合并晚期膝关节病的胫骨近端应力骨折的分型与治疗

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摘要目的由于缺乏合理的分型方法，合并晚期膝关节病的胫骨近端应力骨折的治疗较为混乱。为此本文回顾性分析此类疾病的病例特点和诊治对策，总结出一种新的分型方法用于指导临床。方法自2011年8月至2015年1月，共18例合并胫骨近端应力骨折的晚期膝关节炎患者在我院接受全膝关节置换术，其中男7例，女11例；年龄62~71岁，平均66岁。18例患者中8例为关节内边缘型，切除骨赘后常规截骨及软组织平衡治疗；1例为关节内节段型，使用增强垫块和延长杆治疗。6例为关节外稳定型，使用带延长杆的膝关节假体治疗；3例为关节外不稳定型，合并使用延长杆和钢板内固定治疗。结果随访时间3~21个月，平均12.3个月。美国膝关节协会评分(knee society score，KSS)疼痛评分从23.62分提高到80.87分，KSS膝关节功能评分从18.75分提高到81.75分。通过分析病例特点，首先将胫骨骨折分为关节内骨折和关节外骨折，关节内骨折进一步分为边缘型和节段型，关节外骨折分为稳定型和不稳定型。结论这种新的分型方法具有较好的可行性，在这种新的分型方法指导下，所有伴晚期膝关节炎的胫骨近端应力骨折患者行一期全膝关节置换术单独或者结合增强垫块、延长杆、钢板内固定可得到较好地处理。

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关键词 ：应力骨折, 膝关节炎, 全膝关节置换术

Abstract：Objective Management options of gonarthrosis with proximal tibia stress fracture are ill-defined.In this study，a new classification was proposed based on characteristics of 18 cases of gonarthrosis complicated by proximal tibia stress fracture.Methods From Aug 2011 to Jan 2015，a total of 18 cases of knee arthritis combined with ipsilateral tibia stress fracture were included，including 7 male and 11famale，with an average age of 66 years old(ranging from 62~71 years).In the 18 patients，8 patients underwentexcision of fracture fragment followed by rugular TKA.1 patients were treated by modulated TKA with a long stem and metal augments.TKA with a long stem were applied to 6 patients with extraarticular fracture and another 3 patients were added plate and screws.Results The patients were followed up for 12.3 months (from 3 to 21 months).Gonoarthrosis with proximal tibia stress fracture can be classified as intra-and extra-articular fracture.The former was then classified into segemental and marginal type.The later were then subdivided into stable and unstable type.After treatment according to the classification，average Knee Society Score improved from 23.62 to 80.87；and average functional score improved from 18.75 to 81.75.Conclusion Under the instruction of this simple classification，modulated TKA with or without internal fixtion can be used successfully to treat severe gonoarthrosis with proximal tibia stress fracture.

Key words： knee arthropathy stress fracture total knee arthroplasty

通讯作者: 马建兵

作者简介: 张愿(1981－ )，男，主治医师，山阳县人民医院骨一科，726400。

引用本文:

张愿 1，李辉 2，马建兵 2*，陈信林 2，肖琳 2，姚舒馨 2，孙相祥 2. 合并晚期膝关节病的胫骨近端应力骨折的分型与治疗[J]. 实用骨科杂志, 2019, 25(8): 704-708.
Zhang yuan 1，Li Hui 2，Ma Jianbing 2*，et al. Classification and Management of Severe Arthrosis and Ipsilateral Tibia Stress Fracture. sygkzz, 2019, 25(8): 704-708.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2019/V25/I8/704

［1］Kang X，Fransen M，Zhang Y，et al.The high prevalence of knee osteoarthritis in a rural Chinese population：the Wuchuan osteoarthritis study［J］.Arthritis Rheum，2009，61(5)：641-647.
［2］Sawant MR，Bendall SP，Kavanagh TG，et al.Nonunion of tibial stress fractures in patients with deformed arthritic knees.Treatment using modular total knee arthroplasty.［J］.J Bone Joint Surg(Br)，1999，81(4)：663-666.
［3］Mullaji A，Shetty G..Total knee arthroplasty for arthritic knees with tibiofibular stress fractures：classification and treatment guidelines［J］.J Arthroplasty，2010，25(2)：295-301.
［4］马钢，刘晓民.膝关节置换术前胫骨上段应力性骨折一例［J］.中国骨与关节损伤杂志，2011，26(10)：870-872.
［5］赵光辉，马建兵，肖琳，等.老年膝关节骨关节炎合并胫骨近端应力性骨折的临床报道［J］.实用骨科杂志，2015，21(1)：93-95.
［6］Mittal A，Bhosale PB，Suryawanshi AV，et al.One-stage long-stem total knee arthroplasty for arthritic knees with stress fractures［J］.J Orthop Surg(Hong Kong)，2013，21(2)：199-203.
［7］Dhillon MS，Prabhakar S，Bali K.Management options for total knee arthroplasty in osteoarthritic knees with extra-articular tibial stress fractures：a 5-year experience［J］.J Arthroplasty，2011，26(7)：1020-1024.
［8］Haspl M，Jelic M，Pecina M.Arthroplasty in treating knee osteoarthritis and proximal tibia stress fracture［J］.Acta Chir Orthop Traumatol Cech，2003，70(5)：303-305.
［9］Matcuk GR Jr，Mahanty SR，Skalski MR，et al.Stress fractures：pathophysiology，clinical presentation，imaging features，and treatment options［J］.Emerg Radiol，2016，23(4)：365-375.
［10］Ng YC，Sathappan SS，Wong HP.Management of knee osteoarthritis presenting with tibial stress fractures［J］.Singapore Med J，2010，51(9)：e149-e152.
［11］Molderez A，Clause JM，Delefortrie G.Stress fractures of the tibia and gonarthrosis.apropos of 2 cases of pseudoarthroses and literature review［J］.Acta Orthop Belg，1994，60(2)：216-219.