摘要
目的：分析人工全膝关节置换术后股骨髁上骨折的的原因，探讨其预防措施和治疗方法。方法回顾性分析2013年7月至2015年8月，我科行全膝关节置换术后股骨髁上骨折的12例的临床随访资料，其中男5例，女7例；按照膝关节置换术后股骨骨折 Rorabeck 分型：IIA 型9例，IIB 型1例，III 型2例；9例（ IIA 型）入院2周内行手术内固定，1例（ IIB 型）采取保守治疗予以骨牵引，术后4周改石膏外固定，2例（ III 型）采用膝关节翻修术。结果所有患者均获得随访，平均随访28.9（17～34）个月。10例术后3个月骨折达到骨性愈合，2例发生骨折延迟愈合（分别于术后6个月、11个月达到骨性愈合）。所有病例平均骨性愈合时间4.2个月，随访期间无内固定失败情况发生，无感染和假体松动，膝关节屈伸功能良好，无明显疼痛，末次随访活动度可达90°～120°。术后3个月 HSS 评分平均（81.3±6.3）分，末次随访平均（94.9±3.7）分。结论膝关节置换术后股骨髁上骨折治疗方案的选择应综合考虑假体有无松动、骨折部位和类型、患者生理状况等多项因素，标准的治疗方案仍需进一步研究。
Objective To analyze the causes of femoral condyle fractures after total knee arthroplasty and investigate the preventive measures and treatment methods.Methods The clinical follow-up data of 12 patients who had femoral condyle fractures after total knee arthroplasty from July 2013 to August 2015 were analyzed retrospectively, including 5 males and 7 females. According to Rorabeck classiifcation, there were 9 cases of IIA type, 1 case of IIB type and 2 cases of III type. All the 9 patients （ IIA type ） were treated with internal ifxation in 2 weeks after admission. A patient （ IIB type ） underwent conservative treatment with skeletal traction, and plaster external ifxation was applied 4 weeks later. Knee revision surgery was performed on the 2 patients （ III type ）.Results All the patients were followed up for an average of 28.9 months （ range： 17 - 34 months ）. Bone healing was achieved in 10 cases at 3 months after the surgery. Delayed union occurred in 2 cases, and bone healing was achieved at 6 months and 11 months after the surgery respectively. The average time of bone healing was 4.2 months in all the cases. During the follow-up, there was no internal ifxation failure, infection, prosthetic loosening or obvious pain. Knee lfexion-extension function was good, and the active degree was 90° - 120° at the final follow-up. At 3 months after the surgery, the average hospital for special surgery （ HSS ） score was （ 81.3 ± 6.3 ） points, and at the ifnal follow-up the average HSS score was （ 94.9 ± 3.7 ） points.Conclusions All these factors should be considered in the treatment of femoral condyle fractures after total knee arthroplasty, such as prosthetic loosening, fracture site and type, patients’ physiological condition and so on. A further study should be carried out for a standard treatment option.
作者
宋金辉
张二洋
张晨
王坤正
SONG Jin-hui ZHANG Er-yang ZHANG Chen WANG Kun-zheng(The first Department of Orthopaedics, the second Affiliated Hospital of Xi＇an Jiaotong University, Xi＇an, Shaanxi, 710004, PRC)
出处
《中国骨与关节杂志》
CAS
2016年第10期739-742,共4页
Chinese Journal of Bone and Joint
关键词
关节成形术
置换
膝
假体周围骨折
骨折固定术
内
再手术
Arthroplasty,replacement,knee
Periprosthetic fractures
Fracture fixation,internal
Reoperation
