提高人工全膝关节置换术后屈曲度的临床研究

目的：探讨影响人工全膝关节置换术患者术后屈膝的因素，提高人工全膝关节置换术后的屈曲活动度。方法：自2005年3月-2010年3月，随访112例患者136膝行人工全膝关节置换术（totalkneearthropk—ty，TKA），男42例57膝，女70例79膝：年龄35～79岁，平均64．9岁。膝关节骨关节炎94膝，类风湿关节炎18膝。膝内翻畸形98膝（平均12．8±3．1），膝外翻畸形14膝（平均5．10±2．4），屈曲畸形3l膝（平均15．6±2．1）。膝关节骨关节炎患者术前活动度为61°-135°，平均110．5°；类风湿关节炎患者为41°～120°，平均85．5°。手术均采用Zimmer高屈曲度全膝关节假体。临床疗效以HSS评分为标准，根据影像学资料评估膝关节假体位置、下肢力线以及骨缺损修复情况。结果：112例患者136膝术后平均随访6个月。术前HSS平均（69．6±7．4）分，术后平均（90．9±6．7）分。优86膝，良18膝，可4膝，差4膝，优良率为92．6％。膝关节活动度由术前平均98．5°，改善至术中平均125．4°，终末随访时平均121．5°。结论：患者术前活动度、手术技术、特殊的假体设计以及积极的术后锻炼都是影响全膝关节置换术后屈曲度的重因素，尤其是手术技术。但既往有膝关节手术史、肥胖等患者，人工全膝关节置换术后的活动度都会受到一定的影响。

Clinical Research of Improving Flection Range after Total Knee Arthroplasty

Objective： To study the influencing factors of flection range after total knee arthroplasty. Meth- ods： 112 patients （136 knees） were performed total knee arthroplasty from March 2005 to March 2010, there were 42 male （57 knees） and 70 female （79 knees）, aged from 35 to 79 years （average 64.9 years）. 94 cases were diagnosed as osteoarthritis, 18 cases were rheumatoid arthritis, 98 cases were varus deformity （average 12.8±3.1）, 14 cases were valgus deformity （average 5.1±2.4） and 31 cases were flection deformity （average 15.6±2.1）. High-flex Zimmer prosthesis was used on all cases. HSS standard for evaluation was performed. Results： All patients were followed-up for 6 months, HSS score improved from average 69.6±7.4 to average 90.9±6.7. The range of motion improved from 98.5° to 125.4°. Conclusion： Preoperative range of motion, operation skill, special designed prosthesis and the postoperative rehabilitation were the influencing factors which can influence the flection range after total knee arthroplasty, especially the operation skill.