初次全膝关节置换中应用股四头肌V-Y成形术暴露强直或僵硬膝关节  

Exposure of an ankylosed or stiff knee with V-Y quadricepsplasty in primary total knee arthroplasty

作　　者：刘霄阳 陈绪明 赵恩泽 周宗科[1] Liu Xiaoyang;Chen Xuming;Zhao Enze;Zhou Zongke(Department of Orthopaedics,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院骨科,成都610041

出　　处：《中华骨科杂志》2024年第9期587-593,共7页Chinese Journal of Orthopaedics

基　　金：国家重点研发计划资助(2022YFC2503100,2022YFC2503104)。

摘　　要：目的分析初次全膝关节置换(total knee arthroplasty,TKA)中应用股四头肌V-Y成形术暴露强直或僵硬膝关节的中长期疗效。方法回顾性分析2010年5月至2019年2月于四川大学华西医院因膝关节强直或僵直采用股四头肌V-Y成形术显露的TKA患者12例,男7例、女5例,年龄(53.9±14.9)岁(范围24~72岁),左侧6例、右侧6例。术前诊断:骨关节炎7例、类风湿关节炎2例、创伤性关节炎1例、血友病性关节炎2例。记录患者手术前后膝关节疼痛视觉模拟评分(visual analogue scale,VAS)、关节活动度、股四头肌肌力、美国膝关节协会评分(Knee Society score,KSS)及术后并发症。结果所有患者均顺利完成手术并获得随访,随访时间为(102.2±31.1)个月(范围51~141个月)。手术时间为(87.0±15.7)min(范围73~123 min),术中出血量为(823.6±237.7)ml(范围555~1471 ml),住院时间为(13.3±6.3)d(范围6~28 d)。所有患者术后VAS评分均降低,手术前后比较差异有统计学意义(F=132.000,P<0.001)。术后3个月和末次随访的VAS评分分别为(2.2±0.7)分和(1.2±0.4)分,小于术前的(5.2±0.7)分,差异有统计学意义(P<0.05)。所有患者术后KSS膝评分均升高,手术前后比较差异有统计学意义(F=40.960,P<0.001)。术后3个月和末次随访的KSS膝评分分别为(56.0±14.1)分和(74.3±16.1)分,大于术前的(26.1±7.8)分,差异有统计学意义(P<0.05)。所有患者术后KSS功能评分均升高,手术前后比较差异有统计学意义(F=24.332,P<0.001)。术后3个月和末次随访的KSS功能评分分别为(52.9±19.4)分和(79.2±19.6)分,大于术前的(27.1±15.6)分,差异有统计学意义(P<0.05)。所有患者术后膝关节活动度均升高,手术前后比较差异有统计学意义(F=24.145,P<0.001)。术后3个月和末次随访的膝关节活动度分别为57.5°±22.2°和70.0°±25.9°,大于术前的12.5°±14.1°,差异有统计学意义(P<0.05)。术前股四头肌肌力3级2例,4级10例;末次随访时4级1例,5级11Objective To analyze the medium-and long-term outcomes of V-Y quadricepsplasty in primary total knee arthroplasty(TKA)to expose an ankylosed or stiff knee joint.Methods From May 2010 to February 2019,a total of 12 patients with TKA revealed by V-Y quadricepsplasty in West China Hospital of Sichuan University due to knee ankylosis or stiffness were retrospectively analyzed,including 7 males and 5 females,aged(53.9±14.9)years(range,24 to 72 years),6 patients on the left side and 6 patients on the right side.Preoperative diagnosis:7 cases of osteoarthritis,2 cases of rheumatoid arthritis,1 case of traumatic arthritis,and 2 cases of haemophilic arthritis.Visual analogue scale(VAS),range of motion,quadriceps muscle strength,Knee Society score(KSS)and postoperative complications were recorded before and after operation.Results All patients successfully completed the operation and were followed up for 102.2±31.1 months(range,51-141 months).The operation time was 87.0±15.7 min(range,73 to 123 min),the intraoperative blood loss was 823.6±237.7 ml(range,555 to 1471 ml),and the hospital stay was 13.3±6.3 d(range,6 to 28 d).Postoperative VAS scores were decreased in all patients,and the difference before and after operation was statistically significant(F=132.000,P<0.001).The VAS scores at 3 months and the last follow-up were 2.2±0.7 points and 1.2±0.4 points,respectively,lower than those before operation(5.2±0.7 points),and the difference was statistically significant(P<0.05).KSS knee scores were higher in all patients after operation,and the difference was statistically significant before and after operation(F=40.960,P<0.001).KSS knee scores at 3 months and the last follow-up were 56.0±14.1 points and 74.3±16.1 points,respectively,higher than those before operation(26.1±7.8 points),and the difference was statistically significant(P<0.05).Postoperative KSS functional scores were increased in all patients,and the difference before and after operation was statistically significant(F=24.332,P<0.001).The KSS function

关 键 词：关节成形术 置换 膝 四头肌 活动范围 关节 

分 类 号：R687.4[医药卫生—骨科学]