自体混合植骨治疗初次全膝关节置换术中RandC型骨缺损的疗效

目的 探讨自体混合植骨治疗初次全膝关节置换术中RandC型骨缺损的疗效。方法 总结2002年2月至2007年6月本院使用自体颗粒植骨加结构植骨治疗初次全膝关节置换术中RandC型骨缺损患者12例，其中男3例(4膝)，女9例(12膝)，50~79岁，平均63.4岁。骨关节炎11例(14膝)，类风湿关节炎1例(2膝)。术后随访12~48个月，平均26.8个月。记录患者术前、术后3d、3个月、1年和末次随访X线平片及HSS评分结果。结果 术前膝关节HSS评分为22．5(19～31)分，术后末次随访平均87(78～96)分，术后明显优于术前(P<0.05)，其中优(≥90分)4例(6膝)，良(80～89分)7例(9膝)，中 (70～79分)1例(1膝)，优良率93.75%，术后末次随访复查X线片可见植骨均愈合，未见移位、骨吸收、骨溶解、胫骨平台塌陷、假体松动及感染征象。2例出现透亮带，但均<1mm，未见假体松动。结论 自体混合植骨能有效治疗初次全膝关节置换术中胫骨近端RandC型骨缺损，为胫骨假体提供良好的初始稳定性，近期疗效好。

The evaluation of the therapeutic effect of mixed bone autograft on Rand C proximal tibial defect in primary TKA

Objective To evaluate the therapeutic effect of mixed bone autograft on Rand C proximal tibial defect in primary total knee arthroplasty (TKA). Methods We retrospectively analyzed the data of patients from Feb. 2002 to Jun. 2007. 12 cases (male /female: 3/9), totally 16 knees with Rand C proximal tibial bone defect were handled with granular bone autograft combining with structural bone autograft by the same surgeon. The age of the subjects ranged from 50 to 79 (average 63.4). 11 cases (14 knees) suffered from osteoarthritis, and 1 case (2 knees) suffered from rheumatoid arthritis. The follow-up periods ranged from 12 to 48 months, averaged 26.8 months. Preoperative and postoperative X-ray and HSS score 3 days, 3 months, 12 months before and after surgery, and the latest follow-up were recorded respectively. Results HSS score was promoted from preoperatively 22.5 (19 to 31) to 87 (78 to 96) points in latest follow-up, which has significantly difference (P<0.05), with 4 cases (6 knees) falling into excellent (≥90 points), 7 cases (9 knees) filling into good (80-89), and 1 case(1 knees) moderate (70-79). The excellent and good proportion could reach 93.75%. According to the X ray follow-up, no case was found failed to heal, and no grafts mobilization, bone absorption, bone dissolution, tibial plateau collapse and infection was detected. Although 2 knees were detected out with translucid bands(<1mm), loosening was negative. Conclusion Autologous combined bone grafting is an effective procedure for treating Rand C proximal tibial bone defect in primary TKA, which could provide primary stability and result in good outcome.