全膝关节表面置换术治疗膝骨性关节炎

目的分析人工全膝表面置换治疗膝骨性关节炎的临床效果。方法对21例29膝的膝骨性关节炎病例行人工膝关节置换术,单膝关节置换13例,双膝关节置换8例,全部采用后方稳定性假体。结果随访6~47个月,平均22.6个月,采用HSS评分系统进行分析,优15例,良5例,可1例。患者术后在疼痛、功能方面都有明显改善。结论全膝关节表面置换术对治疗严重膝骨性关节炎效果满意。术中精确的截骨操作、正确的软组织松解及术后指导康复是手术治疗成功的关键。     

全膝表面置换术治疗晚期痛风性膝关节炎临床疗效

[目的] 分析人工全膝表面置换治疗晚期痛风性膝关节炎的临床效果.[方法] 选择2001年3月～2007年7月青海大学附属医院骨科关节组收治的9例10膝晚期痛风性膝关节炎病例,均行全膝关节表面置换术,其中单膝关节置换8例,双膝关节置换1例,采用后方稳定型假体,随访资料完整.[结果] 所有患者均获得1年以上的随访.采用HSS评分系统进行分析,优6膝,良2膝,可2膝.对患者手术前和随访时HSS评分进行t检验有显著性差异(P＜0.05).患者术后在疼痛、功能方面都有明显改善.[结论] 伞膝关节表面置换术对治疗晚期痛风性膝关节炎效果满意.手术前后控制血尿酸、术中彻底清除尿酸盐结晶、精确的截骨操作、正确的软组织松解及术后指导康复是手术治疗成功的关键.     

后稳定型全膝关节假体置换术后疗效分析

目的　分析后稳定型全膝关节假体置换术的处理方式、手术经验及疗效。方法　对 14例15膝行关节置换 ,使用Apollo后稳定型假体 ,单膝关节置换 13例 ,双膝同期置换 1例。原发疾病为类风湿性关节炎 3例 4膝 ,骨关节炎 11例 11膝。术后随访时间平均 11个月。结果　 15个膝关节术前伸曲活动度平均 75°,全膝关节置换术后 2个月关节活动度恢复至平均 10 0°。 14例患者均可自如行走、上下楼梯 ,膝关节稳定性好。 1膝术后脂肪液化致表层伤口裂开 ,清创后愈合 ,余膝术后伤口均愈合良好。结论　后稳定型假体植入的全膝关节置换手术方式简单、疗效肯定、术后并发症少。     

痛风性膝关节炎的关节置换治疗

目的分析人工膝关节置换治疗痛风性膝关节炎的临床疗效。方法 2000年5月至2008年5月我科所收治的12例13膝患者,男11例12膝,女1例1膝;年龄56～70岁,平均63.5岁,均行膝关节置换术。假体为后稳定型表面置换假体,并有完整的随访资料。结果患者术后恢复良好,无深部感染,无血栓形成。全部病例得到随访,时间1～7年,平均3.6年。以VSA评定术前、后疼痛结果,疼痛明显减轻。HSS评分标准进行术前、术后评定结果,优8膝,良4膝,可1膝。结论膝关节置换治疗晚期痛风性膝关节炎效果满意。根据术前膝关节稳定性检查,术中各韧带受累情况,选择适合的假体,滑膜切除加清除尿酸盐结晶。持续控制血尿酸是该治疗方法取得好效果的关键。     

人工膝关节置换术后康复训练几点体会

近年来 ,随着人们生活水平的提高 ,晚期膝关节病变患者对于提高生活质量的要求越来越高。而人工膝关节置换术(TKA)的出现则可以很好的解决这一问题。作者于 1990年以来共收治 2 1例 ( 2 9膝 ) ,术后进行康复训练 ,取得满意疗效。1　临床资料本组 2 1例 ,男 13例 ,女 8例。年龄 2 3～ 78岁 ,平均 5 1 2岁。类风湿性关节炎 14例 ,骨性关节炎 7例 ;双侧置换 8例 ,单侧置换 13例。屈膝畸形 12～ 90° ,平均 3 5° ,活动度 0～ 90° ,平均 46°。股四头肌肌力Ⅱ级 18膝 ,Ⅲ级 11膝。全部病例均行人工全膝关节置换术。术后早期进行康复训练。结…     

人工膝关节表面置换治疗类风湿性关节炎屈膝畸形

目的探讨人工全膝关节置换术治疗类风湿性关节炎屈膝畸形的临床效果。方法选用后稳定型钴合金假体对21例类风湿性关节炎屈膝畸形患者进行人工全膝关节置换术,其中单侧膝关节置换5例,双侧膝关节置换16例,手术前后对患者的膝关节功能进行评分。结果随访1~5年,术前患者平均膝评分(22.84±6.06)分,平均功能评分(12.86±16.09)分;术后2周平均膝评分(70.16±2.71)分,平均功能评分(58.10±8.14)分;术后12周随访平均膝评分(86.14±3.12)分,平均功能评分(89.05±3.01)分。结论人工全膝关节置换术能显著纠正类风湿性关节炎屈膝畸形患者膝关节的畸形,解除疼痛,改善患膝的功能。     

全膝关节表面置换术的初步体会

目的探讨全膝关节表面置换术治疗膝骨性关节炎的近期疗效。方法采取全膝关节表面置换术治疗6例7膝骨性关节炎。结果6例均获随访，最短随访8个月，最长17个月。HSS评分从术前平均33分提高到术后92分，全部膝关节术后力线正常，其中6膝优，1膝良。结论全膝关节表面置换术是治疗晚期膝关节骨性关节炎理想方法。     

人工全膝关节置换术后深部感染的治疗

目的探讨人工全膝关节置换术后深部感染的治疗方法和临床效果。方法1994～2003年对9例人工全膝关节置换术后深部感染患者分别采用抗生素治疗;关节镜下清创、灌洗;切开清创、灌洗;清创后一期假体再置换;清创后二期假体再置换等不同治疗方法。对以上治疗方法采用自身前后对照的方法进行回顾性分析,HSS膝评分标准评估临床治疗效果。结果3例抗生素治疗,2例治愈,1例感染未控制,改行关节切开清创、灌洗治愈;2例关节镜下清创、灌洗治疗,1例治愈,1例感染未控制,改行关节切开清创、灌洗治愈;2例清创后一期假体再置换治愈;2例清创后二期假体再置换治愈。9例均获随访,平均随访51.2个月,均无感染复发。HSS膝评分由38分(21～52分)增加至74分(53～85分),膝关节平均活动度由45°(20°～108°)增加至80°(60°～105°)。结论每一种治疗方法都有其适应证和优缺点,应根据具体病情选择合理治疗方法。关节镜下清创损伤小,可最大程度恢复关节功能,但其彻底性不如切开清创,二期假体再置换临床治疗效果可靠。     

人工全膝置换在严重膝内翻畸形患者中的应用

目的观察保留后交叉韧带人工全膝置换治疗严重膝内翻畸形患者的临床结果.方法回顾性分析1990年1月～1995年7月间严重膝内翻畸形骨关节炎患者(≥20°)人工全膝置换后的临床结果.假体为Miller-Galante-Ⅰ人工全膝(MG-Ⅰ,Zimmer公司).采用KSS评分对临床结果进行评估.结果38人56膝获完整随访,平均随访6(4～9)年.术前至最后一次随访,平均膝评分从33分提高到91分,其中84%优秀;平均膝关节功能评分自39增加到76分;两者的改善均有统计学意义(P＜0.01).86%的患者膝关节活动度超过90°,多数病例(50/56)术后膝关节力线正常,6例残留5～10°内翻畸形.总翻修率21%(12/56),平均翻修时间为术后5.5年.其它并发症包括髌骨半脱位,膝前痛,浅表感染.无深部感染、假体松动及前后向不稳.结论保留后交叉韧带人工全膝可矫正严重膝内翻畸形,术后内、外向不稳问题常致假体早期失败.     

人工全膝关节置换术的临床应用

目的：探讨人工全膝关节置换在临床应用的疗效。方法：1999年5月～2003年4月共有28例患者02膝）在我院行人工全膝关节置换术,其中男性10例,女性18例,年龄最大72岁,最小32岁（平均56．7岁）,晚期骨性关节炎16膝,类风湿性关节炎12膝,骨肿瘤2膝,创伤性关节炎2膝。术前膝关节平均活动度为52度,HSS评分平均为41分。术后平均随访时间为1年4个月。结果：28例32膝中有1例术后发生浅表感染,经换药后好转。其余患者疗效满意,膝关节平均活动度改善为85度,HSS评分平均为79．5分。结论：对于严重的骨性关节炎、类风湿性关节炎晚期、创伤性关节炎、膝部肿瘤等保守治疗无效的疾病人工全膝关节置换是一种较好的选择,但应严格掌握手术适应证和熟练的手术操作技巧才能取得满意的疗效。     

The total condylar knee prosthesis. A report of two hundred and twenty cases.

The total condylar knee prosthesis is a non-hinged surface replacement which can be used for almost all knee deformities. This report discusses the first consecutive 220 arthroplasties in 183 patients. Follow-up time was three to five years. Before operation eighty-six knees had more than 10 degrees of fixed varus deformity and thirty-one knees had more than 10 degrees of fixed valgus deformity. All patients were assessed using The Hospital for Special Surgery scoring system. Of the total of 220 knees, 137 (62%) were rated excellent; sixty-one (28%), good; ten (4.5%), fair; and twelve (5.5%), poor. Of 139 osteoarthritic knees, 93% were rated excellent or good. Complications included three deep infections and four cases of posterior subluxation. The over-all reoperation rate was 3.6%.     

Total knee arthroplasty using a total condylar prosthesis

The authors studied the cases of 52 patients (56 knees) treated with a total knee prosthesis of the type "total condylar" and "total condylar with posterior stabilization" over a 3-year period. Gonarthrosis (41 cases) and rheumatoid arthritis (12 cases) were the major indications. The analysis of functional results proves the success concerning mobility, pain and ability to negotiate stairs after knee arthroplasty. The postoperative radiological results of 44 knees were reviewed and compared to the literature. Proof of the importance of the postoperative axis and the inclination of the tibial component is provided. Few complications were observed. Review of the literature confirms the good results of this type of total knee prosthesis.     

Revision total knee arthroplasty using the total condylar III prosthesis

Implant selection for the severely damaged knee being treated by revision is difficult. Fixed or rotating hinges have provided mixed results with a high frequency of complication. An alternative to a hinge implant is the total condylar III prosthesis, which can substitute for a deficient collateral ligament. Between August 1980 and April 1987 total condylar III prostheses were used for revision of failed total knee arthroplasties (TKA) of 21 knees in 19 patients. In the same time interval, 649 TKA revisions were performed for a frequency of 3.2% using this prosthesis. The indications for using this prosthesis were bone loss in 10 knees, instability in 9 knees, supracondylar femur fracture in 1 knee, and implant malposition in one knee. At a 4-year follow-up evaluation the knee scores were excellent in 25%, good in 25%, fair in 25%, and poor in 25%. Complications occurred in 33% of the knees. The total condylar III prosthesis provided results similar to other constrained implants used for revision in patients with severe bone loss and ligamentous instability.     

The total condylar knee prosthesis: the first 5 years

The total condylar knee prosthesis evolved from previous experience with other prostheses at the Hospital for Special Surgery. This evolution includes patellar resurfacing. Subsequent modifications have led to the total condylar knee prosthesis II (a cruciate substituting prosthesis), and the total condylar knee prosthesis III (a TCP II with increased constraint). The surgical technique requires ligamentous balance with correction of preoperative deformity by a soft-tissue release. Subsequently a standard operation is performed. Four hundred and sixty-one knees were reviewed with a minimum of one year follow-up and a maximum of 5 years. Seventy-five per cent were osteoarthritic knees. Using the Hospital for Special Surgery Knee Rating Scale, the results were excellent in 312 knees (68%), good in 109 knees (23.5%), fair in 18 knees (4%) and poor in 22 knees (4.5%). Osteoarthritic knees (excellent or good 93.5%) did slightly better than rheumatoid knees (excellent or good 87%). Complications include 6 infections, 6 subluxations and 10 cases of component loosening. There were 15 reoperations (3%). The results approach total hip arthroplasty in quality and so far have not deteriorated with time.     

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骨关节炎的临床疗效。[方法]本院自1994年10月～2003年10月采用人工全膝关节置换术治疗膝关节骨关节炎81例（95膝），男10例，女71例；平均年龄65．5岁（50—82岁）；左膝35例，右膝26例，双侧同时置换17例；保留后交叉韧带假体18膝，后方稳定性假体62膝，活动衬垫15膝。[结果]本组平均随访42个月（14—108个月），应用HSS膝关节评分系统进行分析，优：80膝（84．21％），良：10膝（10．53％），可：3膝（3．16％），差：2膝（2．10％）。优良率94．74％。[结论]作者认为人工全膝关节置换术能有效的缓解膝关节骨关节炎的疼痛，改善膝关节功能。正确的选择假体、精细的手术操作和严格的术后康复是保证手术效果的关键。     

国产TC-Dynamic假体全膝关节表面置换的近期疗效

目的评价应用国产后稳定型TC-Dynamic假体行人工膝关节表面置换的临床近期疗效。方法应用国产TCDynamic假体行全膝关节表面置换28例(31膝)。结果患者均获5～17个月随访,按1989年美国膝关节外科学会评分系统评分,膝关节评分平均为83分(术前平均为39分);功能评分平均为85分(术前平均为36分)。结论国产TCDynamic假体设计合理、操作便利、患者功能康复可靠,适宜推广。     

Knee arthroplasty in rheumatoid arthritis. Four- to six-year follow-up study

A consecutive series of total condylar knee arthroplasties in patients with rheumatoid or related arthritis, with a 4-6-year follow-up period, was studied. Eighty-seven percent had an excellent or good overall result (score of 70 or more on the HSS knee rating scale). The median total score increased from 45 points before operation to 83 after operation. Sixteen complications, mostly minor, occurred in 14 patients. There were no early infections. Two prostheses were removed for deep infection, after 3 and 5 years. One patient had patellectomy for avascular necrosis. The crude prosthesis survival rate was 97%. Tibial radiolucencies were noted in 76% of cases; in 29% they were significant (2 mm or more in one or more of three zones). Two tibial components (2%) were believed to be mechanically loose, but no revisions for mechanical loosening were done. The presence of radiolucencies did not signify an inferior clinical result.     

Total knee arthroplasty in neuropathic arthropathy

We describe the results of total knee arthroplasty (TKA) undertaken for severe, neurosyphilitic Charcot arthropathy in ten patients (19 knees). A cemented condylar, constrained prosthesis was implanted in all but two knees. The mean follow-up was 5.2 years (5 to 6). The mean knee score before operation was 36.5 points (30 to 42) which improved to 76 points (58 to 90) after operation as judged by the Hospital for Special Surgery score. At final follow-up three knees (16%) had aseptic loosening which required salvage by an arthrodesis, six (31%) were functioning poorly and ten (53%) were satisfactory. We conclude that although Charcot arthropathy is not an absolute contraindication to total knee replacement, there is a high incidence of serious complications.     

全膝关节置换治疗膝关节畸形

目的:探讨膝关节畸形的人工关节置换术。方法:自1997年1月～2002年10月,采用人工膝关节对36例48膝关节畸形进行了置换,32例42膝进行了随访,随访时间1～5年,平均随访时间2.6年。采用HSS(Hospital for Special Surgery)评分标准对手术疗效进行评价。结果:总优良率95.23％。结论:人工膝关节置换治疗膝关节畸形疗效肯定,远期疗效需进一步随访。     

Revision interventions in aseptic and infected loose knee endoprostheses

From 1984 to 1988 20 revisions for aseptic or septic loosening of knee prosthesis were performed. In 12 case there was an aseptic- and in 8 cases a septic loosening of the prosthesis. Most revision surgery for loosening of knee replacement needs reconstruction of bone stock. In loosening of unconstrained knee prostheses (uni-, totalcondylar knees) it was possible to insert a total condylar knee for revision surgery. Partially gross deviations had to be corrected, but in all cases a good alignment and ligamentous stability were effected. In septic loosening we had good experience with the two stage procedure. We temporarily implanted a gentamycine-PMMA-Spacer to avoid soft tissue contracture and to inhibit fusion of the cancellous bone. Arthodesis after knee replacement is difficult to manage, because the sclerotic bone of the site the prosthesis doesn't easily fuse.