1202个人工膝关节置换术的临床特点分析

目的通过对14年所行1202个人工膝关节置换术的分析,探讨我国行膝关节置换术患者的特点及不同的处理方法。方法1987年4月～2001年8月对833例1202膝行关节置换,其中单膝关节置换464例,双膝同期置换369例738膝。原发疾病为骨关节炎、类风湿性关节炎、强直性脊柱炎、色素绒毛结节性滑膜炎等。畸形包括内翻、外翻、屈膝挛缩、屈膝骨性强直、屈膝半脱位骨性强直及强直性脊柱炎、类风湿性关节炎患者的多发关节破坏。结果有些被文献认为是膝关节表面置换禁忌的严重畸形,术后关节功能和生活质量均有明显改善。通过手术技术的改进,高度屈膝畸形的术后并发症比早期起步阶段明显减少。结论我国人工膝关节置换术在病例的难度、传统观念、患者经济承受能力等方面比发达国家有更多的困难;假体选择必须尽早定型以便得到更好的临床效果;康复对临床疗效至关重要,应建立专职康复队伍;假体早日国产化,是推动我国人工膝关节置换发展的关键。

Analysis of the special clinical features of 1202 cases of total knee arthroplasty

Objective A retrospective analysis was conducted on 1 202 cases of total knee replacements (TKR) during the periord of 14 years, in order to study the special clinical features of the patients and their knee deformities, with the final purpose of finding the appropriate methods for the management. Methods From April 1987 to Augest 2001, 1202 cases of total knee arthroplasty were performed for 833 patients. There were 464 unilateral TKRs in 464 patients, and 738 bilateral TKRs in 369 patients. The diagnosis of the clincal conditions were osteoarthritis (include synovial chondromatosis and kaschin beck disease), rheumatoid arthritis, ankylosing spondylitis, also included were some rare rheumatic diseases of the knee such as pigmented villonodular synovitis, tuberculous arthritis, Charcot arthritis, hemophilic arthritis and psoriatic arthritis. Patients in this series also had several kinds of severe deformities such as genu varus with dislocation or medial plateau defect, genu valgus, flexion contracture of the knee, flexion deformity with joint fusion, flexion joint fusion with subluxation, and deformity in the low extremities involving multiple joints in patients with JRA. Results Some severe deformities were considered as contraindication of surfacing total knee replacement, however the life quality of patients had significant improvement after operations. Through the improvement of surgical skill, the complications following TKR in severe knee flexion deformity are less in number than that happened in the early days. Conclusion 1) TKR in China at the moment is facing more challenges and difficulties than that in the developed countries. 2)The proper types of prosthesis should be selected beforehand in order to get the good result. 3) Physical therapy is very important in the rehabilitation following TKR, so that the establishment of full time rehabilitation team is mandatory. 4)The key point for promoting TKR treatment for patients with various knee disease is to develop homemade prosthesis in China.