目的 探讨人工全膝关节置换术(total knee arthroplasty, TKA)治疗严重畸形膝关节的手术方法和临床疗效。方法 对人工全膝关节置换术916例(1031膝),严重畸形膝关节置换术80例,其中56例(70膝)成功随访。严重内翻畸形19例(23膝)、严重外翻畸形21例(27膝)、严重屈曲畸形16例(20膝)。术后平均随访时间60个月(6个月～10年)。对膝关节屈伸活动度、HSS、KSS膝关节评分系统对手术前后进行回顾性研究。结果 膝关节屈伸活动度由术前平均80°(伸直0°～屈曲 120°)提高到术后115°(伸直0°～屈曲130°) ,膝关节评分系统 HSS、KSS术前及随访时比较差异有统计学意义(P<0.05),KSS评分:临床评分由术前平均33分(10～68分)提高到术后平均81分(70～100分),HSS临床评分由术前平均43分( 27～68分)提高到术后平均86分(72～100分)。膝内外翻、屈曲挛缩畸形得到较好矫正。结论 严重畸形膝关节通过关节置换术同样能恢复正常的关节功能,提高了患者生活质量,获得满意的临床疗效。
Abstract
Objective To investigate the Methods and clinical Results of total knee arthroplasty (TKA) in patients with severe knee deformity. Methods From February 1999 to December 2012,916 patients (1031 knees) underwent TKA in this hospital,including 80 patients with severe knee deformity,of which,56 patients (70 knees) were followed up,among them,19 patients (23 knees) with varus knee deformity,21 patients (27 knees),patients with severe flexion deformity were 16 patients (20 knees) knee flexion deformity.The mean follow-up period was 60 months(ranging from 6 months to 10 years).To evaluate the outcomes of TKA at the time of pre-operation and follow-up respectively,range of motion(ROM),the HSS score and the KSS score were used.Results The average ROM improved from 80°(0°-120°) preoperatively to 115°(0°-130°) postoperatively.The HSS score and the KSS score were significantly improved compared with pre-operation(P<0.05). KSS improved from 33 points (10-68 points) preoperatively to 81 points (70-100 points),HSS improved from 43 points (27-68 points) preoperatively to 86 points (72-100 points). Varus knee deformity,valgus knee defoimity and flexion deformity were corrected. Conclusions TKA improves the function of knee effectively and the quality of patients' life. The effect of TKA is satisfactory.
关键词
关节置换术 /
膝内翻 /
膝外翻 /
屈曲挛缩
Key words
arthroplasty /
varus knee /
valgus knee /
flexion contracture
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Zietz C,Bergschmidt P,Fritsche A,et al.Comparison of cross-sections of different femoral components for revision total knee replacement[J].J Orthop Surg,2012,20 (1):32-36.
[2] 王韶进,段元涛,刘文广,等. 严重畸形膝骨关节病的人工膝关节置换术[J].中华关节外科杂志,2007,10(4):71-74.
[3] 潘文杰,刑 科,贺 艳.膝关节内翻屈曲畸形全膝关节置换的早期疗效[J].中国骨与关节损伤杂志,2011,26(7):595-597.
[4] Siddiiqui M M,Yeo S J,Sivaiah P,et al.Function and quality of life in patients with recurvatum deformity after primary total knee arthroplasty:a review of our joint registry[J].J Arthroplasty,2012,27(6):1106-1110.
[5] Yagishita K,Muneta T,Shinomiya K.Quantitative evaluation of the effect of soft tissue release on soft tissue balance in total knee arthroplasty[J].J Bone Joint Surg,2001,83(4):439.
[6] Engh G A.The difficult knee:severe varus and valgus[J].Clin Orthop Relat Res,2003,(416):58-63.
[7] 耿 磊,陈继营,陈 城,等.全膝关节置换术两种入路效果比较[J].武警医学,2012,23(5):373-375.
[8] 吕厚山,关振鹏,周殿阁,等.膝关节外翻畸形的人工膝关节置换术[J].中华外科杂志,2005,43(10):1305-1308.
[9] Bellemans J, Vandenneucker H ,Victor J, et al. Flexion contracture in total knee arthroplasty[J].Clin Orthop Relat Res,2006,(4520):78-82.
[10] 吕厚山,林剑浩.严重屈膝畸形的人工膝关节表面置换术[J].中华外科杂志,1997,35(7):414-417.
[11] 刘新园,黄继锋,付 强等.CT三维重建技术对骶髂关节理想螺钉选择的意义[J]. 华南国防医学杂志,2012,26(3):211-218.
[12] Springer B D,Hanssen A D,Sim F H,et al.The kinematic rotating hinge prosthesis for complex knee arthroplasty[J].Clin Orthop Relat Res,2001,(392):283-291.
PDF(756 KB)
