全膝关节置换术在晚期骨性关节炎治疗中的应用

目的　探讨全膝关节置换术在膝关节骨性关节炎治疗中的手术要点及康复方法。方法　对46例(5 7侧)晚期膝关节骨性关节炎患者采用全膝关节置换术进行治疗。结果　全部病例均得到6～66个月的随访,根据HSS膝关节评分法,44膝优,13膝良,优良率10 0 %。结论　全膝关节置换术是治疗晚期膝关节骨性关节炎的最佳治疗手段,假体选择,关节面的切除和假体安放位置,膝周软组织平衡以及康复训练是取得优良疗效的关键。     

人工全膝关节置换治疗膝关节骨关节炎

目的探讨人工全膝关节置换术(TKA)治疗终末期膝关节骨关节炎的临床疗效。方法对行TKA治疗的181例终末期膝关节骨关节炎患者(226膝)分别于手术后40、120、180、360 d进行定期随访观察,对患者HSS膝关节功能评分及膝关节最大活动度进行比较。结果患者均获得随访,时间1~2年。膝关节功能HSS评分:优209膝(92.5%),良13膝(5.8%),可3膝(1.3%),差1膝(0.4%),优良率98.2%。术后各时间段的HSS评分及膝关节最大活动度均较术前显著提高,差异均有统计学意义(P0.05)。结论 TKA是治疗终末期膝关节骨关节炎的有效方法,正确的手术操作和合理的功能锻炼是取得满意临床效果决定性因素。     

全膝关节表面置换术治疗晚期骨关节炎效果分析

目的探讨晚期膝骨关节炎患者行全膝关节表面置换术治疗的临床效果。方法对2012-06—2014-06间收治88例晚期膝骨关节炎患者,采用全膝关节表面置换术治疗。并于手术前及手术后15 d行膝功能评分。术后随访12个月,观察效果及并发症情况。结果术后患者膝功能优良率显著高于术前,且膝关节及膝功能评分均较治疗前显著升高,治疗前后比较,差异均有统计学意义(P0.01)。随访期间,患者均无感染、脱位、松动以及屈曲不稳等病例发生。结论晚期膝骨关节炎患者行全膝关节表面置换术治疗的效果显著,能够有效改善患者症状,增强患膝稳定性和患者行走活动能力,改善患者生活质量。     

膝关节术后伸膝迟滞的研究进展

多数文献将伸膝迟滞定义为膝关节主动伸直的角度无法达到被动伸直的角度, 也有文献将膝关节无法完成最后15°的伸直定义为伸膝迟滞。伸膝迟滞是膝关节术后常见的并发症之一, 严重影响患者术后膝关节功能。术后长期制动导致的废用性萎缩、因疼痛和(或)肿胀导致的关节源性肌肉抑制、术中对伸膝装置的直接损伤以及支配股四头肌的神经功能障碍均会造成伸膝迟滞。通过加强康复锻炼、物理因子以及药物治疗可以显著改善伸膝迟滞症状, 但因伸膝装置损伤所致的伸膝迟滞必要时需手术治疗。随着手术技术的不断提高、康复介入的不断提前, 预防伸膝迟滞的发生、最大程度减少术后伸膝迟滞的角度需引起患者、医生及研究者的足够重视。通过对膝关节术后伸膝迟滞的临床研究进行综述, 明确病因、治疗、预防及预后情况, 为临床处理提供依据及指导。     

人工全膝表面关节置换治疗骨性膝关节炎47例

目的　分析总结人工全膝表面关节置换治疗骨性膝关节炎的临床效果及经验。方法　对 4 7例 5 3膝的骨性膝关节炎病例行人工膝关节置换术 ,单膝关节置换 4 1例 ,双膝关节置换 6例 1 2膝。应用后方稳定型假体 2 1例 2 5个膝关节 ,保留后交叉韧带型假体 2 6例 2 8个膝关节。结果　 39例 4 5个膝关节获 1年以上随访 ,采用HSS评分标准 ,膝关节评分从术前 35分提高到术后 89分 ,术后 4 0个膝关节活动度≥ 90°,4 2 / 4 5膝关节术后膝关节力线正常 ,3例残留 5°～ 7°内翻。结论　人工全膝表面关节置换治疗骨性膝关节炎可取得良好效果。术中精确的截骨操作与正确的软组织松解获得的软组织平衡是手术治疗成功的关键。     

保膝治疗的研究进展

"保膝"治疗,即在不破坏软组织生物活性及生理特性的情况下,采用微创手段治疗膝关节周围疾病。临床中常见的膝关节损伤的疾病为膝关节骨关节炎和胫骨平台骨折,针对上述两种疾病,本文主要综述了近年来"保膝"治疗的研究进展。膝关节骨关节炎的治疗以人工膝关节置换术最为常见,但是术后容易出现膝关节僵硬、假体感染等并发症,根据"保膝"理念,腓骨截骨术、胫骨高位截骨术等可以减少手术创伤,降低术后并发症发生率,成为治疗骨关节炎的良好选择;胫骨平台骨折是常见的关节内骨折,胫骨平台骨折的"保膝"治疗指在不破坏骨折端周围软组织情况下实现微创复位、固定骨折块,恢复关节面完整。另外,在此基础上衍生出许多"保膝"治疗的新思路。"保膝"治疗遵循微创理念,符合现代医学技术的发展方向。     

严重膝骨性关节炎人工全膝关节置换术后生存质量评价

目的评价全膝关节置换术治疗严重膝骨性关节炎的临床疗效;方法73例（95膝）严重膝骨性关节炎患者行人工全膝关节置换术,随访时间10个月～4年（平均28个月）,对其术前、术后生存质量评分和膝关节功能HSS评分进行分析和总结。结果根据生存质量评分标准,手术优良率达91.78%,HSS评分标准手术优良率达95.79%,术后在生存质量、疼痛、关节功能及活动度等方面均有明显改善。结论全膝关节置换术是治疗严重膝骨性关节炎的有效方法,生存质量评价对膝关节骨性关节炎患者治疗有临床指导意义。     

透明质酸钠关节内注射配合口服盐酸氨基葡萄糖胶囊治疗膝关节骨性关节炎的疗效分析

目的探讨透明质酸钠关节内注射配合口服盐酸氨基葡萄糖胶囊治疗膝关节骨性关节炎的临床疗效。方法2007年9月至2009年3月收治膝关节骨性关节炎患者181例217膝,男86例101膝,女95例1 16膝;年龄43～73岁,平均57岁。单膝145例,双膝发病36例。随机分为治疗组及对照组。治疗组112膝,采用透明质酸钠关节内注射配合口服盐酸氨基葡萄糖胶囊治疗;对照组105膝,采用透明质酸钠关节内注射治疗。结果患者膝关节疼痛均显著减轻,功能明显改善,其中治疗组优于对照组,差异有统计学意义（P〈0.01）。结论透明质酸钠关节内注射配合口服盐酸氨基葡萄糖胶囊治疗膝关节骨性关节炎是一种行之有效的方法。     

羌归膝舒丸治疗膝骨关节炎的临床疗效及对IL-1β和TNF-α的影响

目的:观察羌归膝舒丸治疗膝骨关节炎的临床疗效及对白细胞介素-1β(IL-1β)和肿瘤坏死因子-α(TNF-α)的影响。方法:选择符合纳入标准的膝骨关节炎患者48例(50膝),给予羌归膝舒丸口服,30 d为1个疗程,共治疗2个疗程,观察临床疗效和治疗前后患者膝关节WOMAC评分,对膝关节液中IL-1β、TNF-α的含量检测并进行分析。结果:治疗结束完成随访共45例(47膝),临床控制18膝,显效15膝,有效12膝,无效2膝,总有效率为95.74%;WOMAC评分及膝关节液中IL-1β、TNF-α含量均下降,差异有统计学意义(P0.05)。结论:羌归膝舒丸在一定程度上降低患者膝关节IL-1β和TNF-α含量,改善KOA患者WOMAC评分,取得了较好的临床疗效。     

人工全膝关节置换术治疗膝关节骨关节炎

目的评价人工膝关节置换术治疗膝关节骨关节炎的临床疗效,探讨人工膝关节置换术后并发症的原因。方法本组24例30膝膝关节骨关节炎患者进行人工全膝关节置换术,一期单膝置换18例,双膝同时置换6例,均采用后方稳定性假体。结果本组随访1～4年,平均2年。应用HSS膝关节评分系统进行分析,优24膝,良3膝,可2膝,差1膝,优良率90%。并发症：腓总神经损伤2例,人工膝关节脱位1例,有1膝差25°不能完全伸直。结论人工全膝关节置换术是治疗严重膝关节骨关节炎的有效方法,正确进行人工膝关节置换的手术操作是取得满意临床效果的保证。     

人工全膝关节置换术治疗膝关节伸直位强直畸形

目的探讨膝关节伸直位强直畸形患者行人工全膝关节置换术的手术要点和术后效果。方法1996年1月至2006年6月,对8例（9膝）膝关节伸直位强直畸形患者行人工全膝关节置换术。术前膝关节活动度均为0°,KSS膝关节评分平均为44分（10～68分）,功能评分平均为17分（-10～55分）。结果8例患者（9膝）围手术期出现的并发症包括髌腱止点撕脱1膝,髌骨下极部分撕脱骨折1膝,术后早期关节血肿1膝,皮肤浅表性感染1膝,经对症治疗后所有患者均治愈出院。术后平均随访40．4个月（7．0～120．0个月）,术后膝关节平均活动度89°（50°～120°）,术后KSS膝关节评分平均为81分（55～93分）,功能评分平均为79分（50～90分）。2例2膝分别存在5°和25°的伸展滞缺。1例1膝因为关节不稳于术后1年行翻修术,更换加厚的胫骨平台垫片。结论膝关节伸直位强直畸形患者行人工全膝关节置换术难度大,并发症发生率较高,但如能恰当处理,仍可以取得较满意的临床效果。术中膝关节的充分暴露,保留足够的髌骨床厚度,保护髌腱和膝关节的血液供应以及正确的软组织平衡技术是手术的关键。     

膝关节伸直位僵硬的人工关节置换治疗

目的 探讨膝关节伸直位僵硬的人工关节置换的手术方法及近期临床疗效.方法 对9例膝关节伸直位僵硬患者(12膝)行人工关节置换术,术中采用二次截骨加软组织松解的方法,分别记录手术前后膝关节HSS评分及关节活动度,并进行统计分析.结果 经过 12～56(36.2±9.61)个月的随访,膝关节HSS评分由术前13～45(28.6±7.12)分提高到术后56～89(65.45±6.25)分(P<0.01).关节活动度由术前0°提高到术后70°～110°(85.5°±10.18°)(P<0.01).结论 膝关节伸直位僵硬可以进行人工膝关节置换,手术效果满意.掌握熟练的手术技巧及正确术后康复至关重要.     

Arthrography in extension stiffness of the knee joint

In the present paper the authors point out in the importance of arthrography in the preoperative diagnosis of stiffness of the knee joint; their findings are based on a study of 29 cases. The majority of the roentgenograms show the knees of patients who subsequently underwent surgical arthrolysis. The technique and special features of the procedure are described. The evaluated contrast films may be classified in three groups, the first including joints with a residual mobility of up to 50 degrees, the second including those with between 50 and 90 degrees and the third those with more than 90 degrees. Typical for the first group is an obliteration of the upper recessus and an omega-shaped form in AP films. Films from Group 2 only show constrictions of the recessus suprapatellaris. In the third group only slight changes are found, which in some cases could only be assessed more accurately by comparison with the healthy side. In cases of knee-joint stiffness due to extra-articular causes there is no correlation between the arthrogram and the range of mobility. The authors conclude that X-rays of the interior of the joint using contrast medium can be a valuable help in planning surgical treatment for fibrotically stiffened knee joints.     

Analysis of a modified active knee extension test

When this study was conducted, the authors were pursuing Master of Science degrees in physical therapy, orthopaedic and sports medicine, at the MGH Institute of Health Professions, Boston, MA. Hamstring injuries occur and reoccur at high rates in the athletic population. The purpose of this study was to describe the effect of contralateral hip flexion on pelvic rotation in the sagittal plane and ipsilateral active knee extension during a modified active knee extension test. Twenty-seven normal subjects were tested, yielding 54 sets of data. Active knee extension was performed in five positions of contralateral hip flexion and was videotaped. Measurements of pelvic and knee joint angles were obtained from the film. The results indicated the least amount of pelvic rotation was 5.5 degrees , which occurred at maximum contralateral hip flexion. Analysis of variance revealed a difference between test positions that was statistically significant for pelvic rotation and knee extension (p < .05). Pelvic rotation can be effectively controlled during an active knee extension test by maximally flexing the contralateral hip. The active knee extension test can be used as an accurate assessment tool to evaluate hamstring muscle length. J Orthop Sports Phys Ther 1992;15(3):141-146.     

Effect of hand position on knee extension and knee flexion torques of intercollegiate rowers

The purpose of this study was to determine if hand position: 1) grasping the test table and 2) grasping the pelvic strap, combined with stabilization via pelvic and distal thigh straps, affected knee extension and flexion torques of intercollegiate athletes. Eighteen male rowers (sweep oarsmen) completed three reciprocal contraction cycles using a 160 degrees /sec knee extension, 0.25 sec pause, and 80 degrees /sec knee flexion protocol. This protocol simulated the knee movements during rowing at about 27 strokes per minute. The order of presenting the hand positions was randomly assigned and a dependent t-test was used to compare hand positions. No statistically significant difference (p > 0.05) was observed between the peak torques produced when grasping the test table and when grasping the pelvic strap, during either knee extension (203 +/- 29 Nm and 207 +/- 26 Nm, respectively) or knee flexion (145 +/- 15 Nm and 149 +/- 18 Nm, respectively). When the knee extensors and flexors of relatively strong individuals are tested in the sitting position and while using a pelvic strap to secure the pelvis to the test table, the subjects may be given the option of grasping either the test table or the pelvic strap without significantly affecting their subsequent knee extension or flexion torques. J Orthop Sports Phys Ther 1990;11(8):367-371.     

膝关节伸直受限的关节镜下治疗

目的 分析膝关节伸直受限的发病机制,探讨关节镜下诊治方法。方法分析2003年1月～10月在本院接受关节镜下手术303例患者的临床资料,通过关节镜确认引起膝伸直受限的直接病因,并根据关节镜下检查结果选择相应的手术方式。结果95例患者膝关节伸直受限,发生率为31．4％。创伤是最常见原因,占67．4％,主要为半月板和韧带损伤。另外,膝关节急、慢性关节内炎性病变也是较常见原因,按发生例数由高到低为：退变性骨关节炎、非特异性滑膜炎、滑膜软骨瘤病、类风湿关节炎、色素沉着绒毛结节性滑膜炎、痛风性关节炎及急性化脓性关节炎等。术后随访3～20个月,平均13．3个月,82例关节镜术后均可立即伸直,9例术后未立即伸直,经伸直锻炼后3周内均可伸直,4例随访1年以上不能完全伸直,4例复发。结论关节镜是诊断膝伸直受限的最佳手段,早期关节镜检查可获得满意疗效。     

Injuries of the extension apparatus of the knee joint

The article analyses problems of the diagnosis, the choice of the therapeutic tactics, and the results of operative treatment in 478 patients. Operation undertaken as early as possible after the injury is indicated in fresh fractures of the patella with displacement of the fragments, ruptures of the tendon of the quadriceps femoris muscle and the patellar ligament. The authors prefer stable fixation of patellar fractures by means of a "tightening" wire loop and a "blocking" wire loop in injuries of the patellar ligament. Additional external immobilization is not employed. Study of the late-term results of treatment confirm the expediency of wider introduction of these methods into traumatological practice.