人工全膝关节置换术后早期胫骨内侧疼痛的病例对照研究  

Case control study on earlier medial tibial pain after total knee arthroplasty

作　　者：柴伟[1] 孙长鲛[1] 倪明[1] 张国强[1] 张强[1] 沈研[1] 周勇刚[1] 陈继营[1] 王岩[1] 

机构地区：[1]解放军总医院骨科,北京100853

出　　处：《中国骨伤》2014年第4期269-273,共5页China Journal of Orthopaedics and Traumatology

基　　金：国家863主题项目资助(编号:2011AA030101)~~

摘　　要：目的:比较人工全膝关节置换术(total knee arthroplasty,TKA)采用骨膜剥离器和电刀松解内侧副韧带及鹅足后发生膝前痛的差异。方法:2009年9月至2012年9月,选取解放军总医院行单侧初次膝关节置换的患者共220例,分为骨膜剥离器组和电刀组。骨膜剥离器组110例,男47例,女63例,平均年龄(58.8±17.2)岁,膝内翻(14.0±3.5)°,体重(65.6±12.8)kg,体重指数(body mass index,BMI)(26.6±3.6)kg/m2;电刀组110例,男49例,女61例;平均年龄(59.6±16.7)岁,膝内翻(15.0±4.7)°,体重(66.4±13.4)kg,BMI(27.4±4.1)kg/m2。平均随访时间24.6个月,术后评定两组患者末次随访时AKS膝评分、VAS疼痛评分和HSS评分。结果:两组患者术后切口均Ⅰ期愈合,无下肢深静脉血栓形成及肺栓塞发生。术后3例发生感染(电刀组2例,骨膜剥离器组1例),行Ⅱ期翻修手术,使用TC3假体及抗生素骨水泥固定,随访期间未再发生感染。20例出现膝前区疼痛,其中电刀组4例,骨膜剥离器组16例,电刀组膝前区疼痛发生率低于骨膜剥离器组。末次随访时AKS膝评分和HSS评分电刀组高于骨膜剥离器组,VAS电刀组低于骨膜剥离器组。结论:与使用骨膜剥离器松解内侧副韧带及鹅足相比,使用电刀术后膝前痛发生率降低。Objective：To compare the difference of anterior knee pain after total knee arthroplasty （TKA） between the ways using periosteal dissector and electric scalpel to release medial collateral ligament and pes anserinus. Methods：From September 2009 to September 2012,220 patients with unilateral osteoarthritis were treated with primary TKA in hospital 301. All the patients were randomly divided into periosteal dissector group （110 cases） or electric scalpel group （110 cases）. In the periosteal dissector group,there were 47 males and 63 females,with an average age of （58.8±17.2） years old; the degree of genuavarus was （14.0±3.5）°; the weight was （65.6±12.8） kg; the body mass index （BMI） was（26.6±3.6） kg/m^2. In the electric scalpel group, there were 49 males and 61 females, with an average age of （59.6±16.7） years old;the degree of genuavarus was （ 15.0＋±4.7 ） o ; the weight was （ 66.4± 13.4） kg; the BMI was （27.4±4.1） kg/m^2. The mean follow-up period was 24.6 months. The AKS,VAS and HSS were used to evaluate clinical results. Results：All incisions healed at the first stage;no deep vein thrombosis of lower limbs or puhnonary embolism occurred. Knee infection occurred in 3 cases （ 1 in the periosteal dissector group and 2 in the electric scalpel group ）, and the 3 patients received stage 2 total knee revision using antibiotic bone cement and TC3 prosthesis. No recurrence of infection occurred during follow-up. Among the 20 patients who had anterior knee pain, 16 patients were in the periosteal dissector group and 4 patients were in the electric scalpel group. The occurrence rate of anterior knee pain in the electric scalpel group was lower than that in the periosteal dissector group. The AKS knee score and HSS score after total knee arthroplasty in the electric scalpel group were all higher than those in the periosteal dissector group, and the VAS in electric scalpel group was lower than that of periosteal dossector group. Conclusion： Compared with u

关 键 词：关节成形术 置换 膝 疼痛 外科手术 病例对照研究 

分 类 号：R687.4[医药卫生—骨科学]