Ebied Ayman, Zayda Ahmed, Marei Sameh, Elsayed Hany
Menoufia University Hospitals, Shebin El Kom, Egypt.
SICOT J. 2018;4:6. doi: 10.1051/sicotj/2017060. Epub 2018 Mar 16.
Successful treatment of knee comminuted periarticular fractures associated with osteoporosis and pre-existing arthritis is a challenging task.
This is a prospective study on 27 patients who had comminuted intra and periarticular knee fractures and pre-existing arthritis. Fractures were classified according to Muller's AO classification. Primary knee arthroplasty was performed ± internal fixation following 4 weeks of splinting. A stem was added to the tibial tray and Legacy Constrained Condylar Knee (LCCK) or Rotating Hinge (RH) prosthesis were used depending on the level of ligament damage and bone defects. The Knee Society Score (KSS) and radiological evaluation were performed at 3, 6 and 12 months then annually thereafter.
The average age of this group of patients was 63 years (range 59-74). Sixteen knees received primary femoral component and Posterior Stabilized insert, while 8 had LCCK. RH implants were chosen in 2 and distal femoral replacement was necessary in one knee. Twenty five patients were available for the final review at an average 6 years in whom the KSS was 80 (range 75-89) points. All patients achieved full knee extension and average knee flexion of 110° (range 90-135°). One knee needed re-admission for early Debridement Antibiotic Irrigation and Retention (DAIR) but none of the knees was revised or awaiting revision.
Knee arthroplasty achieves highly successful outcome when performed as a primary treatment for comminuted intra and periarticular knee fractures in elderly patients. Survival of implants and functional range of movement at midterm are excellent.
成功治疗与骨质疏松症和既往关节炎相关的膝关节粉碎性关节周围骨折是一项具有挑战性的任务。
这是一项针对27例患有膝关节内和关节周围粉碎性骨折及既往关节炎患者的前瞻性研究。骨折根据Muller的AO分类法进行分类。在夹板固定4周后进行一期膝关节置换术±内固定。根据韧带损伤程度和骨缺损情况，在胫骨托上添加一个柄，并使用传统约束髁膝关节（LCCK）或旋转铰链（RH）假体。在术后3、6和12个月进行膝关节协会评分（KSS）和影像学评估，此后每年进行一次。
该组患者的平均年龄为63岁（范围59 - 74岁）。16个膝关节接受了一期股骨组件和后稳定型衬垫，8个膝关节使用了LCCK。2个膝关节选择了RH植入物，1个膝关节需要进行股骨远端置换。25例患者在平均6年时可进行最终评估，此时KSS评分为80分（范围75 - 89分）。所有患者膝关节均实现完全伸直，平均膝关节屈曲度为110°（范围90 - 135°）。1个膝关节需要再次入院进行早期清创、抗生素冲洗和保留（DAIR），但没有膝关节进行翻修或等待翻修。
对于老年患者膝关节内和关节周围粉碎性骨折，一期行膝关节置换术可取得非常成功的结果。中期植入物生存率和功能活动范围极佳。
