目的: 探讨卯榫样植骨修复重度膝关节骨性关节炎胫骨缺损的疗效及技术优化。方法: 对2012年1月至2023年1月内蒙古科技大学包头医学院第一附属医院骨科收治的50例重度膝关节骨性关节炎胫骨平台缺损患者使用卯榫样植骨进行修复,于2023年12月集中对患者进行一次随访。结果: 全部患者顺利完成手术,无严重并发症。随访时间为半年至11年,平均为9.3年,所有患者末次随访时膝关节活动度良好,术后 KSS评分 84～92分,平均88分,较术前有显著改善。末次随访时影像学检查结果显示,胫骨平台骨缺损处均得到有效修复,膝关节假体的位置良好并且承载功能可靠,所有植骨块均与胫骨完全融合,无骨吸收、骨坏死等并发症的出现。末次随访时,对于胫骨平台存在较大缺损的患者,通过增加截骨的角度配合打压植骨修复胫骨平台缺损,所有患者移植的自体骨均完全融入宿主骨,无任何临床症状。结论: 卯榫样植骨修复重度胫骨平台缺损植入骨块更加紧实,早期稳定性好,通过进一步改进手术细节,骨块与主体骨接触间隙更小,适应范围更广,值得临床推广。
Objective: To explore the surgical experience and technical optimization of mortise and tenon bone grafting in repairing tibial defect in severe knee osteoarthritis. Methods: A total of 50 patients of the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology with tibial plateau defect for severe knee osteoarthritis were repaired by mortise and tenon bone graft. Results: All surgeries successfully completed without serious complications. All patients were followed-up for 6 months to 11 years, with an average follow-up of 9.3 years. The postoperative KSS score was 84-92, with an average of 88 scores, which was significantly improved compared with that before surgery. Good knee range of motion were found in all patients at the last follow-up. In the last follow-up, the imaging results showed that defects of the tibial plateau bone were effectively repaired, the knee prosthesis was in good position and of reliable bearing function, and all the bone grafts were completely fused with the tibia without bone resorption, osteonecrosis or other complications. In the last follow-up, for patients with large defects of the tibial plateau, the defect of the tibial plateau was repaired by increasing the osteotomy angle combined with pressure bone grafting, and the transplanted autogenous bone in all patients was completely integrated into the host bone without any clinical symptoms. Conclusion: Mortise and tenon bone grafting in repairing tibial plateau defect for severe knee osteoarthritis is more compact and stable in the early stage. By further improving the surgical details, the contact gap between bone fragments and main bone is smaller and the scope of adaptation is wider, which is a good surgical method and worthy of promotion.
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