术中残留一定程度屈曲畸形对TKA疗效的影响  

The effect of residual flexion deformity of certain degree on the efficacy of TKA

作　　者：黄易 杨辉 王锦文 谈正岗 鲍星安 陈有泉 范卫民[1] 刘锋[1] HUANG Yi;YANG Hui;WANG Jinwen;TAN Zhenggang;BAO Xing’an;CHEN Youquan;FAN Weimin;LIU Feng(Department of Orthopaedics,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029;Department of Orthopaedics,Affiliated Hospital of Yangzhou University,Yangzhou 225012,China)

机构地区：[1]南京医科大学第一附属医院骨科,江苏南京210029 [2]扬州大学附属医院骨科,江苏扬州225012

出　　处：《南京医科大学学报(自然科学版)》2025年第4期551-559,共9页Journal of Nanjing Medical University(Natural Sciences)

基　　金：江苏省自然科学基金(BK20191492)。

摘　　要：目的:探讨全膝关节置换术(total knee arthroplasty,TKA)治疗伴有严重屈曲畸形(flexion deformity,FD)的膝关节骨关节炎,术中残留一定程度FD对疗效的影响。方法:回顾性分析南京医科大学第一附属医院2013年10月—2017年9月间按完全矫正FD(<5°)理念治疗的52例伴有严重FD(>30°)的患者,称为术中完全伸直组(52例),以及2017年10月—2021年9月间按可以适当残留一定程度FD(5°~10°)理念治疗的43例患者,称为术中未完全伸直组(43例)。记录手术时间、手术出血量、术后下肢肿胀程度和术后并发症发生率,记录美国纽约特种外科医院(hospital for special surgery,HSS)膝关节评分、日常生活活动量表(activities of daily living scale,ADLs)和疼痛视觉模拟评分(visual analogue scale,VAS),比较两组的差异。结果:所有患者随访时间为(35.85±1.99)个月(范围33~39个月)。术中未完全伸直组患者手术时间更短(P=0.001),手术出血量更少(P<0.001),术后下肢肿胀程度更轻(P<0.001)。术中未完全伸直组患者术后3个月较术中完全伸直组的患者存在更大的FD(P=0.038),但疼痛程度更轻(P=0.031),两组患者术后HSS和ADLs评分未发现显著差异。术后6、12、24、36个月时,两组患者残留FD、HSS、ADLs和VAS的差异均无统计学意义。两组患者HSS改善程度在术后3~6个月差异有统计学意义(P=0.004),其他阶段的差异无统计学意义。术中未完全伸直组患者较术中完全伸直组患者术后深静脉血栓发生率更低(P=0.048),而两组患者中远期并发症发生率的差异无统计学意义。结论:治疗伴有严重FD的膝关节骨关节炎时,TKA术中可以有限地松解组织并适当残留一定程度FD(5°~10°)不影响膝关节活动度和功能的恢复,且深静脉血栓发生率更低。Objective:To investigate the effect of residual flexion deformity(FD)to a certain degree during total knee arthroplasty(TKA)on the efficacy in patients with severe FD associated with knee osteoarthritis.Methods:A retrospective analysis was conducted at the First Affiliated Hospital of Nanjing Medical University on the 52 patients with severe FD(>30°)treated based on the concept of completely correcting FD(within 5°)from October 2013 to September 2017,referred to as the intraoperatively completely-extended group(n=52),and the 43 patients treated based on the concept of appropriately retaining a certain degree of FD(5°-10°)from October 2017 to September 2021,referred to as the intraoperatively incompletely-extended group(n=43).The operation time,intraoperative blood loss,postoperative lower limb swelling,and the incidence of postoperative complications were recorded.The hospital for special surgery(HSS)score,activities of daily living scale(ADLs),and visual analogue scale(VAS)were also to compare the differences between the two groups.Results:All patients successfully completed the surgery,and were followed up for(35.85±1.99)months(range 33-39 months).Patients in the intraoperatively incompletely-extended group had shorter surgical time(P=0.001),less operative blood loss(P<0.001),and had less postoperative lower limb swelling(P<0.001).At 3 months post-surgery,patients in the incompletely-extended group had greater residual FD(P=0.038)but less pain(P=0.031)than those in the completely-extended group.No significant differences were found in postoperative HSS and ADLs scores between the two groups.At 6,12,24,and 36 months post-surgery,there were no statistically significant differences in residual FD,HSS,ADLs,and VAS between the two groups.The improvement in HSS scores also showed difference at 3-6 months post-surgery(P=0.004),but not at other time points.The incidence of deep vein thrombosis(DVT)was lower in the completely-extended group(P=0.048),but there was no statistical difference in the incidence of medium

关 键 词：骨关节炎 关节置换术 屈曲畸形 预后 

分 类 号：R684[医药卫生—骨科学]