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[内侧单髁膝关节置换术后假体周围骨折的诊断与治疗]

[Diagnosis and treatment of periprosthetic fracture after medial unicompartmental knee arthroplasty].

作者信息

Tan G L, Yu J Y, Shi X T, Wang X

机构信息

Center of Knee Joint Surgery, Henan Luoyang Orthopedic-Traumatological Hospital(Henan Orthopedic Hospital), Luoyang 471002, China.

出版信息

Zhonghua Wai Ke Za Zhi. 2022 Jun 1;60(6):635-640. doi: 10.3760/cma.j.cn112139-20211111-00527.

Abstract

Unicompartmental knee arthroplasty (UKA) is an effective treatment for end-stage anteromedial osteoarthritis of the knee. Medial tibial plateau fracture or femoral condyle fracture may occur after UKA, and its treatment is very challenging. The causes leading to this complication include: surgical technique errors, such as the weakening of posterior cortical strength of the tibial platform during operation, the reduction of bone mass due to too much tibial osteotomy, and the stress concentration in the bone bed due to bad alignment of the prosthesis, etc. Prosthesis design factors, such as press-fit fixation design of cementless UKA prosthesis, and multiple nail holes fixation for tibial osteotomy guide, etc. And the morphology of tibial plateau, such as tibial platform in Asian people with narrow and small shap and medial overhanging condyles. Correct selection of patients, strict surgical principles and standardized surgical techniques are the keys to prevent periprosthetic fractures during and after medial UKA. After the diagnosis is confirmed, the treatment choice mainly depends on the fracture pattern and the stability of the prosthesis.

摘要

单髁膝关节置换术(UKA)是治疗终末期膝关节前内侧骨关节炎的一种有效方法。UKA术后可能发生胫骨内侧平台骨折或股骨髁骨折,其治疗极具挑战性。导致这种并发症的原因包括:手术技术失误,如手术过程中胫骨平台后皮质强度减弱、胫骨截骨过多导致骨量减少以及假体对线不良导致骨床应力集中等;假体设计因素,如非骨水泥型UKA假体的压配固定设计以及胫骨截骨导向器的多钉孔固定等;以及胫骨平台的形态,如亚洲人群胫骨平台形状窄小且内侧髁有悬垂。正确选择患者、严格遵循手术原则和规范手术技术是预防内侧UKA术中及术后假体周围骨折的关键。确诊后,治疗选择主要取决于骨折类型和假体的稳定性。

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