全膝关节翻修术中应用金属垫片修复非包容性骨缺损的中期随访VIP免费

rli’件科志2{}04年4嗣第24卷第4坤jChinJ(}rlhs!p，ApJ2004．_4全膝关节翻修术中应用金属垫片修复非包容性骨缺损的中期随访吴立末金礼斌Th,l盯lasLBema~,,ek·人工关节·【摘要】目的探讨在全膝关节翻修术中采用金属垫片修复股骨及胫骨侧非包窖性骨缺损的临寐效果．．方法对1992—2o(~1年闻227恻全膝关节翻修术中使用盘羁垫片修复AO一Ⅱ型非包容性骨缺损而获得随沂的62例患者进行回顾性分析．男28倒，女34倒；年龄42～B7岁．平均6了．8岁；假体松动翻修30例．感染后眭体二期植^19例．假体阎嗣骨溶解3例，假体位置、下肢力线不佳或关节不稳定l0倒采用金属垫片来修复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，结果术后随访13—132个月．平均6O8个月根据睬关节会评分，睬评分从术前平均25分(15-60舟)增加到随访时的平均76分(30～95分)；功能评分从术前的40分(15-65丹)增加到随访时的62舒(25～90分)；膝盖节活动度从术前的78。(30。一l00o增加到随访时的87。{40。-130。)，2例感豪后二期假体植入的病例由于感染复发而失败1I例股骨后删、4例胫骨内侧可见金属垫片下骨术泥与骨界面有透亮带．但均来呈进行性发展结论采用金属毽片修复全膝关节翻修术中非包窖性骨缺损，尤其适用于老年患者．既可以方便手术操作．获得即刻稳定悱．义可“提高翻修成功率l关键词】关节成彤术，置换，膝：假体和植^物；再手术；随访研究TheuseofmetaIaugmentationforIllllCOlltainedbonedefectsinrevisiontotaIkneearthroplastyk—dang‘．JLi-bin，ThomasLBernr~sek．‘DepartmentOrihop~edies,Smmd蜊iHospita1．Med&．atCollegeqfzUnA~rsity．1fangzhou3i0f】o9．Cht【Abstract】ObjectiveroexploretheclinicalmsuhsoftheljofmeLalaugmentationforuncon—tainedbonedefortsIi1resiontotalkneearthroplastyMethodsAretrospecfiestud)'wascarrier【OLLLon62paliantswiththcuseofnmtalaugmentationandntramedullar~stemforuncontalnedbonedefectslA0HllypeII1in227revMontotalkneearthmplastiesfroml992to200I．Therewere28maleand34femalewithameanageof678years(range．42to87years}Thediagnosisatthetime0fprirnau'totalkneearthropln．qywosteoarthritisin5l(822％)．rhmm~toktarthritisin8fI2．9％1．IupusarthritisiJ1lf1．6％1andpe,sttrau—maticarthritisI玎2门．2％I．RevisionwJlspeforme~In)rasepticlno~ningoffemoralortibialcomponentin30(48_3％)．reimplantatfonpost—iofevtionin】9{30．6％1，polyethylenewearwithosteolysisin3J48％)．malpo—sitfonormalalignmentandinstabifilvinl0门61％)．Re~ultsSixtv-twopafientswelPreviowedatame~tnof608rmmths{range13to132months)CIinit：a【evaluationnvale‘】thatthenF~a]'tkneesc‘】reofthekneesocietyratingsystemhadimlm}ve~t25pointspreoperativelyto76pointsprrslnperafively．therecallit,nationalscorefrom40pointsto62poinLsatthelatestf0】low—upan{】theme．anrangeofmotion(hadin—creasedfromaflexionart．of78。lcl870．RadiolucentIinatthecementhoneinterfoeejnththeposteri—orfen~ralaugmentationwerepresentin11knees．beneaththemedialtibialaugraentationin4kneesNoneofradioluceatlfoeswereprogressiveAllkneeswe．reasymptomatieTw¨casesw艘failedduetnret：unnceofinfectionOliepatientuliderwentforarthrodesislcau舶ofhighriskrreinfectkm．anotherpatientpre一nedforresectionarthmplastyandfusedreimplantatfonPost-oparativemanpalatit,nunderanesthesiaE)rpoormotionw抽carriedouti115knees．ConcluslonMeI{llaugmentationfortmeontainedbonedefectsenmbinedthintramedul1amstemisfe~sibletoaecomp~sh．itprnvidesim／lled[atesecuIfixationtohostbone，andimprovesSuccessrateofrevisionkneearthroplasty．especiallyinelderpatients【Keywords】Arthroplawty，replacement，knee：Prosthesesandimplants；Reoperation；FoUow—upstudies虽然全膝关节置换术的成功率有了很大的提高，...