全膝关节置换治疗严重膝关节疾病  

Total knee arthroplasty for the treatment of severe knee disease

作　　者：李广伟[1] 王红军[1] 孙晓智[1] 

机构地区：[1]郑州市第二人民医院骨二科,河南省郑州市450000

出　　处：《中国组织工程研究》2013年第9期1535-1542,共8页Chinese Journal of Tissue Engineering Research

摘　　要：背景:膝关节畸形施行人工全膝关节置换难度大,涉及面多,包括手术入路、术中截骨、软组织松解顺序、方法及程度、软组织平衡等,专家学者各不相同,意见不统一,争议较多。目的:探讨全膝关节置换治疗成人严重膝关节疾病的手术方法和临床疗效。方法:纳入42例(48膝)严重膝关节疾病合并畸形患者,均采用后稳定型假体进行全膝关节置换,由髌骨内侧入路,正确截骨,选择性的软组织松解,恢复膝关节正常的力线和软组织平衡,获得膝关节稳定,置换后采取针对性的康复训练,定期随访检查膝关节活动度、最大屈曲度并进行HSS评分、WOMAC评分。结果与结论:所有患者均获得随访,随访时间为25-84个月,平均35.5个月。所有患者置换治疗后膝关节活动度、膝关节最大屈曲度、HSS评分、WOMAC评分较置换前比较,均显著提高,差异有显著性意义(P<0.01)。置换后切口均Ⅰ期愈合,无膝关节僵硬、血管及神经损伤、髌骨骨折、髌骨低位、假体松动等并发症发生,下肢力线均恢复正常。说明成人严重膝关节畸形经全膝关节置换,置换后畸形均得到纠正,功能较前明显改善,临床效果满意。BACKGROUND： Total knee arthroplasty used for the treatment of knee joint deformity is difficult and involves multi-aspects, including the surgical approach, intraoperative osteotomy, order, method and extentof soft tissue release and soft tissue balance, There are a lot of controversies due to different scholarly opinions. OBJECTIVE： To explore the surgical methods and clinical efficacy of total knee arthroplasty for the treatment of severe knee disease. METHODS： A total of 42 cases （48 knees） with severe knee disease and knee joint deformity were selected, and all the patients were treated with total knee arthroplasty using posterior stabilized prosthesis. Through patellar medial approach and correct osteotomy, selective soft tissue release was performed to restore normal knee alignment and soft tissue balance to harvest knee stability. The targeted rehabilitation training was performed after replacement and the knee range of motion and maximum knee flex degree were detected regularly. The Hospital for Special Surgery score and the Western Ontario and Mcrnastar Universities Arthritis Index score were performed. RESULTS AND CONCLUSION＂ All patients were followed-up for 25 to 84 months, 35.5 months in average. The knee range of motion, maximum knee flex degree, Hospital for Special Surgery score and the Western Ontario and Mcmaster Universities Arthritis Index score of all the patients were significantly increased after replacement compared with those before replacement （P 〈 0.01）. The wound was in stage Ⅰ recovery. No knee joint rigidity, blood vessel and nerve injury, patella fracture, patella low-site and prosthesis loosening were observed after replacement. The lower limb alignment was restored to normal level. The adult severe knee deformity can be corrected through total knee arthroplasty, and the function is improved significantly with satisfactory clinical results.

关 键 词：骨关节植入物 人工假体 全膝关节置换 畸形 后稳定假体 软组织平衡 截骨 膝关节活动度 最大屈曲度 HSS评分 WOMAC评分 髌骨骨折 假体松动 相容性 

分 类 号：R318[医药卫生—生物医学工程]