摘要
目的:探讨自体骨结构性植骨联合骨髓移植,在初次膝关节置换术(TKA)中修复Rand C型胫骨侧骨缺损的临床疗效。方法:回顾分析2014年1月至2018年1月,13例(20膝)合并有胫骨侧骨缺损Rand C型的重度膝骨关节炎患者,在初次TKA中用自体骨结构性植骨联合浓缩骨髓移植的方法进行骨缺损修复的病例资料。男3例(4膝),女10例(16膝);年龄58~78岁,平均(68.0±7.2)岁;膝关节内翻角度为15°~30°,平均25.2°±3.4°。术后随访12~48个月,平均(24.0±5.6)个月。记录术前、术后1周、1个月、3个月、6个月、12个月及末次复查膝关节KSS评分,定期拍片复查观察植骨块愈合情况、假体松动及下沉等情况。结果:所有患者均获得门诊或信息平台的随访。术前KSS功能评分为(24.1±6.2)分,临床评分为(26.7±5.3)分,至末次随访时膝关节KSS功能评分为(88.3±5.4)分,临床评分为(87.2±6.8)分,均高于术前KSS评分,差异有统计学意义(P<0.05)。术后全长X线片提示:膝关节内翻角度为5°~8°,平均为6.5°±2.3°。结构性植骨块在半年后拍片复查时均已达到一期愈合,所有患者未见切口愈合不良,末次随访时未见骨吸收、骨不愈合,未见假体松动、下沉,未见关节功能障碍。结论:重度膝关节骨关节炎合并Rand C型胫骨侧骨缺损的初次TKA中,采用自体骨结构性植骨后并在其周围注射浓缩骨髓液移植修复骨缺损,可促进植骨后早期愈合,在保留最大骨量的同时重建关节的稳定性。
Objective:To investigate the clinical efficacyof autologous structural bone graft combined with bone marrow transplantation in the repair of Rand C type tibial bone defect in primary knee arthroplasty(TKA). Methods: 13 patients(20 knees) with severe knee arthritis(rand C type) complicated with tibial bone defect were retrospectively analyzed from January 2014 to January 2018.There were 3 males(4 knees) and 10 females(16 knees) with an average age of(68.0±7.2) years old(58 to 78 years old).The varus angle was 15° to 30° with an average of 25.2°±3.4°.The patients were followed up for 12 to 48 months(mean(24.0±5.6) months).The KSS score of knee joint was recorded before operation, 1 week, 1 month, 3 months, half a year, 1 year after operation and the last visit.The healing of bone graft, loosening and sinking of prosthesis were observed by regular follow-up.Results:All patients were followed up by outpatient or information platform.The preoperative KSS score was 24.1±6.2 and the clinical score was 26.7±5.3.At the last follow-up, the knee KSS score was 88.3±5.4 and the clinical score was 87.2±6.8, which were higher than the preoperative KSS score(P<0.05).The postoperative full-length film showed that the varus angle of knee joint was 5° to 8°, with an average of 6.5°±2.3°.There was no poor healing of incision in all patients.At the last follow-up, there was no bone resorption, nonunion, loosening and sinking of prosthesis, and no joint dysfunction.Conclusion: In the primary TKA of severe knee osteoarthritis complicated with Rand C type tibial bone defect, autologous bone structural graft followed by injection of concentrated bone marrow fluid around the graft can promote early healing after bone graft and restore the stability of the joint while retaining the maximum bone mass.
作者
汪庚申
周瑾
牛存良
赵海燕
王世中
WANG Gengshen;ZHOU Jin;NIU Cunliang;ZHAO Haiyan;WANG Shizhong(Department of Orthopedics,People’s Hospital of Wuwei,Wuwei 733000,Gansu China;Department of Laboratory,Wuwei Academy of Medical Sciences,,Wuwei 733000,Gansu China;Department of Orthopedics,First Hospital of Lanzhou University,Lanzhou 730030,China)
出处
《中国中医骨伤科杂志》
CAS
2021年第7期51-54,59,共5页
Chinese Journal of Traditional Medical Traumatology & Orthopedics
基金
武威市科技局市列科技计划项目(WW2001056)。
关键词
自体骨植骨
全膝关节置换术
骨髓移植
骨缺损
autogenous bone graft
total knee arthroplasty
bone marrow transplantation
bone defect
