Pan Wenjie, He Yan, Ma Jianbing, Xiao Lin, Jang Kuo
Department of Bone and Joint Surgery, Xi'an Honghui Hospital, Affiliated to Medical College of Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China.
Department of Pharmacy, Xi'an NO.4 Hospital, Xi'an Shaanxi, 710004, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2018 Sep 15;32(9):1177-1180. doi: 10.7507/1002-1892.201802047.
To evaluate the early effectiveness of one-stage total knee arthroplasty (TKA) with tibial stem extender for knee arthritis complicated with tibial stress fractures.
Between January 2014 and November 2016, 12 patients (12 knees) with knee arthritis and tibial stress fractures underwent one-stage TKA with tibial stem extender. There were 5 males and 7 females with an average age of 71.5 years (range, 60-77 years). There were 8 cases with osteoarthritis and 4 cases with rheumatoid arthritis. The radiographic examination showed the 6 cases of intra-articular fractures and 6 of extra-articular fractures (including transverse fractures in 4 cases and short oblique fractures in 2 cases); 2 cases complicated with middle and upper fibular stress fractures; all patients of varus deformities. Preoperative Knee Society Score (KSS) clinical score was 31.5±8.4 and functional score was 33.3±9.0. The preoperative range of motion (ROM) of the knee was (65.6±9.6)°.
All indexes healed primarily and no wound infection or skin necrosis occurred. All patients were followed up 36.5 months on average (range, 6-52 months). X-ray films showed that all fractures healed at 3-7 months (mean, 4 months); the position of the prosthesis was good, and no loosening or signs of infection occurred. At last follow-up, the KSS clinical score was 90.5±8.9 and functional score was 92.1±7.8; the ROM of the knee was (115.0±9.8)°. All indicators were significantly improved than those before operation ( =40.340, = 0.000; =32.120, =0.000; =8.728, =0.000).
One-stage TKA with tibial stem extender for patients with knee arthritis and tibial stress fractures can restore limb alignment, facilitate fracture healing, and obtain the satisfactory early effectiveness.
评估采用胫骨延长柄一期全膝关节置换术（TKA）治疗合并胫骨应力性骨折的膝关节炎的早期疗效。
2014年1月至2016年11月，12例（12膝）合并胫骨应力性骨折的膝关节炎患者接受了采用胫骨延长柄的一期TKA手术。其中男性5例，女性7例，平均年龄71.5岁（范围60 - 77岁）。骨关节炎8例，类风湿关节炎4例。影像学检查显示，关节内骨折6例，关节外骨折6例（其中横行骨折4例，短斜行骨折2例）；2例合并中上段腓骨应力性骨折；所有患者均有内翻畸形。术前膝关节协会评分（KSS）临床评分为31.5±8.4，功能评分为33.3±9.0。术前膝关节活动度（ROM）为（65.6±9.6）°。
所有指标均一期愈合，未发生伤口感染或皮肤坏死。所有患者平均随访36.5个月（范围6 - 52个月）。X线片显示所有骨折在3 - 7个月愈合（平均4个月）；假体位置良好，未发生松动或感染迹象。末次随访时，KSS临床评分为90.5±8.9，功能评分为92.1±7.8；膝关节ROM为（115.0±9.8）°。所有指标均较术前显著改善（ =40.340， = 0.000； =32.120， =0.000； =8.728， =0.000）。
对于合并胫骨应力性骨折的膝关节炎患者，采用胫骨延长柄一期TKA可恢复肢体对线，促进骨折愈合，并获得满意的早期疗效。
