重症类风湿性关节炎膝关节屈曲挛缩畸形全膝关节置换术的软组织平衡  

BALANCING OF SOFT TISSUES IN TOTAL KNEE ARTHROPLASTY FOR PATIENTS WITH RHEUMATOID ARTHRITIS WITH KNEE FLEXION CONTRACTURE

作　　者：王维军[1] 牛东生[2] 

机构地区：[1]宁夏医学院临床学院,银川750004 [2]宁夏自治区人民医院骨科

出　　处：《中国修复重建外科杂志》2008年第10期1173-1176,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨重症类风湿性关节炎膝关节屈曲挛缩畸形患者行全膝关节置换(total knee arthroplasty,TKA)软组织平衡的方法及疗效。方法1997年11月-2006年5月,收治38例重症类风湿性关节炎膝关节屈曲挛缩畸形患者。男8例,女30例;年龄48～71岁,平均58.2岁。病程2年4个月～16年,平均7.6年。术前膝关节屈曲挛缩(38.2±11.3)°,关节活动度为(49.1±17.8)°;HSS评分为(23.9±16.9)分。患者均初次行双侧TKA。术前根据屈曲挛缩畸形程度分为轻度(≤20°)5例,中度(20～60°)26例,重度(≥60°)7例。术中在准确截骨的基础上,对于不同程度的膝关节屈曲畸形采取不同的软组织平衡方法,将软组织松解与平衡归结为后房室结构的松解、内外侧副韧带的平衡等。结果术中除5例膝关节残留5～10°屈曲挛缩畸形外,33例患者膝关节均能完全伸直。术后3～6d5膝发生下肢深静脉栓塞,术后1周3膝出现皮下浅部感染,经对症处理后愈合。38例患者均获随访,随访时间10个月～8年,中位随访时间37个月。患者膝关节屈曲挛缩度为(2.4±5.7)°,关节活动度为(96.3±14.6)°,膝关节HSS评分为(81.7±10.4)分,与术前比较差异均有统计学意义(P<0.05)。HSS评分获优27例(71.05%),良6例(15.79%),可5例(13.16%),优良率达86.84%。结论软组织平衡是矫正膝关节屈曲挛缩畸形的主要手段,合理的软组织平衡可避免过量截骨,使屈曲挛缩的膝关节在TKA术后获得明显的畸形矫正、活动度增加和功能恢复。Objective To explore the technique of the soft tissue balancing in the total knee arthroplasty （TKA） for the patients of rheumatoid arthritis with flexion contracture. Methods From November 1997 to May 2006, 38 patients with rheumatoid arthritis with flexion contracture underwent primary bilateral TKA and balancing of the soft tissues, among whom there were 8 males and 30 females, aged 48-71 years old （58.2 on average）. The course of disease was 28 months-16 years （7.6 years on average）. The preoperative flexion contracture was （38.2 ± 11.3）°. The average range of motion （ROM） and HSS score were （49.1 ±17.8）° and 23.9 ±16.9, respectively. According to the preoperative flexion-contracture degree of the knees, these patients were divided into 3 levels： 5 patients with ≤ 20° 26 patients with 20-60° and 7 patients with ≥60°. During the TKA procedure, based on the correct osteotomy, different methods of soft tissue balancing were used for different degrees of flexion contracture. The TKA soft tissue treatment was summed up as the releasing of posterior structures and the balancing between medial collateral ligaments （MCL） and lateral collateral ligaments （LCL）, etc. Results The flexion contractures in 38 cases were all improved after the operation, among which 33 patients had a complete correction and only 5 patients had a residual flexion contracture of 5-10% Eight knees suffered from complications within 1 week after operation, among which 3 had subcutaneous superficial infection and 5 had deep vein thrombus （DVT）. These patients obtained good healing after active treatment. All the 38 patients were followed up for 10 months to 8 years with the median time of 37 months. The postoperative flexion deformity declined to （2.4 ±5.7）°, and the ROM and HSS scores were （96.3 ±14.6）° and 81.7 ±10.4, respectively. There was statistical difference （P 〈 0.05）. According to the HSS score, 27 patients （71.05%）were rated as excellent, 6 good （15.79%） and

关 键 词：类风湿性关节炎 膝关节 屈曲挛缩畸形 全膝关节置换 软组织平衡 

分 类 号：R687.42[医药卫生—骨科学] R684.3[医药卫生—外科学]