伸直位骨性强直膝的全膝关节置换术

 目的 探讨伸直位骨性强直膝全膝关节置换术的手术方法与临床疗效。方法 2000 年6月至2007 年6 月, 对10 例伸直位骨性强直膝患者施行全膝关节置换术。男4 例, 女6 例;年龄29~63岁, 平均49 岁。双膝关节置换2 例, 单膝关节置换8 例。强直性脊柱炎3 例, 类风湿关节炎2 例, 血友病性关节炎1 例, 创伤性关节炎3 例, 化脓性关节炎1 例。膝关节均处于伸直位骨性强直畸形, 活动度0°, 美国特种外科医院(the Hospital for Special Surgery, HSS)膝关节评分(32.5±10.26)分。结果 全部病例随访3~10 年, 平均5.3 年。末次随访时HSS 膝关节评分提高至(87.75±6.45)分, 与术前比较差异有统计学意义(t=18.668, P=0.000)。关节活动度提高至97.08°±11.57°, 与术前比较差异有统计学意义(t=29.063, P=0.000)。术后发生皮肤坏死2 例、下肢深静脉栓塞1 例、假体周围骨折1 例、假体深部感染翻修1 例。术后X线复查未见假体松动。结论 采用髌旁内侧入路、股四头肌切开、二次截骨加软组织松解的全膝关节置换术可矫正伸直位骨性强直膝关节畸形, 配合正确的康复锻炼, 患者的膝关节功能和生活质量能得到明显提高。

Total knee arthroplasty in the treatment of knees with bony ankylosis in extension

Objective To explore the clinical Results of total knee arthroplasty (TKA) in the treatment of knees with bony ankylosis in extension. Methods From June 2000 to June 2007, 10 patients had knees with bony ankylosis in extension were treated with TKA, including 4 males and 6 females, with an average age of 49 years (range, 29 to 63 years). The primary diseases were as follows: ankylosing spondylitis in 3 cases, rheumatoid arthritis in 2 cases, hemophilic arthritis in 1 case, traumatic arthritis in 3 cases and pyogenic arthritis in 1 case. The range of motion (ROM) was 0° in all knees, and the average HSS (the Hospital for Special Surgery) score before operation was 32.5±10.26. Two patients underwent bilateral TKA, and 8 underwent unilateral TKA. Results All patients were followed up for 3 to 10 years (average, 5.3 years). The average HSS score was improved to 87.75±6.45 at the last follow-up, and there was significant difference compared with that before operation (t=18.668, P=0.000). The average ROM was improved to 97.08°±11.57° at the last follow-up, and there was remarkable difference compared with that before operation (t=29.063, P= 0.000). The postoperative complications included cutaneous necrosis in 2 cases, deep venous thrombosis of lower limb in 1 case, periprosthetic fracture in 1 case, and deep prosthetic infection in 1 case who underwent revised TKA later. The postopertative X-ray showed no looseness of the prostheses. Conclusion TKA through medial parapatellar approach, with dissection of the rectus femoris, secondary osteotomy and soft tissue balance intraoperatively is effective in the treatment of knees with bony ankylosis in extension, which can correct the ankylosed knee deformitis successfully. Combining with the correct rehabilitation exercise, it is possible to improve significantly the function of knee and life quality in these patients.