全膝关节置换治疗Charcot膝关节病  

Total knee arthroplasty for Charcot arthropathy of knee

作　　者：王鹏[1] 王海彬[2] 周驰[2] 唐宏宇[2] 霍少川[2] 张濛 WANG Peng;WANG Hai-bin;ZHOU Chi;TANG Hong-yu;HUO Shao-chuan;ZHANG Meng(Guangzhou TCM University,Guangzhou 510000,China)

机构地区：[1]广州中医药大学,广州市510000 [2]广州中医药大学第一附属医院关节骨科,广州市510000

出　　处：《中国矫形外科杂志》2020年第11期898-902,共5页Orthopedic Journal of China

基　　金：国家自然科学基金面上项目(编号:81774339)。

摘　　要：[目的]探讨夏科氏(Charcot)膝关节病患者行全膝关节置换术(TKA)的中短期疗效。[方法]回顾性分析2007年9月~2018年12月采用TKA治疗15例(19膝) Charcot膝关节病患者。6例8膝采用半限制假体,8例9膝采用旋转铰链膝(RHK)假体,1例2膝分别采用上述假体。比较两组围术期、随访和影像资料。[结果]两组患者均顺利手术,无严重术中并发症。两组患者在手术时间、切口长度、术中失血量、术后引流量、术后下地时间和住院天数的差异均无统计学意义(P>0.05)。随访8~120个月,平均(39.21±33.81)个月。随访过程中,半限制性组1例术后2年术侧髋部疼痛乏力,影响行走,诊断Charcot髋关节,膝关节活动度可,假体无松动,予保守治疗处理。RHK组1例术后1年因外伤至术侧股骨颈骨折,行保守治疗,随访5年未见异常。1例术后1年因外伤至假体半脱位,行翻修术更换垫片及股骨侧旋转轴,随访至今4年膝关节功能尚可,假体位置满意。1例术后3个月出现髌韧带断裂,行修补术后治愈。末次随访时,两组HSS评分均较术前显著增加(P<0.05),半限制组HSS评分高于RHK组,但差异无统计学意义(P>0.05);半限制组关节活动度(ROM)较术前显著增加(P<0.05),但RHK组两时间点间ROM无显著变化(P>0.05),半限制组ROM显著高于RHK组(P<0.05)。影像方面,术后冠状股骨角、冠状胫骨角及胫骨后倾角两组对比差异无统计学意义(P>0.05);半限制组术后髋膝踝角显著小于RHK组(P<0.05)。[结论]半限制性假体和RHK假体均可作为TKA治疗Charcot膝关节病的适宜假体选择,所有患者均获得良好的近期结果,远期效果待随访观察。[Objective] To explore the clinical outcomes of total knee arthroplasty(TKA) for Charcot arthropathy of knee.[Methods] A retrospective study was conducted on 15 patients(19 knees) who received TKA from September 2007 to December2018 for Charcot arthropathy of knee. Of them, 6 patients(8 knees) had TKA performed with semi-restrictive prosthesis(SR), 8 patients(9 knees) were with rotating hinge knee prosthesis(RHK), and one patient(2 knees) was with the each above prosthesis on each knee. The perioperative, follow-up and radiographic documentations were compared between the two groups of prosthetic type. [Results]All the patients had TKA performed smoothly without serious complications, and with on statistically significant differences between the two groups regarding operative time, incision length, intraoperative blood loss, postoperative drainage, time to return ambulation and hospitalization days(P>0.05). During follow-up period lasted for 8~120 months with an average of(39.21±33.81) months, no adverse event happened in anyone of the SR group, whereas in the RHK group 1 patients got femoral neck fracture of the affected side 1 year after operation and was treated conservatively, 1 patient suffered from prosthetic subluxation 1 year later, and had the insertion and axis components changed, 1 patient had patellar tendon tear which healed after repair. The HHS score significantly increased at the latest follow up in both groups compared with those before operation(P<0.05). The SR group was marked higher HHS score than the RHK group at the latest follow up regardless of no a statistical significance between them(P>0.05). In addition, the SR group got a significant ROM increases at the follow up compared with that before operation(P<0.05), whereas the RHK group had no significant change in ROM between the two time points(P>0.05), therefore the SR group was significantly superior to the RHK group in ROM at the latest interview(P<0.05). Regarding to radiographic assessment, the SR group had significantly less hip-kne

关 键 词：Charcot膝关节病 全膝关节置换(TKA) 半限制性假体 旋转铰链假体 

分 类 号：R687.4[医药卫生—骨科学]