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膝关节急性骨折的膝关节置换术。

Knee arthroplasty for acute fractures around the knee.

作者信息

Tampere Thomas, Ollivier Matthieu, Jacquet Christophe, Fabre-Aubrespy Maxime, Parratte Sébastien

机构信息

Department of Orthopaedic Surgery, Ghent University Hospital, Ghent, Belgium.

Institute for Locomotion, Aix-Marseille University, St. Marguerite Hospital, Marseille, France.

出版信息

EFORT Open Rev. 2020 Oct 26;5(10):713-723. doi: 10.1302/2058-5241.5.190059. eCollection 2020 Oct.

DOI:10.1302/2058-5241.5.190059
PMID:33204515
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7608576/
Abstract

Results of open reduction and internal fixation for complex articular fractures around the knee are poor, particularly in elderly osteoporotic patients.Open reduction and internal fixation may lead to an extended hospital stay and non-weight-bearing period.This may lead to occurrence of complications related to decubitus such as thrombo-embolic events, pneumonia and disorientation.Primary arthroplasty can be a valuable option in a case-based and patient-specific approach. It may reduce the number of procedures and allow early full weight-bearing, avoiding the above-mentioned complications.There are four main indications: 1) Elderly (osteoporotic) patients with pre-existing (symptomatic) end-stage osteoarthritis.2) Elderly (osteoporotic) patients with severe articular and metaphyseal destruction.3) Pathological fractures of the distal femur and/or tibia.4) Young patients with complete destruction of the distal femur and/or tibia.The principles of knee (revision) arthroplasty should be applied; choice of implant and level of constraint should be considered depending on the type of fracture and involvement of stabilizing ligaments. The aim of treatment is to obtain a stable and functional joint.Long-term data remain scarce in the literature due to limited indications. Cite this article: 2020;5:713-723. DOI: 10.1302/2058-5241.5.190059.

摘要

膝关节周围复杂关节骨折的切开复位内固定术效果不佳，尤其是在老年骨质疏松患者中。切开复位内固定术可能导致住院时间延长和非负重期延长。这可能会导致与褥疮相关的并发症，如血栓栓塞事件、肺炎和定向障碍。一期关节成形术在基于病例和患者个体化的方法中可能是一个有价值的选择。它可能会减少手术次数，并允许早期完全负重，避免上述并发症。主要有四个适应证：1）患有（有症状的）终末期骨关节炎的老年（骨质疏松）患者。2）患有严重关节和干骺端破坏的老年（骨质疏松）患者。3）股骨远端和/或胫骨的病理性骨折。4）股骨远端和/或胫骨完全破坏的年轻患者。应应用膝关节（翻修）关节成形术的原则；应根据骨折类型和稳定韧带的受累情况考虑植入物的选择和约束程度。治疗的目的是获得一个稳定且功能良好的关节。由于适应证有限，文献中的长期数据仍然很少。引用本文：2020；5：713 - 723。DOI：10.1302/2058 - 5241.5.190059。

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