膝骨关节炎患者本体感觉特征

目的 探讨行单髁膝关节置换术(unicondylar knee arthroplasty,UKA) 和全膝关节置换术(total knee arthroplasty,TKA)膝骨关节炎( knee osteoarthritis,KOA)患者术前膝关节本体感觉特征。方法 选取单间室KOA患者29名,15例接受 UKA 治疗（UKA组）,14例接受 TKA 治疗（TKA组）。术前1~3 d进行测试,对比UKA、TKA组KOA患者膝关节学会评分（knee society score, KSS）以及手术组与健康对照组的位置觉和运动觉特征。结果 UKA、TKA组之间KSS评分有显著差异,位置觉和运动觉无显著差异;UKA、TKA组患者术侧腿和未术侧腿之间位置觉和运动觉均无显著差异,对照组左、右腿位置觉和运动觉无显著差异;与对照组相比,UKA、TKA组在60°位置觉时术侧腿和未术侧腿均有显著差异,患者术侧腿和未术侧腿的运动觉也均有显著差异。结论 与健康对照组相比,KOA患者术前的膝关节本体感觉明显减退,但UKA、TKA组患者术前本体感觉特征相近。     

全膝关节置换术后早期步态与预后功能的相关性分析

目的探讨全膝关节置换(total knee arthroplasty, TKA)术后14 d步态参数与术后3个月膝关节功能和生活质量的相关性。方法采用三维步态系统分析18名患者TKA术后14 d患侧步行特征,运用WOMAC和SF-36评价量表评估患者TKA术后3个月的膝关节功能指数及生活质量并分析其相关性。结果 TKA术后14 d,术侧单支撑时间和摆动期膝关节屈角峰值均显著小于健侧,术侧站立中期膝关节屈角和膝外翻角均显著大于健侧;步行过程中,术侧的时空参数指标与WOMAC评分存在中度负相关,膝屈角峰值、站立中期膝屈角及外翻角与WOMAC评分存在高度相关性;除步长、步速外,其余步态参数指标均与SF-36生活质量评分具有显著相关性。其中,单支撑时间和膝关节屈角峰值具有高度正相关,站立中期膝屈角及外翻角具有中度负相关。结论术后早期(14 d)步态分析结果中术侧单支撑时间、站立中期膝关节屈角、膝外翻角及摆动期膝关节屈角峰值可以作为判断TKA手术预后膝关节功能及生活质量康复疗效的有效指标。     

髌骨软骨退变分级对保留髌骨型全膝关节置换术疗效的影响

目的探讨髌骨软骨退变分级对保留髌骨型全膝关节置换术疗效的影响。方法选择132例膝关节骨关节炎患者为研究对象,按照Outerbridge分级分为I、II、III、IV级(四组)。均行全膝关节置换术(TKA),比较患者间术前,术后膝前痛情况、KSS评分、髌骨评分情况。结果四组患者膝前痛程度较术前均减轻,四组患者间膝前痛情况比较差异无统计学意义(0.05)。四组患者术后KSS功能评分均较术前明显改善,四组患者间KSS功能评分比较差异无统计学意义(0.05)。四组患者髌骨功能评分均较术前明显改善,四组患者间髌骨功能评分比较差异无统计学意义(0.05)。结论不同髌骨软骨退变分级对保留髌骨型TKA患者膝前痛的发生及关节功能无明显影响。     

后稳定型与后交叉韧带保留型膝关节假体在人工膝关节置换术后的早期临床疗效比较分析

目的比较后稳定型膝关节假体(Posterior Stabilized Total Knee Prostheses PS)与后交叉韧带保留型膝关节假体(Posterior Cruciate-Retaining Total Knee Prostheses CR)在人工膝关节置换术(Total Knee Arthoplasty TKA)后的临床疗效,并分析两种假体在TKA术后可能存在的相关问题。方法回顾自2010年1月至2012年12月我院收治的晚期骨关节炎、并进行人工全膝关节置换术治疗的66位患者资料,其中PS假体30例,CR假体36例,观察两组患者手术时间、术后引流量,以及术后2周、1年、3年的下肢力线、膝关节活动度(Range Of Motion ROM)、膝关节最大屈曲角度、术后视觉模拟评分法((Visual Analogue Score VAS)、纽约特种外科医院膝关节功能评分(hospital for special surgery knee score HSS)评分、髋膝关节炎评分(The Western Ontario and Mc Master Universities,WOMAC,Osteoarthritis Index)。结果 PS组的术中手术时间、术后引流量明显大于CR组,差异具有统计学意义(P0.05),术后两周PS组膝关节ROM、膝关节最大屈曲角度明显大于CR组,差异具有统计学意义(P0.05),而在术后1年、3年的随访数据中均无明显差异。结论对于无严重畸形的初次膝关节置换,后稳定型膝关节假体与后交叉韧带保留型膝关节假体均具有重要的临床使用价值,可有效改善患者的膝关节功能,降低膝关节疼痛评分等。     

膝关节表面置换术治疗重度骨性关节炎的疗效观察

目的：观察全膝关节表面置换术(TKA)治疗膝关节骨性关节炎( KOA)的临床疗效。方法选择64例DOA患者,均行后稳定型人工全膝关节表面置换术(TKA)治疗,术后应用膝关节功能(HSS)评分系统判定疗效。结果术后对患者平均随访1年半,膝关节功能优良率为95.3%;HSS评分由(41±3.25)分升至(96±6.37)分,关节活动度由平均70o,提高至平均100o,均<0.05。结论 TKA治疗KOA疗效确切,严格手术指征、术中矫正畸形时保持膝关节内外侧间隙及周围软组织平衡是手术成功的关键。     

人工全膝关节置换术中髌股关节轨迹不良的处理策略及疗效

目的　总结人工全膝关节置换（total knee arthroplasty,TKA）术中,纠正髌股关节轨迹不良的方法及效果。 方法　2012年6月-2014 年12 月,对52例58膝TKA术中出现髌骨向外侧脱位倾向髌股关节轨迹不良的患者,针对发生原因,通过单纯调整髌骨内、外侧支持带张力,髌骨修整成形或调整胫骨假体位置等方法,或者联合应用上述两种或两种以上方法进行纠正。 结果 术中无拇指试验髌股关节轨迹恢复正常,术后髌骨未出现向外脱位倾向。术后切口均Ⅰ期愈合,2例因外翻明显,术中外侧支持带松解范围较大,术后出现关节积血,经对症处理后好转,无其他并发症发生。所有患者术后均获随访,随访时间 17-47个月,平均32个月。膝关节内、外翻畸形均获得矫正,4例残留 5-10°(平均8°）左右的屈曲畸形。随访末期KSS评分78-89分,平均84分,膝关节KSS功能评分为82-91分,平均86分。术后至随访期末X线片均显示人工关节位置正常,无松动及感染迹象。 结论 TKA术中出现髌股关节轨迹不良时,通过单纯调整髌骨内、外侧支持带张力,髌骨修整成形或调整胫骨假体等方法,或者联合应用上述两种或两种以上方法等进行调整,是处理髌股轨迹不良的有效方法,有利于术后膝关节的功能恢复。     

髌周去神经化预防全膝关节置换术后膝前疼痛

目的　依据髌周解剖学特点，探讨全膝关节置换术（total knee arthroplasty，TKA）中应用髌周电灼去神经化的临床效果。 方法　纳入82名诊断为骨性关节炎的患者（91膝），予行双侧或单侧不置换髌骨的TKA，按随机对照原则将病人分为两组，共有41名实验组患者（45膝）在TKA中接受了髌周去神经化处理，41名对照组患者（46膝）未做该处理。手术主刀为同一骨科医师，均使用相同的膝关节假体系统。主要评价项目包括膝关节KSS评分、Western Ontario and McMaster Universities（WOMAC）、Feller髌骨评分及VAS评分。 结果　82名患者术后均获随访，平均随访时间为12个月，两组病人的膝关节KSS评分、WOMAC、Feller髌骨评分及VAS评分均无显著统计学差异（P>0.05）。 结论　在TKA中行髌周电灼去神经化，不能显著改善病人的预后。     

焦点解决短程治疗对全膝关节置换术后患者焦虑抑郁的影响

目的:研究焦点解决短程治疗(SFBT)对全膝关节置换术(TKA)后患者焦虑抑郁的影响。方法:选取2016年2月-2017年8月在本院接受全膝关节置换术治疗的患者86例,将其随机分为研究组和对照组,各43例;对照组患者给予常规干预,研究组患者在常规干预的基础上给予焦点解决短程治疗,分别在术前(干预前)和术后3个月(干预后)观察两组患者焦虑抑郁情况、生活质量、膝关节功能及活动度。结果:两组患者干预前的焦虑自评量表(SAS)评分和抑郁自评量表(SDS)评分对比差异无统计学意义(P0.05),干预后研究组SAS评分和SDS评分显著低于对照组,差异有统计学意义(t=-13.995,-27.526;P0.001);两组患者干预前健康调查简表(SF-36)中生活功能、社会功能、生理职能、情感职能、身体疼痛、生命活力、总体健康、精神健康评分对比差异无统计学意义,干预后研究组的上述各项评分均显著高于对照组,差异有统计学意义(t=4.992,5.500,8.533,6.966,5.433,6.140,5.052,7.229;P0.001);两组干预前膝关节评分(KSS)、最大被动屈曲角度(PFL)和最大主动屈曲角度(AFL)对比差异无统计学意义,干预后研究组的KSS显著高于对照组,PFL和AFL显著大于对照组,差异均有统计学意义(t=2.736,4.134,3.153;P0.01)。结论:SFBT可显著减少TKA术后患者焦虑、抑郁情绪,提高其生活质量,并显著改善患者的膝关节功能及活动度,应用效果优于单独常规干预。     

3D打印截骨导板辅助下的TKA手术在河西走廊地区的临床应用

目的　比较3D打印截骨导板辅助全膝关节置换（total knee arthroplasty,TKA）与传统手术方式行TKA的临床效果差异,探讨应用3D打印个性化截骨技术在TKA中的临床应用价值。 方法　将2015年10月~2018年6月间行TKA的120例（136膝）患者,随机分成3D组和传统组,3D组60例（70膝）采用3D打印截骨导板辅助膝关节置换手术,传统组60例（66膝）采用传统的膝关节置换方法。术前两组患者年龄、性别、KSS（knee society score）评分,均无统计学差异（P>0.05）。记录手术时间,术中实际股骨远端、胫骨近端截骨量,术后X线片测量平均股骨、胫骨机械轴夹角（MFTA）,矢状位胫骨平台后倾角（STCA）,并进行统计学分析,末次随访时行KSS评分。 结果　术后随访9~32个月,两组病例均未出现关节感染,假体松动、移位、下沉等并发症。3D导板组术前规划的股骨远端、胫骨近端截骨量与手术实际无统计学差异（P>0.05）;3D导板组的手术时间、MFTA值、STCA值与传统组相比差异有统计学意义（P<0.05）;末次随访3D导板组KSS临床及功能评分均高于传统组,两组间差异有统计学意义（P<0.05）。 结论　3D打印个性化截骨技术简化了TKA手术步骤,可提高手术的精准度与临床疗效,值得进一步推广应用。     

外科治疗膝关节色素沉着绒毛结节性滑膜炎的有效性分析

目的探讨膝关节置换术及关节镜下滑膜切除术治疗膝关节色素沉着绒毛结节性滑膜炎的临床有效性。方法回顾性分析南京中医药大学无锡附属医院2008年6月~2015年8月手术治疗的有完整随访资料的膝关节色素沉着绒毛结节性滑膜炎(Pigmented villonodular synovitis,PVNS)患者25例。将患者分为膝关节置换(Total knee arthroplasty,TKA)组(9例)和关节镜下滑膜切除组(16例),术后平均随访40.5月(12~96个月)。对患者术前及末次随访的关节功能进行评分。TKA组采用美国膝关节协会AKS评分(American knee score,AKS),关节镜下滑膜切除组采用Lysholm评分。结果随访期间TKA组未有患者复发,关节镜下滑膜切除组有1例复发,复发率6.25%。TKA组AKS评分膝评分部分由术前的(42.2±3.9)分提高至末次随访的(79.6±2.5)分,功能评分由术前的(52.1±3.1)分提高至末次随访的(80.4±2.1)分。关节镜下滑膜切除组Lysholm评分由术前的(52.4±4.4)分提高至末次随访的(79.9±2.5)分。差异均有统计学意义(0.01)。结论两种手术方式对膝关节色素沉着绒毛结节性滑膜炎均有良好疗效。     

Functional characteristics of female patients based on ambulatory ability 1 year after total knee arthroplasty

BackgroundTotal knee arthroplasty (TKA) is commonly performed to reduce knee pain and improve physical function. Compared with the values for healthy, age-matched women, previous studies have reported large deficits in functional ability, such as muscle strength and ambulatory ability, in women 1 year post-TKA. Ambulatory ability is to move around, particularly by walking and is clinically assessed by the timed up and go test (TUG).AimThis study aimed to clarify the characteristics of knee functions in female patients whose ambulatory ability recovered to a normal level at 1 year after TKA.MethodsThis cross-sectional study included 151 female patients who underwent TKA. The muscle strength of the lower extremity was measured, and the 2011 Knee Society Scoring (2011 KSS) system was used postoperatively. The TUG was conducted to assess ambulatory ability after TKA; then the patients were classified into the fast and slow ambulation groups based on previously reported gait-speed values of healthy female individuals. Then, we identified significant indicators of ambulatory ability at 1 year after TKA.ResultsForty-nine percent of patients after TKA achieved the level of ambulatory ability of a healthy female. Logistic regression analysis identified that the non-operative side knee extensor strength and the functional activity score, as assessed by the 2011 KSS, were variables significantly associated with the mid-term ambulatory ability after TKA.ConclusionFemale patients with high non-operative knee extensor strength and a functional activity score at 1 year postoperatively can achieve better ambulatory ability than those of healthy, age-matched females.     

Evaluation of anteroposterior accelerometric change after bi-cruciate stabilized total knee arthroplasty and posterior stabilized total knee arthroplasty

BackgroundIn conventional total knee arthroplasty (TKA), the anterior cruciate ligament (ACL) is resected. ACL dysfunction causes knee instability and is regarded as one factor in poor TKA outcomes. In bi-cruciate stabilized (BCS) TKA, the implant reproduces ACL function and provides anterior stability. The objective of this study was to evaluate preoperative and postoperative X-rays and accelerometer gait measurements in patients who underwent BCS TKA and posterior-stabilized (PS) TKA to assess the postoperative acceleration changes of knees after these procedures and to compare them in terms of joint range of motion (ROM) and the New Knee Society Score (New KSS).MethodsThe subjects were 60 patients, 30 of whom underwent BCS TKA and 30 PS TKA. Joint ROM, New KSS, lateral X-rays of the standing extended knee, and accelerometer data were evaluated 12 months postoperatively.ResultsThere was no significant difference in joint ROM between the groups. Both had good New KSS results, but the functional activity score was significantly higher after BCS TKA than after PS TKA. X-rays showed a lower posterior offset ratio after BCS TKA than after PS TKA, with anteroposterior positioning closer to that of the normal knee.Accelerometer data showed that postoperative anteroposterior acceleration on the femoral side in the stance phase and swing phase was lower after BCS TKA than after PS TKA.ConclusionCompared with PS TKA, BCS TKA resulted in a higher functional activity score, closer positioning to that of the normal knee on lateral X-ray, and lower anteroposterior acceleration on the femoral side.     

Correlation between objective gait parameters and subjective score measurements before and after total knee arthroplasty

The absence of uniformity, the use of different terminologies, and the diversity of methods used to translate numerical data into clinical outcomes have been described as potential problems when dealing with clinical knee scores for total knee arthroplasty (TKA). Gait analysis is believed to provide more objective parameters. The aim of the present study was to obtain information about the correlation between the outcome in terms of locomotion and the clinical knee score after TKA. Thirty consecutive patients awaiting TKA were involved in the study. One day prior to surgery and 3 months postoperatively, data pertaining to the Hospital for Special Surgery Score (HSS) and the Knee Society Score (KSS) (subgroups 'pain', 'knee', 'function' and 'total sum') were analyzed for correlations with kinematic and temporospatial parameters of gait analysis. At a significance-level of p相似文献   

前稳定型垫片在全膝关节置换术中的早期临床研究

目的探讨全膝关节置换术(TKA)中应用前稳定型(AS)垫片的临床效果。方法 2018年1月至2018年12月选取北京大学人民医院收治的107例终末期骨性关节炎行全膝关节置换患者,术中采用邦美公司提供的后交叉韧带保留型(CR)Vanguard膝关节假体,其中使用AS垫片组45例,CR垫片组62例。统计全部患者的手术时间,术后伤口引流量,感染并发症,术前、术后膝关节活动度和膝关节协会评分,比较AS垫片组和CR垫片组之间的差异。结果全部病例均获得随访,随访时间为12~24个月,平均(20.3±2.8)个月。术前AS垫片组、CR垫片组膝关节活动度分别为平均90.2°±17.4°、92.7°±18.6°,术后末次随访时AS垫片组、CR垫片组分别为平均108.5°±22.3°、110.6°±19.3°。膝关节协会评分术前AS垫片组为临床评分(50±15)分、功能评分(52±21)分,CR垫片组为临床评分(49±13)分,功能评分(52±19)分;术后末次随访时AS垫片组临床评分(80±16)分、功能评分(82±20)分;CR垫片组临床评分(82±15)分、功能评分(83±22)分。上述各评价指标、手术时间、术后伤口引流量两组间差异均无统计学意义。所有病例均未出现感染并发症。结论 TKA术中应用AS垫片术后早期膝关节活动度、膝关节协会评分结果良好,与CR垫片相比较效果相当。     

初次全膝关节置换术中自体骨结构性植骨加带延长杆胫骨假体修复胫骨平台骨缺损

目的 探讨初次全膝关节置换术(TKA)中采用自体骨结构性植骨结合带延长杆的胫骨假体修复中、重度胫骨骨缺损的临床疗效。方法 回顾性分析2010年3月—2015年2月鄂东医疗集团黄石市中心医院骨科初次采用TKA治疗的15例中、重度内翻膝合并胫骨骨缺损患者的临床资料。其中男4 例,女11 例;年龄52～75 岁,平均58岁。膝关节内翻角17°～29°,平均(26.2°±2.4)。术前按美国膝关节协会评分(KSS)标准评定膝关节功能,临床评分(20.4±7.2)分,功能评分(21.3 ±8.5)分。胫骨平台内侧骨缺损按照Anderson骨科研究所骨缺损分型,Ⅱ型13 例,Ⅲ型2 例。均采用后交叉韧带替代型假体进行全膝关节置换,自体骨结构性植骨结合延长杆胫骨假体修复胫骨骨缺损。术后观察膝内翻角、骨愈合情况,植骨块是否移位,及假体松动、下沉等情况,末次随访时再次采用膝关节KSS评定膝关节功能。结果 15例患者均顺利完成手术,手术时间65～80 min,平均(72±6.3) min;术中出血20～55 mL,平均(43±8.5) mL。患者均获随访10~32 个月,平均(18.7±5.4)个月。末次随访时采用KSS评定膝关节功能:临床评分(92.2 ±5.0)分,功能评分(90.6±7.5)分,均明显高于术前评分,差异均有统计学意义(t_临床=42.138、t_功能=35.254, P值均<0.01)。术后X 线片显示:膝内翻角5°～9°,平均(7.6°±1.3),结构植骨块与平台骨组织一期愈合,植骨块无移位、骨吸收,无假体松动、下沉,无关节感染等情况发生。结论 对初次TKA患者,术中采用自体骨结构性植骨结合带延长杆的胫骨假体,修复胫骨平台中、重度骨缺损,可重建关节稳定性,早期临床疗效满意。     

Relationships between early postoperative gait biomechanical factors and patient-reported outcome measures 6 months after total knee arthroplasty

BackgroundThis study was focused on the gait parameters of the knee extensor and hip abductor muscle groups, which are believed to contribute to knee joint function improvement in early postoperative TKA. The associations between patient-reported outcome measures (PROMs) 6 months after total knee arthroplasty (TKA) and the early postoperative internal knee extension moment, knee extension negative joint power, and internal hip abduction moment while walking were investigated.MethodsTwenty-one patients who underwent primary TKA for knee osteoarthritis were included. Three weeks after TKA, gait at a comfortable speed was measured by three-dimensional motion analysis. The lower limb joint angle, internal joint moment, and joint power parameters on the operated side while standing were calculated. The PROMs 6 months after TKA were assessed using the Japanese Knee Osteoarthritis Measure (JKOM). The relationship between each gait biomechanical parameter and the JKOM was determined.ResultsThe maximum internal knee extension moment and maximum knee extension negative joint power during the early stance showed moderate negative correlations with the JKOM scores. The maximum internal hip abduction moment was not correlated with the JKOM scores. The maximum internal hip extension moment during the early stance and internal hip flexion moment during the late stance showed moderate negative correlations with the total JKOM scores.ConclusionThe early postoperative internal knee extension moment, maximum knee extension negative joint power, and internal hip extension and flexion moment are associated with patient PROMs 6 months after TKA.     

多针穿刺松解内侧副韧带在中度膝内翻畸形全膝关节置换术中的应用

目的 分析多针穿刺延长法松解内侧副韧带（MCL）对中度膝关节内翻畸形全膝关节置换术（TKA）中软组织平衡的有效性和安全性。方法 回顾性分析2013年1—6月上海交通大学附属第六医院骨科,TKA术中采用多针穿刺技术松解MCL以获得软组织平衡的中度内翻型膝关节骨性关节炎55例患者资料,其中男19例、女36例,年龄57～79岁。术后康复按照我科标准膝关节康复计划进行。术后3周复查拍摄下肢站立位全长片,术后3个月、6个月、1年拍摄患膝关节站立位正侧位片,并检查膝关节活动度,进行美国膝关节协会评分（KSS）临床评分和功能评分,做内外翻应力测试检查膝关节稳定性。平均随访时间14个月,采用配对t检验分析术前及术后膝关节力线、膝关节屈曲活动度、KSS临床评分及功能评分的差异。结果 根据术中松弛度测量标准,55例病例术中均获得了满意的内外侧软组织平衡,未出现内侧过度松弛的情况。术后利用膝关节站立位全长片测量膝关节力线显示,由术前的内翻13．5°±3．36°（9°-25°）纠正至术后的内翻0．8°±1．07°（内翻3．5°-外翻2．0°）;KSS临床评分从术前（39．9±7．84）分（20—65分）改善至末次随访的（94．0±7．27）分（65～100分）,KSS功能评分从术前（35．2±10．51）分（20～80分）改善至末次随访的（85．0±10．84）分（50～100分）;膝关节屈曲活动度从术前90．0°±9．87°（65°～110°）改善至末次随访的115．0°±10．08°（95°-135°）,差异均有统计学意义（P值均〈0．01）。随访中,除了2例仍存在5°屈曲挛缩外,其余53例膝关节均能完全伸直,未发现膝关节失稳病例,未发现感染、下肢深静脉血栓及其他并发症。结论 TKA术中采用多针穿刺松解技术,可以通过增加穿刺次数逐渐延长MCL,增加内侧间隙,从而获得满意的软组织平衡,