膝关节翻修手术中干骺端骨缺损的重建与管理

Reconstruction and Management of Metaphyseal Bone Defects in Revision Knee Arthroplasty

摘要: 随着社会的发展，中国人口逐渐呈现出老龄化的现象，人工关节置换术的患者数量也逐渐增多。人工关节置换手术是目前治疗骨关节炎等导致膝关节疼痛、活动受限等疾病的可靠治疗方案。然而，某些患者因各种原因需要进行膝关节翻修手术，常见原因包括感染、松动或骨折等。但是因其手术复杂性，导致其预后和临床效果不如初次置换。再翻修往往会导致不同程度的骨缺损，是否妥善处理骨缺损往往决定着翻修手术成败与否。这不仅考验着手术医师的经验，还将影响患者膝关节的功能及稳定性，因此使得膝关节干骺端骨缺损的处理，日渐引起临床医师的重视，并且目前没有绝对治疗骨缺损的方案。如今重建骨缺损的目标在于达到膝关节稳定、恢复患者活动、功能正常。根据骨缺损的位置和大小，目前有很多重建措施，例如骨水泥、骨移植(自体骨移植、同种异体骨移植、打压骨移植、结构性同种异体骨移植)、金属增强模块、干骺端固定物(金属钽锥或干骺端袖套)、定制假体等。每种方式有不同的优缺点，重建前应详细制定手术计划及选择合适的假体，减少假体松动，增强假体稳定性及生存率，提高患者临床满意度。

Abstract: With the development of society, China’s population is gradually aging, and the number of patients undergoing artificial joint replacement is also gradually increasing. Artificial joint replacement surgery is currently a reliable treatment option for treating osteoarthritis and other diseases that cause knee joint pain and limited movement. However, some patients require revision knee surgery for a variety of reasons, including infection, loosening, or fracture. However, due to the complexity of the operation, its prognosis and clinical effect are not as good as those of primary surgery. Revision often leads to varying degrees of bone defects, and whether the bone defects are properly handled often determines the success or failure of the revision surgery. This not only tests the experience of the surgeon, but also affects the function and stability of the patient’s knee joint. Therefore, the treatment of metaphyseal bone defects in the knee joint has increasingly attracted the attention of clinicians, and there is currently no absolute treatment plan for bone defects. Today, the goal of reconstructing bone defects is to stabilize the knee joint and restore patient activity and normal function. Depending on the location and size of the bone defect, there are currently many reconstructive measures, such as bone cement, bone grafting (autograft, allograft, impact bone graft, structural allograft), metal reinforcement modules, metaphyseal End fixation (metal tantalum cone or metaphyseal sleeve), custom prosthesis, etc. Each method has different advantages and disadvantages. Before reconstruction, a detailed surgical plan and appropriate prosthesis selection should be made to reduce prosthesis loosening, enhance prosthesis stability and survival rate, and improve patient clinical satisfaction.