全膝关节置换股骨切迹发生因素分析及远期随访研究

[目的]分析全膝关节置换(total knee arthroplasty,TKA)股骨切迹发生的相关因素及其对术后功能康复和股骨髁上骨折的影响.[方法]2004年1月～2006年1月本组行初次TKA 417例(471膝),单膝置换363例,双膝置换54例;男186例,女231例.417例中骨性关节炎351例,类风湿性关节炎62例,创伤性关节炎14例.分析TKA术中股骨开髓点、股骨远端屈曲角度、髓内定位杆插入深度、股骨假体型号选择策略与股骨切迹的相关性,随访并记录KSS评分和股骨髁上骨折发生情况.[结果]417例中失访21例,深部感染4例,共392例(442膝)列入本研究.随访4～6年,股骨切迹发生率为8.7%(41/471).切迹组41例(41膝)末次随访未出现骨折病例,无切迹组351例(401膝)中2例(2膝)股骨髁上骨折,两组骨折发生率比较无显著性差异(x2检验,P＞0.05).股骨切迹组和无切迹组术后4年KSS评分无显著性差异(t检验,P＞0.05);切迹深度和KSS评分之间无明显相关性(P=0.761).[结论]TKA术中股骨切迹相关因素包括进针点失误、股骨假体旋转不良、股骨假体型号选择偏小以及股骨截骨模块后移等.股骨切迹对TKA术后远期功能康复及髁上骨折发生无明显影响.

Risk factor analysis of the femoral notch in total knee arthroplasty and long-term follow-up

[Objective]To evaluate the risk factors of femoral notch in total knee arthroplasty and long-term follow-up of postoperative functional rehabilitation and the impact of supracondylar fracture. [Methods]From January 2004 to January 2006,417 patients(471 knees) underwent total knee arthroplasty(TKA) in our hospital,including 351 patients of osteoarthritis,62 patients of rheumatoid arthritis,14 patients of traumatic arthritis.We analyzed the problems encountered in the surgery,including the femoral entry point...