终末期膝关节夏科氏关节病1例的诊疗体会

doi:10.3877/cma.j.issn.1674-134X.2022.04.022

中华关节外科杂志(电子版) ›› 2022, Vol. 16 ›› Issue (04) : 512 -515. doi: 10.3877/cma.j.issn.1674-134X.2022.04.022

个案报道

终末期膝关节夏科氏关节病1例的诊疗体会

史建伟¹, 丁清和¹^,^†(

), 赵樑¹

^1. 510000　广州市正骨医院

收稿日期:2020-08-28 出版日期:2022-08-01
通信作者: 丁清和

Diagnosis and treatment of end-stage Charcot's arthropathy in knee

Jianwei Shi¹, Qinghe Ding¹(), Liang Zhao¹

Received:2020-08-28 Published:2022-08-01
Corresponding author: Qinghe Ding

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夏科氏关节病(Charcot's arthropathy)是以神经感觉和神经营养障碍为特点的破坏性骨关节病，由于早期膝关节假体设计、手术操作技术和疾病自身特点等众多原因，夏科氏关节病曾被视为全膝关节置换(total knee arthroplasty，TKA)手术的绝对禁忌证。近年来，随着TKA假体设计及手术技术的完善，TKA治疗夏科氏关节病的经验报道越来越多。然而由于各种原因导致的术后疗效的不确定性，TKA用于夏科氏关节的治疗仍具有一定的挑战性。故笔者拟回顾性分析1例膝关节夏科氏关节病行TKA治疗过程，总结治疗体会。

图1 术前左膝关节X光片。图A为左下肢全长片，示胫骨内侧平台骨破坏缺损；图B为左膝关节正位片，示全关节无明显骨赘，胫骨内侧平台骨破坏缺损，股骨外侧髁关节面塌陷；图C为左膝关节侧位片，示全关节无明显骨赘，胫骨股骨无明显前后移位，胫骨内侧平台塌陷；图D为左髌骨轴位片，示髌骨轨迹正常，髌股关节无明显骨赘和骨破坏

图2 左膝关节MRI注：示胫骨平台及股骨髁明显骨破坏，关节腔内大量滑膜增生，关节腔及滑膜内散在骨信号，内侧副韧带深层止点及外侧结构破坏

图3 术中取出关节腔内滑膜。图A为术中左膝关节滑膜，示左膝关节腔大量增生变性滑膜组织，部分呈颗粒样改变；图B为术中取出的滑膜，示增生变性滑膜组织

图4 术中左膝关节骨及韧带结构破坏情况。图A为膝关节股骨侧，示前交叉韧带破坏缺如，股骨相对胫骨脱位，股骨髁骨质破坏并缺损；图B为膝关节胫骨侧，示半月板破坏缺如，胫骨平台骨质破坏并缺损，呈塔尖样畸形

图5 术后8个月左膝关节功能恢复情况注：示术后膝关节功能恢复，关节屈伸活动度约0°~120°

图6 术后左膝关节X光片。图A为术后即刻左膝关节正侧位片，示胫骨缺损垫块及螺钉骨水泥填充，膝关节对位对线好，假体位置良好，无明显松动；图B为术后1个月左膝关节正侧位片，示胫骨缺损垫块及螺钉骨水泥填充，膝关节对位对线好，假体位置良好，无明显松动；图C为术后1个月左膝髌骨轴位片，示髌骨假体在位，髌骨轨迹良好；图D为术后1个月左下肢全长片，示膝关节对位对线可，假体位置良好，下肢力线恢复；图E为术后3个月左膝关节正侧位片，示胫骨缺损垫块及螺钉骨水泥填充，膝关节对位对线好，胫骨侧水泥骨界面出现透亮线；图F为术后3个月左膝髌骨轴位片，示髌骨假体在位，髌骨轨迹良好；图G为术后8个月左下肢全长片，示膝关节对位对线可，假体位置良好，下肢力线恢复；图H为术后8个月左膝关节正侧位片，示胫骨缺损垫块及螺钉骨水泥填充，膝关节对位对线好，胫骨侧水泥骨界面透亮线与术后3个月比无明显改变

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