 knees by plates. Results： All the cases were followed up of 3.7 a averagely （ range, 1 - 8 a）. All the patients can walk without crutch 3 months after operation, and enstrophe or ecstrophy or contraction anisotrophy were rectified right after operation. The HSS knee score improved from preoperative 17. 2（ 11 -29） to postoperative 85.2 （76 -94） . Distal femur allograft fracture occured 1 year postoperatively in one allograft-prosthesis composites case. There were no complications such as infection, fracture or loosening of the prostheses, obvious displacement, fracture, bone absorption or nonunion. Conclusions： For uncontained bone defect in primary total knee arthroplasty, autograft and allograft could provide long term stability for the protheses and preserve more bone mass for young patients.