创伤性膝关节炎的全膝关节置换  

Total knee replacement for post traumatic degenerative arthritis

作　　者：吴立东[1] 熊炎[1] 严世贵[1] 杨泉森[1] 

机构地区：[1]浙江大学医学院附属第二医院骨科,杭州310009

出　　处：《中华创伤杂志》2004年第11期647-649,共3页Chinese Journal of Trauma

摘　　要：目的评价膝关节骨折后创伤性膝关节炎全膝关节置换的疗效。方法对1997～2002年间膝关节骨折后创伤性关节炎行全膝关节置换的11例患者进行回顾性研究。男10例,女1例;年龄31～76岁,平均59岁。骨折至全膝置换手术的间隔时间2～27年,平均8.7年。有7例患者曾进行手术内固定治疗。全膝置换手术同时拆除内固定4例,分期手术拆除内固定后行全膝关节置换3例。手术时有2例股骨骨折畸形愈合,全膝置换时行外侧支持带松解4例,伸膝装置重建1例,侧副韧带重建2例。结果平均随访时间36个月(12～72个月)。无失访病例。膝关节协会评分从术前的平均37分(10～69分)提高到随访时的85分(10～100分),功能评分从术前的42分(0～60分)提高到随访时的75分(20～100分)。膝活动度从术前的83°增加到随访时的93°。术后由于膝关节活动度差而进行麻醉下手法松解4例。未发现需要进行翻修的假体无菌性松动。有1膝发生切口浅表感染行清创术,假体保留而愈合。结论先前骨折所造成的创伤性关节炎,采用全膝置换可明显改善功能,缓解疼痛。术中恢复肢体的良好对线,确保假体置入正确,达到软组织平衡可促进全膝置换的效果。Objective To evaluate the results of total knee replacement (TKR) in treating post traumatic degenerative arthritis. Methods A retrospective study was carried out on the results of TKR that performed in 11 patients with post traumatic degenerative arthritis due to a previous fracture around knee from 1997 to 2002. There were one female and 10 males with an average age of 59 years (31 76 years). The time from fracture to TKR averaged 8.7 years (2 27 years). Internal fixation was performed in seven cases, among which the removal of the hardware at one stage at the time of TKR was performed in four and TKR in three. Lateral retinacular release was done in four cases, extensor mechanism realignment in one and collateral ligament reconstruction in two at the time of TKR. Fracture malunion appeared in two cases during operation. Results All the cases were followed up for average 36 months (12 72 months). The mean pre operative Knee Society Scores for 37 scores (10 69 scores) for knee and 42 (0 60) for function were improved significantly to mean post operative 85 (10 100) and 75 (20 100), respectively. The mean knee arc of motion improved from pre operative 83°to post operative 93°. Post operative manipulation under anesthesia for poor motion was carried out in four knees. No knee had aseptic loosening that required subsequent revisions. One knee developed superficial infection treated with debridement and retention of components. Conclusions Significant improvement in function and relief in pain is seen in the patients with previous fractures following subsequent TKR. However, special efforts to restore limb alignment, ensure correct component position and manage soft tissue balance may improve outcome of TKA.

关 键 词：全膝关节置换 创伤性 术前 膝关节炎 随访 置换手术 活动度 结论 支持 评分 

分 类 号：R687[医药卫生—骨科学]