Legion假体在膝外翻畸形初次全膝关节置换手术中应用疗效

目的探讨Legion假体在膝外翻畸形初次全膝关节置换手术中的临床应用疗效。方法回顾性分析沈阳军区总医院骨科2012年1月至2015年12月收治的膝外翻畸形患者32例(37膝)。记录患者术后髌股轨迹、切口愈合情况、膝外翻矫正角度、膝关节Harris评分(HSS)。结果所有患者术后均获得随访。32例患者膝关节髌股轨迹良好,切口愈合情况佳,无感染发生。34膝完全矫正了膝外翻畸形,仅余3膝存在3°~5°膝外翻遗留。患者HSS评分由术前34.5分提升至术后87.0分。结论在膝外翻畸形患者的初次膝关节置换手术中应用Legion假体可以达到满意的手术疗效,术后患者膝关节稳定,大部分患者的膝外翻畸形得到了纠正,患者在术后早期功能锻炼即可达到屈曲90°、伸直0°。     

人工膝关节置换术治疗膝关节重度骨性关节炎58例临床疗效

目的探讨人工膝关节置换术治疗膝关节重度骨性关节炎临床疗效。方法对58例重度膝骨性关节炎行人工膝关节置换术,观察患者术后HSS评分、膝关节屈曲挛缩度及关节活动度情况。结果对58例患者随访9~36(15±2)个月,2例膝切口局部脂肪液化,经换药愈合。其余患者均无切口及关节内感染或关节松动。疗效优49例,良5例,优良率为93.1%,膝关节HSS评分从术前(36.5±2.8)分增加到术后(90.6±6.3)分,关节活动度由术前(32.2±11.8)°增加到术后(98.5±13.6)°,膝关节屈曲挛缩度由术前(18.5±1.3)°降低到术后(0.4±0.1)°,差异有统计学意义(P<0.05)。结论人工膝关节置换术应用于严重骨性关节炎的治疗,能有效缓解疼痛,改善关节功能及生活质量。     

人工全膝关节置换术治疗胫骨平台骨折内固定术后创伤性关节炎回顾性研究

目的探讨胫骨平台骨折内固定术后创伤性骨关节炎的人工全膝关节置换术及其临床疗效。方法北京积水潭医院矫形骨科自2003年1月至2015年1月,收治12例(12膝)胫骨平台骨折术后创伤性关节炎患者。所有患者骨折后均曾行切开复位内固定术治疗。应用KSS评分和功能评分术前和术后随访评估。术前膝关节屈伸活动度(80.0°±34.9°)。膝关节学会KSS评分(62.7±11.1)分,功能评分(61.7±10.7)分。12例患者均行全膝关节置换术。9例患者选择后稳定型假体,2例患者选择限制性LCCK假体,1例患者选择旋转铰链膝关节假体。结果本组共12例患者,1例患者出现伤口并发症和浅表感染,1例患者术中内侧副韧带部分撕脱。术后随访1~13年(平均4.3年),无晚期并发症出现。末次随访时,KSS评分(80.5±10.4)分,功能评分(82.5±16.6)分,膝关节屈伸活动度(101.7°±16.0°),均较术前显著改善(P<0.05)。结论胫骨平台骨折内固定术后创伤性骨关节炎的人工全膝关节置换术可以显著改善患者的关节功能,但易出现感染及伤口并发症,具有较高的技术要求。     

旋转平台高屈曲型人工全膝关节置换术的临床应用

目的 探讨旋转平台高屈曲型人工全膝关节置换术(total knee replacements,TKR)的特点及临床效果.方法 对61例患者(78膝)行旋转平台高屈曲型(Sigma RP-F)人工TKR,其中17例为双侧膝关节置换.男13例15膝,女48例63膝;年龄45～79岁,平均64.3岁.术前诊断:膝骨关节炎56例,类风湿关节炎5例.采用正中切口髌旁内侧入路,所有膝关节都未进行髌骨置换,但对髌骨进行去神经化和修复术.结果 本组随访3～16个月,平均10.5个月.影像学显示无松动,无髌骨翘起、半脱位或脱位.临床评定采用美国膝关节学会(KSS)评分,术前平均膝评分48分(33～72分),膝功能评分41分(28～63分),术后随访膝评分97分(88～100分),膝功能评分96分(84～99分),膝关节活动度平均为(130.)(110.～150.),未发现假体旋出、不稳定或感染的患者.结论 旋转平台高屈曲人工全膝关节可提供足够的关节接触面积、全程的髌骨轨迹、足够的胫骨关节轴向旋转自由度,使膝关节可安全达到高屈曲的目的,近期随访疗效满意,但是否达到实验室分析的减少磨损、增加假体使用寿命的目的仍需进一步随访.     

膝关节置换矫正外翻畸形时个性化截骨与统一6°外翻截骨的中期疗效比较

目的探讨膝关节置换矫正外翻畸形时个性化截骨与统一6°外翻截骨中期疗效。方法将2008年1月至2014年1月在我科行膝关节置换矫正外翻畸形患者32例,随机分为观察组和对照组,各16例。观察组患者给予个性化截骨膝关节置换术;对照组给予统一6°外翻截骨膝关节置换术。根据X线片比较术前和术后膝外翻角度,应用HSS膝关节评分系统进行中期疗效评价。结果术后随访6个月,两组患者切口均一期愈合,无感染、无腓总神经麻痹发生。两组患者术后膝外翻角度、膝关节HSS评分、膝关节活动度较手术前明显好转,差异具有统计学意义(P<0.05)。观察组患者平均手术时间、下床活动时间、术后平均引流量明显低于对照组患者,差异有统计学意义(P<0.01)。结论个性化截骨技术保证每位患者都有适合自己的截骨模具,从而达到理想的手术效果。     

人工全膝关节置换术治疗膝关节骨关节炎36例疗效观察

目的：分析研究人工全膝关节置换术治疗膝关节骨关节炎的临床效果。方法：回顾性分析2009—03～2010—03期间本院行人工全膝关节置换术治疗的36例膝关节骨关节炎患者的临床资料。结果：所有患者均随访12～24个月,根据HSS膝关节评分系统进行疗效评价：优27膝（67．5％）,良10膝（25％）,一般3膝（7．5％）,无1例出现效果差的病例,优良率为92．5％;术前平均HSS评分为（44．5±5．7）分,术后平均HSS评分为（86．7±6．1）分,治疗后较治疗前明显提高,差异有统计学意义（P〈0．05）。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．可改善膝关节功能,近期疗效满意,但其远期疗效尚需进一步观察。     

拉网式松解技术在人工膝关节置换术治疗重度外翻膝中临床应用

目的探讨拉网式松解技术在人工膝关节置换术治疗外翻膝中的安全性及疗效。方法回顾性分析2014年10月至2015年5月北京积水潭医院矫形骨科采用人工膝关节置换术治疗的膝关节外翻畸形患者20例(23膝)的临床资料。所有患者均进行膝关节置换手术治疗,在术后1、3、6个月及1年进行随访,拍摄膝关节负重位X线影像、下肢全长X线影像,观察有无腓总神经损伤的症状,并进行美国膝关节协会(KSS)评分。结果本组20例患者,18例使用后稳定型假体,2例使用限制性假体。全部患者膝关节置换术中行外侧软组织的拉网式松解,松解深度≤5 mm。平均手术时间(79±12)min,平均出血量(150±30)ml,术中及术后无输异体血,术后伤口平均引流量(190±70)ml。术后第1天患者可以扶拐杖下地活动。术后和随访过程中均未发现腓总神经损伤的并发症。KSS评分从术前的(39±10)分提高至术后的(91±6)分,术前、术后KSS评分比较,差异有统计学意义(P<0.05)。结论拉网式松解技术是人工膝关节置换术治疗膝关节外翻畸形的有效方法,松解深度≤5 mm安全、有效,可以得到满意的软组织平衡。     

应用旋转平台人工全膝关节置换术的初步报告

目的探讨旋转平台人工全膝关节置换术的临床效果。方法对49例患者行70膝的Sigma旋转平台人工全膝关节置换术，其中21例为双侧膝关节置换。男7例，女42例；年龄38—78岁，平均63岁。术前诊断膝骨关节炎42例，类风湿关节炎7例。采用正中切口髌旁内侧入路、后稳定型假体，所有膝关节都未进行髌骨置换，但对髌骨进行去神经化和修复术。结果本组随访时间6—22个月，平均12．7个月，共70膝。影像学显示均无松动，无髌骨脱位。对膝关节临床评定采用美国膝关节学会评分（KSS评分），术前膝评分49分（35—70分），膝功能评分40分（30—60分），术后最后一次随访膝评分为96分（83—100分）；功能评分为95分（65—100分），没有旋转平台的旋出，没有翻修或者感染的发生。结论旋转平台人工全膝关节置换术在运动学分析和实验室磨损试验的数据上有潜在的优势，尤其是在年轻的活动能力强的患者，近期随访获得了满意的疗效，远期的疗效还需进一步随访。     

2011KSS评分对全膝关节置换术后的短期临床疗效评价

目的:探讨2011膝关节协会评分(Knee Socirty score,KSS)对全膝关节置换术后的短期临床疗效评价.方法:对在我院初次行全膝关节置换术的膝骨关节炎患者45人(57膝)术后平均随访2.3年(2-4年),根据术前及术后的2011KSS评分来评价全膝关节置换术的疗效.并探讨在不同民族间2011KSS评分有无差异.结果:所有评分(除患者期望值评分以外)术后较术前均有显著改善,而期望值评分术后明显低于术前.不同民族间术前BMI值、症状、满意度、期望值及总得分之间有差异,术前膝关节活动度、疼痛年限间无差异.结论:TKA是治疗中晚期膝骨关节炎的有效方法,期望值在评估TKA疗效时有重要作用.     

壤塘地区全膝关节置换术治疗大骨节病性膝骨关节炎的疗效分析

目的 探讨采用初次全膝关节置换术治疗壤塘地区膝关节大骨节病(KBD)患者的近期临床效果。方法 回顾性分析2017-01至2019-09四川省壤塘县人民医院骨科收治膝关节大骨节病患者88例，男32例，女56例，年龄34～67岁，平均(53.57±10.40)岁。Ⅰ期35例，Ⅱ期53例。全部膝关节大骨节病患者行人工全膝关节置换术，分别在术前，术后1、3、6、12、36个月，采用疼痛视觉模拟评分(VAS)评估膝关节疼痛严重程度、美国膝关节协会评分(KSS评分)、美国特种外科医院膝关节评分(HSS评分)系统评估膝关节功能，简明健康状况量表(SF-36)评分评估生活质量，测量膝关节活动度(ROM),治疗前和末次随访时拍摄双下肢负重全长X光片测量髋-膝-踝角及胫股角评估下肢力线情况。结果 随访36～54个月，平均随访(39.85±6.89)个月。VAS疼痛评分、HSS临床评分、KSS功能评分、SF-36评分、生理职能、躯体疼痛、活力、社会功能、情感职能、精神健康评分得到明显改善(P<0.05)。下肢力线髋膝踝角(HKA)、ROM得到改善(P<0.05)。结论 高原地区膝关节大骨节病Ⅰ期...     

胫骨高位截骨术失败后行全膝关节假体置换术的长期疗效观察

目的 针对胫骨高位截骨术(high tibial osteotomy,HTO)失败后行全膝人工关节置换术(total knee arthmplasty,TKA)进行长期疗效观察,分析其远期临床疗效及术中注意事项.方法 选择法国Medico-Chirurgical du Cedre中心1990年3月-1992年6月18例(19膝)HTO术后失败的患者并行TKA治疗.所有关节均有内外侧间室退变,4例伴有外侧胫骨平台中度骨缺损.采用X线测量和膝关节协会评分系统(Knee Society Scoring System,KSS)评估手术疗效,X线测量包括髋膝踝角(hip knee ankle,HKA)、α角、β角、髌骨指数、胫骨平台后倾角等.结果 TKA中11膝因HTO术后严重外翻和髌骨外侧半脱位而在TKA中行胫骨结节截骨及内移术;5膝因侧方软组织条件差或平衡不良而置入半限制型假体.随访时18例患者中2例死亡,获访16例(17膝).无失访和翻修病例.7膝在随访时出现严重聚乙烯衬垫磨损,但临床症状较轻.随访时KSS平均147.2分,优良率82%. 结论 HTO术后行TKA临床疗效优良.但由于外翻畸形和髌股关节并发症多见,可能需采用胫骨结节截骨术并内移术;HTO术后外翻畸形为TKA软组织平衡和胫骨截骨造成一定困难,术前应准备置入限制性更高的假体.     

Total knee arthroplasty without patellar resurfacing in active and overweight patients

Overweight patients are often considered poor candidates for total knee arthroplasty (TKA). A retrospective study of this was done on 47 osteoarthritic knees treated by TKA without patella resurfacing between March 1991 and June 1993. The Hospital for Special Surgery (HSS) rating system was used for clinical evaluation, and radiographs to study the degree of osteoarthritis and radiolucency. Correlations between overweight, range of motion (ROM) and stage of patellar damage and other measured variables (HSS score, patellar pain and radiolucency) were studied. Overweight was not correlated with HSS score, radiolucency or patellar pain. ROM was significantly correlated with patellar pain and HSS score, with better results in patients with ROM between 90° and 110°. Therefore, we believe that TKA in osteoarthritic knees can lead to successful results, even in active or overweight patients. Received: 19 November 1996 Accepted: 7 April 1997     

Total knee arthroplasty following failed high tibial osteotomy: mid-term comparison of posterior cruciate-retaining versus posterior stabilized prosthesis

This study evaluated the mid-term results of total knee arthroplasty (TKA) following high tibial osteotomy (HTO), comparing posterior cruciate-retaining prostheses to posterior stabilized prostheses. The Knee Society score for the entire group (20 knees) improved significantly from 62 (median) preoperatively to 87 at the latest follow-up. The postoperative Knee Society score of 85 in posterior cruciate-retaining prostheses (8 knees) was significantly inferior to the 94 score in posterior stabilized prostheses (12 knees). Of Knee Society score, Stability and ROM scores (17 and 21, respectively) in posterior cruciate-retaining TKA were inferior to those in posterior stabilized TKA (25 and 24, respectively). Since postoperative knee instability due to posterior cruciate ligament (PCL) insufficiency is thought to contribute to the inferior results of posterior cruciate-retaining prostheses after HTO, PCL-substituting TKA would be suitable for use after HTO.     

Preoperative flexion does not influence postoperative flexion after rotating-platform total knee arthroplasty

Purpose

Preoperative range of motion (ROM) has been regarded as one of the most important factors in predicting postoperative ROM following total knee arthroplasty (TKA). Mobile-bearing TKA designs have been suggested to possibly improve the knee kinematics compared to fixed-bearing designs. The purpose of this study was to examine the difference in postoperative flexion as a function of preoperative flexion in a consecutive series of TKAs done using a posterior-stabilized rotating-platform prosthesis.

Methods

ROM was assessed in 153 consecutive TKAs done using a rotating-platform posterior cruciate-substituting design. Patients were divided into two groups based on their preoperative ROM (Group 1 < 95°, Group 2 > 95°). The Knee Society Score (KSS) and ROM were assessed preoperatively, 3 months and 12 months postoperatively.

Results

There was no difference in flexion 12 months after surgery between groups (mean 120° and 123°, respectively. n.s.). After 3 month follow-up, no increase in ROM was experienced by either group. Patients in Group 1 experienced significantly greater increases in both ROM (p < 0.001) and KSS (p < 0.05). There was no difference in the KSS at 12 months after surgery between groups.

Conclusion

In this series of patients undergoing TKA with a rotating-platform prosthesis, the preoperative ROM was not predictive of the postoperative ROM. Patients with stiff knees preoperatively may benefit from a mobile-bearing design prosthesis.

Level of evidence

Case–control study, Level III.     

Early results of high-flex total knee arthroplasty: comparison study at 1 year after surgery

We compared clinical [including maximal flexion and range of motion (ROM)] and radiographical outcomes of high-flex versus conventional implants for total knee arthroplasty (TKA) after 1 year. We also analyzed the factors affecting postoperative ROM in high-flex implants. The high-flex group (n = 90) had an average maximal flexion of 129.8° (standard deviation (SD), 5.2°) significantly higher than the 124.3° (SD, 9.2°) of the conventional group (n = 90), especially for patients with less than 90° of knee flexion (P < 0.05). There was no significant difference in hospital for special surgery (HSS) score between the two groups. No knee developed osteolysis, aseptic loosening, or other complications. We found that, for high-flex implants, preoperative ROM had a significant effect on postoperative ROM.     

The anterior–posterior laxity after total knee arthroplasty inserted with a ligament tensor

Goal of this study is to determine the anterior–posterior laxity in 30° of knee flexion for a posterior cruciate retaining total knee arthroplasty with a relative dished insert and implanted with a ligament tensor. Furthermore, the correlation between these AP laxities and the postoperative range of motion (ROM) and postoperative Knee Society Score (KSS) is analysed. Fifty-one balanSys™ total knee arthroplasties were performed in 49 patients between 1998 and 2000. These arthroplasties are analysed with respect to AP laxity (Rolimeter), ROM and KSS with a mean follow-up of 4.6 years. The mean anterior laxity is 2.8 mm with no posterior laxities at all. The average postoperative ROM is 110° with an average KSS of 142. No correlations between AP-laxity and postoperative ROM or between AP-laxity and postoperative KSS are found. A posterior cruciate retaining TKA with a relative dished insert and implanted with a tensor is very stable in the anterior–posterior direction in 30° of knee flexion. This limited laxity does not seem to disadvantage the mean postoperative ROM and KSS, when compared to other TKA studies.     

三维CT重建应用于个体化全膝关节置换术的研究

目的探讨三维CT重建在个体化全膝关节置换术中应用的临床效果,研究两者的有机结合点,为进行标准化个体化全膝关节置换术提供依据。方法对2011年3月~2014年5月入组的72例中重度膝骨性关节炎病例行双下肢全长CT扫描并三维建模,获取关键角度和截骨数据,制定个体化截骨方案,获得最佳下肢力线和截骨参数,将术前所得数据付诸手术操作中,分别于术前和术后第2周获取下肢力线角与标准角度的偏差度数和美国特种外科医院膝关节评分(HSS)数据,计算优良率。结果术后患者的下肢力线接近理想力线,术前下肢力线角与标准角偏差度数为8.1482°±1.5957°,术后下肢力线角与标准角偏差度数为1.0627°±0.6401°,术前术后偏差度数采用配对资料t检验(t=13.6683,P=0.039),具有统计学意义;膝关节HSS评分较高,由术前的(49.6±6.1)分提高到术后2周的(88.2±4.1)分,术后与术前相比,有统计学意义(P=0.041);根据术后HSS评分进行评价,优58例,良10例,中3例,差1例,优良率为94.44%。结论术前三维重建膝关节,测量重要参数并制定术前规划,能够减少手术误差,提高手术精度,有助于正确重建下肢力线、准确定位截骨和植入假体,为实现全膝关节置换术的个体化和标准化提供临床依据。