切换至 "中华医学电子期刊资源库"

中华关节外科杂志(电子版) ›› 2018, Vol. 12 ›› Issue (03) : 390 -395. doi: 10.3877/cma.j.issn.1674-134X.2018.03.016

所属专题: 文献

综述

全膝关节翻修术中骨缺损的处理研究进展
闫昭1, 曹晓瑞1, 孙孟帅1, 朱庆生1,()   
  1. 1. 710032 西安,空军军医大学附属西京医院骨科
  • 收稿日期:2016-12-12 出版日期:2018-06-01
  • 通信作者: 朱庆生
  • 基金资助:
    卫生部公益性行业科研专项项目(201302007)

Research progress on treatment of bone defects in total knee revision

Zhao Yan1, Xiaorui Cao1, Mengshuai Sun1, Qingsheng Zhu1,()   

  1. 1. Xijing Hospital affiliated to the Fourth Military Medical University, Xi’an 710032, China
  • Received:2016-12-12 Published:2018-06-01
  • Corresponding author: Qingsheng Zhu
  • About author:
    Corresponding author: Zhu Qingsheng, Email:
引用本文:

闫昭, 曹晓瑞, 孙孟帅, 朱庆生. 全膝关节翻修术中骨缺损的处理研究进展[J]. 中华关节外科杂志(电子版), 2018, 12(03): 390-395.

Zhao Yan, Xiaorui Cao, Mengshuai Sun, Qingsheng Zhu. Research progress on treatment of bone defects in total knee revision[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2018, 12(03): 390-395.

全膝关节翻修术是重建关节结构,恢复关节功能的有效方法之一。在关节翻修术中不容忽视的一个问题是由松动、感染、医疗操作等引起的骨缺损。近年来,随着全膝关节置换术的广泛应用和接受关节置换术患者的年轻化,全膝关节翻修术的数量也在不断增加,关于全膝关节翻修术中处理骨缺损的报道也越来越多。翻修术的假体选择对于手术结果十分重要,近年来这一问题的研究也更加深入,多元化。关于骨缺损处理的研究不仅仅在于传统的骨水泥,植骨等方法,还有基于新的理念所开发出的金属垫块、3D打印等方法。在临床上,应当根据具体情况,采用合适的方法治疗,重建关节力线,恢复关节功能。

Total knee revision surgery is to reconstruct the joint structure. It’s an effective way to restore joint function. One of the problems in joint revision surgery is bone defects caused by loosening, infection, medical procedures and other factors. In recent years, with the widespread use of total knee arthroplasty (TKA) and the younger patients receiving arthroplasty, the number of TKA revision is also on the rise, and reports of treatment of bone defects in t TKA is more. The choice of prosthesis for revision surgery is very important for the outcome of the surgery. In recent years, the study of this issue has also deepened and diversified. The study on the treatment of bone defects not only lies in the traditional methods such as bone cement and bone grafting, but also the methods of metal pads and 3D printing developed based on the new concept. In clinical practice, appropriate methods should be used to rebuild joint lines, and restore joint function.

[1]
Sadoghi P, Liebensteiner M, Agreiter M, et al. Revision surgery after total joint arthroplasty: a complication-based analysis using worldwide arthroplasty registers[J]. J Arthroplasty, 2013, 28(8):1329-1332.
[2]
Fehring TK, Christie MJ, Lavernia C, et al. Revision total knee arthroplasty: planning, management, and controversies[J]. Instr Course Lect, 2008, 57:341-363.
[3]
Lavernia C, Lee DJ, Hernandez VH. The increasing financial burden of knee revision surgery in the United States[J]. Clin Orthop Relat Res, 2006, 446:221-226.
[4]
Whittaker JP, Dharmarajan R, Toms AD. The management of bone loss in revision total knee replacement[J]. J Bone Joint Surg Br, 2008, 90(8):981-987.
[5]
Tsahakis PJ, Beaver WB, Brick GW. Technique and results of allograft Reconstruction in revision total knee arthroplasty[J]. Clin Orthop Relat Res, 1994, Jun(303):86-94.
[6]
Engh GA, Ammeen DJ. Bone loss with revision total knee arthroplasty: defect classification and alternatives for Reconstruction[J]. Instr Course Lect, 1999, 48:167-175.
[7]
Huff TW, Sculco TP. Management of bone loss in revision total knee arthroplasty[J]. J Arthroplasty, 2007, 22(7 Suppl 3):32-36.
[8]
Toms AD, Barker RL, Mcclelland D, et al. Repair of defects and containment in revision total knee replacement: a comparative biomechanical analysis[J]. J Bone Joint Surg Br, 2009, 91(2):271-277.
[9]
Sakanaka T, Watanabe S, Shirakata H, et al.The management of bone defect in total knee arthroplasty for the patients with rheumatoid arthiritis[J]. J Chugoku-Shikoku Orthopaedic Assoc, 2003, 15:171-174.
[10]
Yu X, Xu M, Xu S, et al. Clinical outcomes of giant cell tumor of bone treated with bone cement filling and internal fixation, and oral bisphosphonates[J]. Oncol Lett, 2013, 5(2):447-451.
[11]
Dorr LD, Ranawat CS, Sculco TA, et al. Bone graft for tibial defects in total knee arthroplasty[J]. Clin Orthop Relat Res, 1986 (205):153-165.
[12]
Goldhahn J, Suhm N, Goldhahn S, et al. Influence of osteoporosis on fracture fixation-a systematic literature review[J]. Osteoporos Int, 2008, 19(6):761-772.
[13]
Berend ME, Ritter MA, Keating EM, et al. Use of screws and cement in revision TKA with primary or revision specific prosthesis with up to 17 years followup[J]. J Arthroplasty, 2015, 30(1):86-89.
[14]
Ritter MA, Harty LD. Medial screws and cement: a possible mechanical augmentation in total knee arthroplasty[J]. J Arthroplasty, 2004, 19(5):587-589.
[15]
Juvonen T, Nuutinen JP, Koistinen AP, et al. Biomechanical evaluation of bone screw fixation with a novel bone cement[J]. Biomed Eng Online, 2015, 14:74-86.
[16]
Brooks PJ, Walker PS, Scott RD. Tibial component fixation in deficient tibial bone stock[J]. Clin Orthop Relat Res, 1984(184):302-308.
[17]
刘志宏,张炅,何川,等.活动平台全膝关节假体和单髁膝关节假体置换术后的步态对比分析[J/CD].中华关节外科杂志(电子版),2017, 11(1):17-23.
[18]
孙铁铮,吕厚山.延长柄假体在植骨术后吸收导致假体松动的人工膝关节翻修术中应用[J/CD].中华关节外科杂志(电子版),2009, 3(6):760-763.
[19]
Patel JV, Masonis JL, Guerin J, et al. The fate of augments to treat type-2 bone defects in revision knee arthroplasty[J]. J Bone Joint Surg Br, 2004, 86(2):195-199.
[20]
Tsukada S, Wakui M, Matsueda M. Metal block augmentation for bone defects of the medial tibia during primary total knee arthroplasty[J]. J Orthop Surg Res, 2013, 8:36-41.
[21]
任博,朱庆生,朱锦宇.骨小梁金属胫骨假体的临床应用新进展[J/CD].中华关节外科杂志(电子版),2014,8(1):116-120.
[22]
De Martino I, De Santis V, Sculco PK, et al. Tantalum cones provide durable mid-term fixation in revision TKA[J]. Clin Orthop Relat Res, 2015, 473(10):3176-3182.
[23]
Higuchi Y, Hasegawa Y, Komatsu D, et al. Survivorship between 2 different Ceramic-on-Ceramic total hip arthroplasty with or without a Metal-Backed Titanium sleeve bearing: a 5-to 14-Year Follow-Up study[J]. J Arthroplasty, 2017, 32(1):155-160.
[24]
De Martino I, D’apolito R, Sculco PK, et al. Total knee arthroplasty using cementless porous Tantalum monoblock tibial component: a minimum 10-Year Follow-Up[J]. J Arthroplasty, 2016, 31(10):2193-2198.
[25]
Rudert M, Holzapfel BM, Von Rottkay E, et al. Impaction bone grafting for the Reconstruction of large bone defects in revision knee arthroplasty[J]. Oper Orthop Traumatol, 2015, 27(1):35-46.
[26]
王汝鑫.自体打压植骨法在胫骨平台骨缺损膝关节置换术中的应用[J].中国现代药物应用,2014:57-58.
[27]
裴征,关振鹏,张绍龙,等.重度膝内翻伴骨缺损的全膝表面置换术中的自体骨移植治疗[J].北京大学学报(医学版),2011, 43(5):707-713.
[28]
Arumugam G, Nanjayan SK, Quah C, et al. Revision hip arthroplasty using impacted cancellous bone and cement: a long-term follow-up study[J]. Eur J Orthop Surg Traumatol, 2015, 25(8):1279-1284.
[29]
Judas F, Figueiredo MH, Cabrita AM, et al. Incorporation of impacted morselized bone allografts in rabbits[J]. Transplant Proc, 2005, 37(6):2802-2804.
[30]
Toms AD, Mcclelland D, Chua L, et al. Mechanical testing of impaction bone grafting in the tibia: initial stability and design of the stem[J]. J Bone Joint Surg Br, 2005, 87(5):656-663.
[31]
Hilgen V, Citak M, Vettorazzi E, et al. 10-year results following impaction bone grafting of major bone defects in 29 rotational and hinged knee revision arthroplasties: a follow-up of a previous report[J]. Acta Orthop, 2013, 84(4):387-391.
[32]
Van Loon CJ, Buma P, De Waal Malefijt MC, et al. Morselized bone allografting in revision total knee replacement-a case report with a 4-year histological follow-up[J]. Acta Orthop Scand, 2000, 71(1):98-101.
[33]
Dennis A. The structural allograft composite in revision total knee arthroplasty[J]. J Arthroplasty, 2002, 17(4 Suppl 1):90-93.
[34]
盛璞义,Jamsen E,Lehto M, et al.结构性植骨修复膝关节翻修术中严重骨缺损的临床效果及相关分析[J/CD].中华关节外科杂志(电子版),2009,3(4):427-435.
[35]
Hoeffel DP, Rubash HE. Revision total knee arthroplasty: current rationale and techniques for femoral component revision[J]. Clin Orthop Relat Res, 2000, (380):116-132.
[36]
孙铁铮,吕厚山.延长柄假体在植骨术后吸收导致假体松动的人工膝关节翻修术中应用[J/CD].中华关节外科杂志(电子版),2009,3(6):56-58.
[37]
Willems WF, Kremer T, Friedrich P, et al. Surgical revascularization in structural orthotopic bone allograft increases bone remodeling[J]. Clin Orthop Relat Res, 2014, 472(9):2870-2877.
[38]
周海,王燎,姚天平,等.人工关节失效类型及起因分析[J]. 中国医疗器械杂志,2012,36:8-11.
[39]
Mason JB, Fehring TK, Estok R, et al. Meta-analysis of alignment outcomes in computer-assisted total knee arthroplasty surgery[J]. J Arthroplasty, 2007, 22(8):1097-1106.
[40]
Angibaud LD, Dai Y, Liebelt RA, et al. Evaluation of the accuracy and precision of a next generation computer-assisted surgical system[J]. Clin Orthop Surg, 2015, 7(2):225-233.
[41]
Anderl W, Pauzenberger L, Kölblinger R, et al. Patient-specific instrumentation improved mechanical alignment, while early clinical outcome was comparable to conventional instrumentation in TKA[J]. Knee Surg Sports Traumatol Arthrosc, 2016, 24(1):102-111.
[42]
Zamora LA, Humphreys KJ, Watt AM, et al. Systematic review of computer-navigated total knee arthroplasty[J]. ANZ J Surg, 2013, 83(1/2):22-30.
[43]
Mishra R, Bishop T, Valerio IL, et al. The potential impact of bone tissue engineering in the clinic[J]. Regen Med, 2016, 11(6):571-587.
[44]
金光辉,张馨雯,孙晓飞,等.组织工程化纳米羟基磷灰石/聚己内酯人工骨支架修复兔桡骨大段骨缺损的实验研究[J/CD].中华损伤与修复杂志(电子版),2015,10(1):36-40.
[45]
曹雪飞,宋朋杰,乔永杰,等.3D打印骨组织工程支架的研究与应用[J].中国组织工程研究,2015,19(25):4076-4080.
[46]
Mouriño V, Cattalini JP, Roether JA, et al. Composite polymer-bioceramic scaffolds with drug delivery capability for bone tissue engineering[J]. Expert Opin Drug Deliv, 2013, 10(10):1353-1365.
[47]
Yala S, Boustta M, Gallet O, et al. New synthesis method of HA/P(D,L)LA composites: study of fibronectin adsorption and their effects in osteoblastic behavior for bone tissue engineering[J]. J Mater Sci Mater Med, 2016, 27(9):140-149.
[48]
Paschos NK. Recent advances and future directions in the management of knee osteoarthritis: can biological joint reconstruction replace joint arthroplasty and when?[J]. World J Orthop, 2015, 6(9):655-659.
[49]
林剑浩,吕厚山,寇伯龙,等.全膝关节初次置换术失败行翻修手术的必要性[J/CD]. 中华关节外科杂志(电子版),2010:458-464.
[1] 邓华梅, 袁札根, 曾德荣, 潘珊珊, 张葆青, 欧爱华, 曹学伟. 全膝关节置换术中气压止血带应用效果与影响因素分析[J]. 中华关节外科杂志(电子版), 2023, 17(06): 788-794.
[2] 张思平, 刘伟, 马鹏程. 全膝关节置换术后下肢轻度内翻对线对疗效的影响[J]. 中华关节外科杂志(电子版), 2023, 17(06): 808-817.
[3] 闫文, 谢兴文, 顾玉彪, 雷宁波, 马成, 于文霞, 高亚雄, 张磊. 微小RNA与全膝关节置换术后深静脉血栓的研究进展[J]. 中华关节外科杂志(电子版), 2023, 17(06): 842-846.
[4] 黄子荣, 罗渝鑫, 杨文瀚, 陈小虎, 谢环宇, 朱伟民. 前交叉韧带重建对膝关节稳定性影响的研究进展[J]. 中华关节外科杂志(电子版), 2023, 17(06): 847-854.
[5] 樊绪国, 赵永刚, 杨砚伟. 腓骨在膝骨关节炎作用的研究观点[J]. 中华关节外科杂志(电子版), 2023, 17(06): 855-859.
[6] 王宏宇. 固定与活动平台假体在全膝关节置换术中的应用价值[J]. 中华关节外科杂志(电子版), 2023, 17(06): 871-876.
[7] 夏传龙, 迟健, 丛强, 连杰, 崔峻, 陈彦玲. 富血小板血浆联合关节镜治疗半月板损伤的临床疗效[J]. 中华关节外科杂志(电子版), 2023, 17(06): 877-881.
[8] 李善武, 叶永杰, 王兵, 王子呓, 银毅, 孙官军, 张大刚. 胫骨高位截骨与单髁置换的早期疗效比较[J]. 中华关节外科杂志(电子版), 2023, 17(06): 882-888.
[9] 李辉, 吴奇, 张子琦, 张晗, 王仿, 许鹏. 日间全膝关节置换术早期疗效及标准化流程探索[J]. 中华关节外科杂志(电子版), 2023, 17(06): 889-892.
[10] 梁家敏, 黄子荣, 崔家鸣, 钟名金, 冯文哲, 陈康, 胡艳, 欧阳侃, 杨雷, 王大平, 王满宜, 朱伟民. 前交叉韧带保留残端重建促进膝关节功能的研究进展[J]. 中华关节外科杂志(电子版), 2023, 17(05): 708-714.
[11] 吴香敏, 吴鹏. 超声引导下收肌管阻滞联合腘动脉与膝关节后囊间隙阻滞在老年患者全膝关节置换术中的应用效果[J]. 中华损伤与修复杂志(电子版), 2023, 18(06): 516-522.
[12] 中华医学会骨科分会关节学组. 中国髋、膝关节置换日间手术围手术期管理专家共识[J]. 中华老年骨科与康复电子杂志, 2023, 09(06): 321-332.
[13] 邱红生, 林树体, 梁朝莹, 劳世高, 何荷. 模拟现实步态训练对膝关节前交叉韧带损伤的功能恢复及对跌倒恐惧的影响[J]. 中华老年骨科与康复电子杂志, 2023, 09(06): 343-350.
[14] 付庆鹏, 邓晓强, 高伟, 姜福民, 范永峰, 吴海贺, 齐岩松, 包呼日查, 徐永胜. 新型股骨测量定位器在全膝关节置换术中的临床应用[J]. 中华临床医师杂志(电子版), 2023, 17(9): 980-987.
[15] 李岩松, 李涛, 张元鸣飞, 李志鹏, 周谋望. 头戴式虚拟现实设备辅助全膝关节置换术后康复的初步研究[J]. 中华临床医师杂志(电子版), 2023, 17(06): 676-681.
阅读次数
全文


摘要