背景:Charcot关节病是一种罕见的神经源性关节病变,其特征是进行性关节破坏并伴有脱位或半脱位。然而,对于严重的关节损伤是否应进行关节置换是有争议的。
方法:本文报道了一例严重的Charcot关节病,并伴有较大的骨缺损,该病例采用定制的3D打印多孔钽进行关节成形术治疗。患者入院,有9年的双侧膝关节疼痛病史,在过去2个月中加重。X线照相显示双膝有骨生成和硬化,游离的骨头碎片,异位骨化,新骨,和骨赘的形成,不规则边缘,关节间隙明显变窄,和严重的关节损伤(安德森骨科研究所分类III型)。基于目前的疾病,历史,成像,和实验室检查,Charcot关节病被证实。文献中已经报道了保守治疗。关于严重Charcot关节疾病的手术治疗的报道有限。手术后我们对病人进行了一年的随访,影像学及临床评价结果良好。术后X线检查显示力线对齐良好,良好的接头空间,也没有松动的证据.病人是流动的,不需要拐杖。
结论:通过准确的手术评估和3D打印多孔钽植入物的制备,严重的AORI分级Ⅲ型Charcot关节病能有效恢复膝关节的活动范围,下肢对齐,最终实现无拐杖行走的良好功能效果。
BACKGROUND: Charcot joint disease is a rare neurogenic lesion of the joint characterized by progressive joint destruction with dislocation or subluxation. However, whether a joint replacement should be performed for severe joint damage is controversial.
METHODS: This paper reports a case of severe Charcot joint disease with a large bone defect that was treated with arthroplasty assisted by a customized 3D-printed porous tantalum. The patient was admitted to the hospital with a 9-year history of bilateral knee pain that had aggravated in the past 2 months. Radiography showed osteogeny and sclerosis in both knees, free bone fragments, heterotopic ossification, new bone, and osteophyte formation, irregular margins, apparent narrowing of joint space, and severe joint damage (Anderson Orthopedic Research Institute classification type III). Based on the present illness, history, imaging, and laboratory examination, Charcot joint disease was confirmed. Conservative treatment has been reported in the literature. There are limited reports on the surgical treatment of severe Charcot joint disease. We followed up with the patient for a year after the operation, and the imaging and clinical evaluation results were good. Postoperative X-ray examinations showed good alignment of force lines, good joint space, and no evidence of loosening. The patient was mobile and did not need crutches.
CONCLUSIONS: Through accurate surgical evaluation and preparation of 3D-printed porous tantalum implants, severe AORI classification type III Charcot joint disease can effectively restore the range of motion of the knee joint, the lower limb alignment, and finally achieve good functional results of walking without crutches.