中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (22): 4060-4063.doi: 10.3969/j.issn.1673-8225.2010.22.017

• 骨科植入物 orthopedic implant • 上一篇    下一篇

全膝关节翻修中应用金属垫块和髓腔柄组成的翻修假体系统重建骨缺损和关节稳定性：12例随访

黄华扬，郑小飞，李凭跃，王泽锦   

  1. 解放军广州军区广州总医院骨科医院关节骨病科，广东省广州市 510010
  • 出版日期:2010-05-28 发布日期:2010-05-28
  • 作者简介: 黄华扬，男，1956年生，广东省普宁市人，汉族，1983年解放军第二军医大学毕业，主任医师，主要从事骨与关节损伤研究。johnhzy@sina.com

Metal augmentation and intramedullary stem in total knee arthroplasty revision for repair of bone defect and joint stability: A follow-up of 12 cases 

Huang Hua-yang, Zheng Xiao-fei, Li Ping-yue, Wang Ze-jin   

  1. Department of Bone and Joint Surgery,  Orthopedics Hospital, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou  510010, Guangdong Province, China
  • Online:2010-05-28 Published:2010-05-28
  • About author:Huang Hua-yang, Chief physician, Department of Bone and Joint Surgery, Orthopedics Hospital, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou 510010, Guangdong Province, China johnhzy@sina.com

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摘要：

背景：全膝关节翻修比初次全膝关节置换技术上更具挑战性，骨缺损或侧副韧带的缺失，使假体的固定、力线的保持及稳定性的重建更加复杂和困难。
目的：观察全膝关节翻修过程中采用金属垫块和髓腔柄组成的翻修假体系统的临床效果。
方法：2004-02/2008-01对12例12膝行全膝关节翻修，其中假体松动翻修8例，感染后假体置入4例。翻修过程中使用金属垫块修复AORI-Ⅱ型非包容性骨缺损及恢复关节线水平，并使用髓内假体柄来增加翻修假体的稳定性，使用的假体为组合式髁限制型膝关节OPTETRAK.CCK。翻修后进行随访观察，采用膝关节协会评分及膝关节活动度评估膝关节功能。
结果与结论：翻修后随访 6~37个月，平均21个月。患者膝关节协会评分从翻修前27分增加到最后随访时的75分，膝关节活动度由翻修前63°增加到最后随访时的97°。除一例患者皮肤伤口感染延迟愈合外，未见下肢静脉血栓、肺部感染等并发症出现。提示采用金属垫块和髓腔柄组成的翻修假体系统重建全膝关节翻修术中非包容性骨缺损和软组织平衡，既可以方便手术操作，获得即刻稳定性，又可以提高翻修成功率。

关键词: 感染, 假体置入, 关节成形术, 膝关节, 置换, 翻修

Abstract:

BACKGROUND: Total knee arthroplasty revision is technically challenging compared with primary arthroplasty. Bone defect or injury of lateral collateral ligament increases the difficulty of prosthesis fixation, component alignment and stability reconstruction.
OBJECTIVE: To explore the clinical results of metal augmentation and intramedullary stem in total knee arthroplasty revision. 
METHODS: A retrospective study was performed through the use of metal augmentation and intramedullary stem for uncontained bone defects (AORI Type Ⅱ) in 12 total knee arthroplasties from February 2004 to January 2008, including 8 cases revision due to aseptic loosening and 4 cases due to infection. The prosthesis was OPTETRAK.CCK. The patients were followed up after revision, and evaluated by HSS scores.
RESULTS AND CONCLUSION: The patients were followed up for a mean of 21 months (range, 6 to 37 months). Clinical evaluation revealed that the mean knee score of the HSS had improved from 27 points preoperatively to 75 points postoperatively, and the mean range of motion had increased from a flexion arc of 63° to 97°. Except a delayed healing in one case, no lower limb phlebothrombosis or pulmonary infection occurred. Metal augmentation for uncontained bone defects and soft tissue balance combined with intramedullary stem is feasible to accomplish, it provides immediate secure fixation to host bone, and enhances success rate of knee arthroplasty revision.

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