改良正中微创切口行LPS高屈曲度全膝关节置换术早期疗效观察  

Early experience of modified central minimal incision in high-flex total knee arthroplasty

作　　者：郭林[1] 杨柳[1] 代灿[1] 王晓宇[1] 段小军[1] 陈光兴[1] 戴刚[1] 

机构地区：[1]第三军医大学西南医院关节外科中心,重庆400038

出　　处：《重庆医学》2006年第20期1841-1842,共2页Chongqing medicine

摘　　要：目的观察改良正中微创切口行LPS高屈曲度膝关节假体（LPS—Flex Fixed Bearing Kncc．Zimmcr）置换术的早期疗效．探讨二者结合后对膝关节功能的改善。方法2003年11月～2005年12月对69例（73膝）患者行LPS高屈曲度膝关节假体置换术，术中采用改良正中微创切口，长11～15cm．平均13．8cm。术中改善髌股对线、清理后关节囊、平衡软组织并植入高屈曲度假体。术后6～31个月进行随访，使用膝关节协会临床评分、HSS评分、10级疼痛评分、6min行走试验（6MWT）和30s爬梯测试对患者术后的膝关节功能进行评估。结果73膝术后屈曲度在100～150°间．平均122．7°．较术前提高41．6°,膝关节协会临床评分中疼痛评分42分；HSS评分170分；膝关节平均前移（6．7±3．1）mm；内外翻角度和（13．24±4．5）。；10级疼痛评分2．05分；6MWT为425m；30s登梯试验28．5阶，下梯试验28．6阶。65例为单侧高屈曲度假体置换．其中2例患者对侧膝关节曾行普通假体置换术，3例有对侧膝关节疾患；另有4例双侧膝关节置换，此9例患者在本组中疼痛评分可，功能评分较低，尤其6MWT和30s爬梯测试差。结论使用改良正中微创切口可减少手术创伤，早期恢复膝关节功能．本组中未出现假体植入失误和早期松动等并发症；LPS高屈曲度膝关节假体能够明显改善术后活动度，随访中未发现膝关节过度松弛与撞击症等。膝关节置换术后功能评定受对侧膝关节病变影响较大，在效果评定中值得注意。总之，结合改良正中微创切口和LPS高屈曲度假体行全膝关节置换术的近期疗效满意，远期疗效有待进一步观察。Objective To observe the early result of a modified minimal incision in total knee arthroplasty with LPS-FIex Fixed Bearing Knee and to evaluate the therapeutic effect of the combination of the two newly developed techniques. Methods A case series of 69 patients （73 knees） undergoing TKA with LPS high flexion knee prosthesis between November, 2003 and December, 2005 is reported. All eases were performed with 11-15cm modified central minimal incisions. Maximal intraoperative flexion angle was obtained by correction of patellofemoral alignment, clearence of posterior capsule and soft tissue balancing. In a 6 to 31 months follow-up study, postoperative Keen Society Clinical Scale, HSS scale, 10 grade pain scale, 6-min walking test（6MWT）and 30s ascending and descending stairs test were evaluated. Results Postoperative ROM increased in 73 cases significantly to 100°- 150° （122.7° on average）, with an average increase of 41.6°Average pain evaluation in Keen Society Clinical Scale was 42. Average HSS score was 170. Average anterior translation was 6.7±3.1mm and coronal laxity was （13.2±4.5）°. 10 grade pain scale was 2.05. 6MWT was 425m. 30s ascending stairs test was 28.6, and descending test was 28.5. In 65 cases of single side LPS replace ment, there were 9 cases with relatively poor result on functional evaluation especially in 6MWT and 30s climbing test. There were 2 cases with common prosthesis, 3 cases with disease in contralateral knee, 4 cases of double side LPS knee replacement. Conclusion The modified incision reduced the surgical trauma and promoted rehabilitation protocol. No mal-positioned prosthesis was found. LPS-Flex Fixed Bearing Knee can increase postoperative ROM significantly and no laxity was found in these cases. In short, modified incision TKA with LPS high flexion prosthesis has a relatively good therapeutic effect from the study but further study in a long-time follow-up is needful.

关 键 词：膝 关节置换 微创切口 高屈曲度 

分 类 号：R687.4[医药卫生—骨科学]