老年固定性髌脱位骨关节炎髌骨旷置全膝置换

[目的]介绍老年固定性髌脱位骨关节炎髌骨旷置全膝置换（total knee arthroplasty, TKA）的手术技术及初步疗效。[方法]对4例（5膝）老年膝骨关节炎（knee osteoarthritis, KOA）伴固定性髌骨脱位患者,采用限制性假体行TKA。沿髌骨内侧切开关节囊,髌骨予以修整成形,去神经化,并做外侧支持带松解,判断髌骨仍无法复位,将髌骨旷置于外侧间沟,股骨和胫骨端截骨后,分别安装假体,缝合切口。[结果]所有患者均顺利完成手术,术中无并发症。随访时间平均（4.0±0.8）年,与术前相比,末次随访VAS评分[(7.0±0.9),(1.1±0.9), P<0.001]和HSS评分[(29.9±5.5),(79.2±3.6), P<0.001]均显著改善。末次随访时,伸膝肌力均为4级,患者均可正常行走,但卧位状态下仍有10°～25°的伸膝迟滞,所有患者未见假体松动。[结论]对于老年膝关节OA伴固定性髌骨脱位,若患者功能需求不高,TKA术中可采用髌骨旷置,疗效满意,可作为临床治疗的一种选择。     

全膝关节置换术治疗成人双侧先天性髌骨脱位伴膝骨关节炎1例报告

先天性髌骨脱位又称先天性髌骨外侧脱位,是一种罕见畸形,病因不明,有遗传倾向。早期临床症状及体征不明显,待3～5岁髌骨骺核出现后经X线检查方能发现。有关成人先天性髌骨脱位治疗的文献报道较少见。2010年,我们收治1例成人双侧先天性髌骨脱位伴膝骨     

机器人辅助全膝关节置换术治疗先天性双侧固定性髌骨脱位合并重度畸形1例报道

<正>髌骨脱位是临床上一种常见的膝关节损伤,占膝关节损伤的2%～3%,高发人群为青少年女性~[1]。髌骨脱位通常分为急性髌骨脱位、复发性髌骨脱位和固定性髌骨脱位,急性髌骨脱位通常是指髌骨在急性损伤时脱出了滑车沟,大多数在膝关节伸直时可自行复位,但在初次髌骨脱位发生后,再次脱位的概率为50%~[2]。固定性髌骨脱位是在整个膝关节屈伸中,     

机器人辅助全膝关节置换术治疗膝骨关节炎的临床研究

目的 通过前瞻性随机对照研究,探讨国产机器人辅助人工全膝关节置换术(robot-assisted total knee arthroplasty, RATKA)治疗膝骨关节炎的早期疗效。方法 以2021年8月至2022年1月拟接受初次单侧全膝关节置换术(total knee arthroplasty, TKA)的18例患者作为研究对象,根据随机数字表法分为传统TKA组和RATKA组,每组9例患者。传统TKA组男3例,女6例;平均年龄(70.00±10.63)岁。RATKA组男3例,女6例;平均年龄(68.22±6.12)岁。记录两组手术时间、术中出血量、术后住院天数、术后血红蛋白(hemoglobin, HB)及红细胞比容(hematocrit, HCT);采用活动度(range of motion, ROM)、膝关节学会评分系统(knee society score, KSS)评分以及西安大略和麦克马斯特大学(the Western Ontario and McMaster Universities, WOMAC)关节炎指数疼痛、僵硬、功能评分,评估膝关节功能及疼痛情况;拍摄双下肢全...     

全膝关节置换术联合胫骨结节截骨内移治疗膝关节炎合并髌骨完全脱位

目的 探讨全膝关节置换术(TKA)联合胫骨结节截骨内移治疗膝关节炎合并髌骨完全脱位的疗效.方法 采用TKA联合胫骨结节截骨内移治疗10例膝关节炎合并髌骨完全脱位患者.记录术后并发症、髌骨位置以及末次随访时临床疗效.结果 切口均一期愈合.患者均获得随访,时间1～4年.术后摄X线片复查显示假体位置良好,髌骨完全复位.随访期...     

全膝关节置换术在严重老年性膝骨关节炎中的应用

我院自2000年3月～2003年12月,对保守治疗无效的10例老年性膝关节骨关节炎患者采用保留后交叉韧带全膝关节置换术,疗效明显。一、临床资料1.一般资料:本组10例,其中男3例,女7例;年龄49～78岁,平均年龄65岁;右膝7例,左膝3例。所有病例均为严重骨关节炎,病程在5～25年之间,其中,内翻畸形7例,范围在15°～20°,伸屈范围在80°～90°之间。X光照片显示膝关节间隙变窄,边缘增生硬化,骨赘形成。本组假体均为非限制性膝关节假体,保留后交叉韧带。2.手术方法与术后处理:手术取膝前正中切口,经内侧髌旁入路,彻底切除髌上囊、滑膜、髌下脂肪垫及内外…     

全膝关节置换术治疗膝骨关节炎围手术期研究进展

膝骨关节炎的手术治疗方式有多种。全膝关节置换术作为晚期膝骨关节炎患者的治疗方法,虽然是公认的金标准,但是仍存在术后感染、假体松动、下沉、位置不良等风险。现就全膝关节置换术的术前、术中和术后阶段的研究进展进行综述,以指导临床上选择合适方法提高患者术后满意度。     

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。     

人工全膝关节置换治疗膝关节骨关节炎

目的探讨人工全膝关节置换术(TKA)治疗终末期膝关节骨关节炎的临床疗效。方法对行TKA治疗的181例终末期膝关节骨关节炎患者(226膝)分别于手术后40、120、180、360 d进行定期随访观察,对患者HSS膝关节功能评分及膝关节最大活动度进行比较。结果患者均获得随访,时间1~2年。膝关节功能HSS评分:优209膝(92.5%),良13膝(5.8%),可3膝(1.3%),差1膝(0.4%),优良率98.2%。术后各时间段的HSS评分及膝关节最大活动度均较术前显著提高,差异均有统计学意义(P0.05)。结论 TKA是治疗终末期膝关节骨关节炎的有效方法,正确的手术操作和合理的功能锻炼是取得满意临床效果决定性因素。     

全膝关节置换术髌骨置换与否的比较

目的回顾性分析、比较全膝关节置换术髌骨置换与否的疗效及优缺点,为临床治疗提供参考。方法自1994年1月～2000年12月间住院治疗的骨关节炎及类风湿性关节炎患者86例(109膝)。对髌骨置换和未置换的两组患者进行随访,膝关节评分采用美国HSS评分系统,髌骨评分采用Feller等的髌骨评分标准。随访时拍摄膝关节正、侧位及髌骨30°、90°轴位X线片。结果使用SPSS统计软件进行统计学分析。结果置换组与未置换组术后疗效及并发症的发生率无明显差异,髌骨功能评分差异有非常显著性意义(P<0.01)。置换组部分功能(上下楼梯及从椅子上坐起)略好于未置换组,未置换组术后膝前痛的发生率高于置换组,但多为轻度,差异有显著性意义(P<0.05)。术后髌骨不稳定和半脱位的发生率无统计学差异。结论髌骨不稳定的发生与术前畸形明显及术前髌骨外侧偏移倾向有关,是造成未置换组膝前痛的因素之一。未置换组髌骨不稳定与髌骨分型有关,建议如果术前拍摄髌骨轴位X线片时发现髌骨属于Ⅲ型者应置换髌骨。     

Revision surgery for patellar dislocation after primary total knee arthroplasty

This study evaluated risk factors for patellar dislocation after primary total knee arthroplasty and determined functional outcomes in patients following revision. Thirty-nine knees in 39 patients averaging 68 years (range, 27-91 years) at the time of revision were evaluated at a mean of 3.2 years (range, 2-7 years). Mean Knee Society and Function scores significantly improved from 34 and 35 to 77 and 54, respectively. Patellar dislocation most commonly resulted from errors in technique such as soft-tissue imbalance and malaligned components that led to poor tracking of the patella. Patellar tracking only improved after soft-tissue realignment in combination with revision of malaligned or loose components. Although revision significantly improved active knee extension and Knee Scores, two thirds of the patients had residual disabilities and pain.     

Gradual low riding of the patella during postoperative course after total knee arthroplasty in osteoarthritis and rheumatoid arthritis

Patellar height in the lateral view of radiograms was measured on 94 knees of 61 women before and after total knee arthroplasty in order to study postoperative changes of position. The mean age of patients at surgery was 58.4 years (range, 30-77 years). Eighty-one knees were rheumatoid and 13 osteoarthritic. Inserted prostheses were Kinematic anteriorly joined type in 49 knees, Kinematic posterior cruciate retention type in 19, and UCI type in 26. The observation period ranged from 6 months to 9 years, with an average of 2.6 years after surgery. The ratio of length of the patellar ligament to that of the patella (Insall-Salvati's ratio) decreased by more than 10% of preoperative value in 61 knees, remained unchanged in 31, and increased in only 2. The average ratio was 0.93 +/- 0.16 before surgery and 0.75 +/- 0.20 at the final follow-up examination (P less than .01).     

Osteoarthritis with permanent dislocation of the patella treated by total knee arthroplasty through a lateral approach: A report of two cases

IntroductionPermanent dislocation of the patella (PDP) is a rare condition. In cases of PDP with tibiofemoral arthritis, total knee arthroplasty may be performed through a medial parapatellar approach with patellar realignment. In this article we present two cases of PDP with tibiofemoral osteoarthritis successfully treated via lateral approach TKA without any additional realignment procedure. We performed two total knee arthroplasties for PDP with lateral tibiofemoral arthritis through a lateral approach without any realignment procedure. Mobile bearing inserts were used to adjust rotational alignment. The patients showed improved functional outcomes (Japanese Orthopaedic Association Knee score and Oxford Knee Score), and improved range of motion. Three years postoperatively, the patellae remain stable without dislocation nor maltracking, maintaining a high functional score.ConclusionTo treat permanent dislocation of the patella with lateral knee osteoarthritis, TKA through a lateral approach have potential to be a new treatment option to achieve both a good outcome and repositioning of the patella.     

Acquired permanent dislocation of the patella in a patient with rheumatoid genu valgum

A case of acquired permanent dislocation of the patella associated with severe genu valgum in a patient with rheumatoid arthritis (RA) is herein reported. The pain and genu valgum progressed because of poor RA control. The patient had no history of major trauma of the knee before or after the onset of RA. The most reasonable hypothesis to explain this patient''s pathology is that occult patellar dislocation developed after a minor trauma and progressed to permanent dislocation; poor RA control then worsened both the patellar dislocation and genu valgum. Total knee arthroplasty (TKA) with patella reduction was successfully performed with release of the lateral retinaculum and extension of the extensor mechanism by partial snipping of the rectus femoris tendon. Two years after the operation, the patient exhibited improvement in her Knee Society Knee and Function Scores from preoperative scores of 18 and 20 to postoperative scores of 94 and 80, respectively. Acquired permanent dislocation of the patella associated with severe genu valgum in patients with RA is rare. Excellent results were obtained with TKA, and the proximal realignment method was a useful procedure for patella reduction.     

Recurrent total knee arthroplasty dislocation after dorsal meningioma diagnosed

We report on a 68-year-old woman with gonarthrosis who underwent total knee arthroplasty. Having initially achieved a satisfactory result, she developed at 5 months postoperation an irreducible flexion contracture necessitating revision surgery; but no pathological findings were discovered. In the immediate postoperative period, the patient developed a severe spasm of the hamstring muscles and a paralysis of the external popliteal sciatic nerve with a posterior dislocation of the knee. After reduction, an electromyography study showed an alteration in medullary sensitive conduction; and the magnetic resonance image showed a lesion compatible with meningioma. This complication has not been previously described as a consequence of spinal tumor. Technical considerations are described for this rare complication, which remains a serious challenge for the orthopedic surgeon.     

Oxford单髁置换治疗膝内侧间室骨性关节炎

目的探讨Oxford单髁置换(UKA)治疗膝内侧间室骨关节炎的临床疗效。方法采用Oxford UKA治疗25例膝内侧间室骨关节炎患者(26膝)。采用膝关节功能HSS评分评价疗效。结果 25例患者均获随访,时间8~16个月。术后患膝关节疼痛均明显缓解,关节活动度改善,生活质量提高。术后2周、3个月、6个月膝关节功能HSS评分、膝关节活动度均较术前增加,差异均有统计学意义(P0.01),术后2周、3个月、6个月膝关节屈曲挛缩度数均较术前减少,差异均有统计学意义(P0.01)。结论 Oxford UKA治疗膝内侧间室骨关节炎,具有术后功能恢复良好、并发症少等优点。     

小切口单髁置换术治疗膝关节内侧间室骨关节炎94膝的中短期疗效研究

[目的]探讨小切口单髁置换术治疗膝关节内侧间室骨性关节炎的中短期疗效与手术技术。[方法]回顾性分析本院2003年1月～2010年6月收治的87例(94膝)经小切口单髁置换术治疗的膝关节内侧间室骨性关节炎患者的资料。对患者膝关节疼痛VAS评分、关节活动度、膝关节HSS评分、关节力线等进行评估分析,分析单髁关节置换临床效果、遇到的问题及应对方法。[结果]术后平均随访3.4年(6个月～7年),返修2例,无感染、深静脉血栓、假体脱位等,HSS评分由术前61.05分增至92.67分,优良率达92%。VAS评分由术前6.46分降至2.80分。术后疼痛缓解率94%。膝屈曲度平均达127.53°。术后力线平均内翻2°。[结论]小切口单髁置换术治疗膝关节内侧间室骨性关节炎中短期疗效满意,具有创伤小、恢复快、症状改善明显、术后功能良好等特点。     

人工单髁置换治疗膝单间室严重骨关节炎

目的 观察人工单髁置换(UKA)治疗膝关节单间室严重骨关节炎的疗效.方法 对52例(60膝)骨性关节炎患者行UKA.术前关节镜检查,采用微创小切口技术和Sled、M-G假体.结果 8例(8膝)因关节镜下髌骨关节面软骨损伤严重,改行关节镜清理或全膝置换术.44例(52膝)获随访1～6年.Bristol评分较术前均有升高,术前为21.93分,术后1个月达36.98分,6个月达48.12分.40例(46膝)患者术后1年胫骨假体周围出现约2 mm透光带,此后未再进一步发展,患膝无症状.结论 人工单髁置换治疗膝单间室严重骨关节炎是一种行之有效的方法,较全膝置换费用降低,创伤小,恢复快,功能好.