Sagittal laxity in vivo after total knee arthroplasty

Introduction A stress arthrometry study of 77 knees undergoing total knee arthroplasty was performed to determine the difference in anteroposterior (AP) laxity between posterior cruciate ligament (PCL)-retaining (PCLR) and PCL-substituting (PCLS) prostheses using the Genesis I TKA.Materials and methods Fifty-three knees had PCLR and 24 had PCLS prostheses. The selected patients had successful arthroplasties after a minimum follow-up of 5 years. AP laxity was measured with a KT-2000 arthrometer (Medmetric, San Diego, CA, USA) using standard protocols.Results At 30° of flexion, there was no statistical difference in anterior (PCLR: 4.7 mm, PCLS: 4.5 mm), posterior (PCLR: 1.1 mm, PCLS: 0.7 mm), or total (PCLR: 5.8 mm, PCLS: 5.3 mm) displacement. At 75°, significant differences were seen in both anterior (PCLR: 3.3 mm, PCLS: 2.3 mm) and total (PCLR: 4.8 mm, PCLS: 3.4 mm) displacement (p=0.001 and p=0.009, respectively), although there was no statistical difference in posterior displacement (PCLR: 1.5 mm, PCLS: 1.1 mm).Conclusion The above values are considered the suitable degree of AP laxity in total knee arthroplasty for a satisfactory clinical outcome 5–9 years after surgery. The PCL in a PCLR prosthesis and the central tibial spine and femoral cam in a PCLS prosthesis might play comparable roles in determining the laxity in the posterior direction in these prostheses.     

Coronal laxity in extension in vivo after total knee arthroplasty

We performed stress arthrometric studies on 77 knees (71 patients) with total knee arthroplasty to determine the presence and magnitude of femoral abduction and adduction in knee extension. A total of 53 knees (49 patients) had posterior cruciate ligament-retaining (PCLR) prostheses, and 24 (22 patients) had PCL-substituting (PCLS) prostheses. The selected patients had successful arthroplasties with no clinical complications a minimum of 5 years after primary surgery. Each patient was subjected to a successive abduction and adduction stress test at 0°–20° of flexion using a Telos arthrometer. The mean values for abduction and adduction were 4.8° and 4.5° with a PCLR prosthesis, respectively, and 4.6° and 4.0° with a PCLS prosthesis. There were no statistical differences between PCLR and PCLS knees. The results suggest that approximately 4° of laxity in these directions is suitable in total knee arthroplasty for a satisfactory clinical outcome 5–9 years after surgery.     

Effect of soft tissue tension on measurements of coronal laxity in mobile-bearing total knee arthroplasty

Background The purpose of this study was to determine the effect of intraoperative coronal laxity in total knee arthroplasty on the postoperative condition. Methods We conducted stress arthrometric studies using a Telos arthrometer on 40 knees in 36 patients. Both posterior cruciate ligament-retaining (PCLR) prostheses and posterior cruciate-sacrificing (PCLS) prostheses were placed in 20 knees respectively. All of the TKA procedures were judged clinically successful (Hospital for Special Surgery scores: PCLR 92 ± 3 points, PCLS 91 ± 4 points). Laxities were measured under spinal anesthesia (immediately postoperatively) and 6 months postoperatively. Results PCLR prostheses had an average of 2.9° ± 1.8° and 3.0° ± 1.2° in abduction and 4.4° ± 2.8° and 3.6° ± 1.5° in adduction under anesthesia and the postoperative condition. PCLS prostheses had average laxities of 3.8° ± 1.4° and 3.5° ± 0.9° in abduction and 4.6° ± 3.8° and 4.0° ± 1.7° in adduction. There were no significant differences between them. Conclusions The findings suggest that surgeons should emphasize the achievement of suitable laxity under anesthesia to ensure the success of total knee arthroplasty.     

Range of motion of standard and high-flexion cruciate retaining total knee prostheses

Recently, use of high-flexion design was introduced in cruciate-retaining (CR) total knee prostheses. The purpose of this study was to prospectively compare the ranges of motion (ROMs) of 89 knees with standard and 87 knees with high-flexion CR total knee prostheses. Differences in age, gender, diagnosis, preoperative ROM of the knee, and Knee Society Score between the 2 groups were not statistically significant. At 12-month follow-up, average ROM was 112.0 degrees +/- 12.6 degrees for standard, and 115.3 degrees +/- 13.4 degrees for high-flexion CR prosthesis (P = .101). To our knowledge, this is the first report on the ROM with the high-flexion CR total knee prosthesis. Using the technique of anterior referencing for femoral component sizing and using a fixed 7 degrees slope for the tibial component, we found no significant differences between groups with regard to ROM, clinical, or radiographic parameters.     

Factors influencing segmental range of motion after lumbar total disc replacement using the ProDisc II prosthesis

OBJECT: The purpose of this prospective controlled study was to evaluate possible factors that could affect postoperative segmental range of motion (ROM) after lumbar total disc replacement (TDR) using the ProDisc II prosthesis. METHODS: Thirty-two consecutive patients with intractable discogenic pain underwent lumbar TDR using the ProDisc II prosthesis, 30 of whom were followed up for at least 24 months. Segmental ROM was assessed preoperatively and every 6 months postoperatively using dynamic x-ray films. Segmental ROM at the reference level was assessed in relation to patient age, sex, body mass index (BMI), levels with implants, preoperative ROM, prosthesis size, and prosthesis position. RESULTS: At the last follow-up visit, mean ROM of the disc prostheses was significantly increased from 4.23 +/- 3.12 degrees to 6.81 +/- 3.76 degrees at L3-4, and from 3.66 +/- 2.47 degrees to 6.09 +/- 2.11 degrees at L4-5. Mean ROM at L5-S1, however, was decreased from 3.12 +/- 1.56 degrees to 2.86 +/- 1.26 degrees (p > 0.05). This difference in the changes in postoperative ROM between L5-S1 and the other operated levels was the only statistically significant factor (p = 0.025) among the variables related to the postoperative ROM that the authors assessed, but other factors such as patient age, sex, BMI, disc height, and the size and position of the prosthesis were not related to segmental ROM. CONCLUSIONS: The data demonstrate that after TDR using the ProDisc II prosthesis, ROM of the prosthesis at L5-S1 is significantly lower compared with ROM at the other levels. In preserving ROM, the advantage of lumbar TDR using the ProDisc II might be minimal at L5-S1. Among the variables related to postoperative ROM, the level at which the ProDisc II prosthesis was implanted was the only one found to be statistically significant.     

人工腰椎间盘置换术后异位骨化的危险因素及其对策

目的总结引起人工腰椎间盘置换术后异位骨化的危险因素并探讨预防对策。方法随访1998年4月至2003年12月使用SB CharitéⅢ假体进行的人工腰椎间盘置换术患者共65例78个间隙,收集其所有X线片。由独立的2名放射科医师和1名骨科医师,根据M cA fee的评价系统,对术后X线片显示的异位骨化进行分级,测量该节段的活动度,记录各级异位骨化的发生时间并分析其可能的潜在危险因素。结果共有9例患者的10个椎间隙发生了不同程度的异位骨化。Ⅰ级异位骨化(7例)发生于术后平均2.1年,手术节段活动度正常,其中3例于此后2.5年内发展为Ⅱ~Ⅲ级,平均活动度为10°。2例术前已有纤维环钙化的患者,术后2年即发现Ⅲ级异位骨化,平均活动度为9°,但在术后6年发展为Ⅳ级,活动度为0°和4°。9例异位骨化病例中,共有8例发现可能诱发异位骨化的危险因素共11例次,其中术前纤维环钙化2例次,终板损伤5例次,假体下沉2例次,假体植入位置严重偏斜2例次。结论人工腰椎间盘置换术后异位骨化的危险因素有:术前纤维环钙化、术中终板损伤、假体植入位置严重偏斜及术后假体下沉,但大部分椎间隙的活动仍然得到保持。严格掌握手术适应证,预防上述危险因素的发生,可有效减少术后异位骨化的形成。     

Posterior Cruciate Ligament Retention or Substitution During Total Knee Arthroplasty Does Not Affect Long-Term Bone Mineral Density or Quality

Background

Physical activity is recognized as one of the factors that influence bone mineral density (BMD) and bone quality after total knee arthroplasty (TKA). According to biomechanical analyses after posterior cruciate ligament (PCL) retaining (PCLR) and substituting (PCLS) TKA, each implant design has different kinematics and kinetics. The purposes of this study were: (1) to perform within-patient comparisons of the midterm and long-term effects of PCL retention in mobile-bearing TKA on proximal femur and tibia BMD and calcaneus bone quality measured using ultrasound and (2) to identify correlations between them.

Cervical spinal motion before and after surgery in patients with Chiari malformation type I associated with syringomyelia

OBJECT: There have been few reports about the cervical spinal motion in patients with Chiari malformation Type I (CM-I) associated with syringomyelia. To investigate this phenomenon, the relationship between the preoperative cervical range of motion (ROM) and the stage of cerebellar tonsillar descent as well as the cervical ROM before and after foramen magnum decompression (FMD) were evaluated. METHODS: Thirty patients who had CM-I associated with syringomyelia and who underwent FMD participated in the study. The ROM and lordosis angle of the cervical spine were measured on x-ray films. In addition, the relationship between preoperative degree of cerebellar tonsillar descent and the ROM between the levels of the occiput (Oc) and C2 was investigated. RESULTS: The mean flexion-extension ROM at Oc-C2 was 15.5 degrees before and 14.1 degrees after surgery, and the mean flexion-extension ROM of C2-7 was 55.1 degrees before and 52.8 degrees after surgery. The mean pre- and postoperative lordosis angles at C2-7 were 16.8 and 19.1 degrees, respectively. There was no significant difference between the values measured before and after surgery. There was no correlation between the degree of cerebellar tonsillar descent and the ROM at Oc-C2. CONCLUSIONS. Foramen magnum decompression is an excellent surgical technique that has no effect on the postoperative cervical ROM and cervical alignment.     

Clinical and radiological results of surgical removal of periarticular ossifications after hip prosthesis implantation

The occurrence of heterotopic ossification (HO) is a well-recognized problem after total hip replacement. In a retrospective study, we investigated 32 patients who had undergone surgical excision of symptomatic HO followed by radiation with 7 Gy and nonsteroidal anti-inflammatory drug therapy between 1994 and 1999. The mean follow-up was 20 months (range: 12-60). Clinical and radiographic follow-up examinations included Harris hip score and classification according to Brooker. The preoperative Brooker class was III in 16 cases and IV in 16 patients. Comparison of the Brooker classification at follow-up revealed a statistically significant improvement (p < 0.0001; class 0:3, class I: 14, class II: 8, class III: 7 patients). In one case with symptomatic Brooker class III ossification, surgical reexcision of HO was necessary. A statistically significant increase (p < 0.05) in mean range of motion (ROM) was observed in flexion [preoperative: 57 degrees (+/- 26), follow-up: 83 degrees (+/- 21)], in abduction [preoperative: 17 degrees (+/- 12), follow-up: 24 degrees (+/- 9)], and in rotation (preoperative: 16 degrees (+/- 17), follow-up: 31 degrees (+/- 18)]. Comparison of preoperative Harris hip score (60 +/- 11) and Harris hip score at the time of follow-up examination (73 +/- 17) revealed a statistically significant increase (p < 0.0001) after treatment. At the time of follow-up examination, 18 patients (56%) assessed their pain symptoms as low but 6 patients (19%) reported strong pain symptoms. Nevertheless, the score at the time of examination (35 +/- 10) was statistically improved (p < 0.02) when compared to the preoperative score (30 +/- 8). Surgical excision of Brooker class III or IV heterotopic ossification with limited ROM followed by irradiation and anti-inflammatory prophylaxis results in significant improvement in flexion, abduction, and rotation arc and significant reduction of HO in radiographic examination at follow-up, but pain relief was only satisfactory.     

Accurate measurement of ankle range of motion after total ankle arthroplasty

There is no standardized method reported in the literature to measure ROM of the ankle after a total ankle arthroplasty, which limits the possibility to compare results from the various ankle designs. It seems that most of the measurements are a combination of ankle and midfoot motion, not the tibiotalar joint. A protocol was developed to accurately measure the true tibiotalar and midfoot motion before and after an ankle replacement. Lateral radiographs were taken of the ankle with the patient in a weightbearing position, and measurements were done along fixed landmarks. In this study, the tibiotalar, midfoot, and combined ROM were measured preoperative and 1 year postoperative in a standardized, reproducible fashion. The preoperative tibiotalar ROM was 18.5 degrees and combined ankle and midfoot motion 25.1 degrees. The true tibiotalar motion after an Agility total ankle arthroplasty was 23.4 degrees, and the combined ankle and midfoot motion was 31.3 degrees. The average improvement in ROM in the tibiotalar joint was approximately 5 degrees, and combined ROM was 6.1 degrees. Preoperative ROM proved to be the main factor determining the eventual postoperative ROM. It is possible to accurately measure the true ankle and the midfoot motion and those measurements should be used when reporting on the results of ankle replacements. Total ankle arthroplasty resulted in a statistically significant, but clinically less than expected, increase in ROM.     

Hepatectomy in patients with nonuremic minimal renal failure

In this study, the perioperative management and short-term outcome of hepatectomy were evaluated in patients with nonuremic minimal renal failure to assess the safety of hepatectomy in such patients. Ninety-one patients who underwent hepatectomy were retrospectively divided into two groups based on their creatinine clearance (Ccr) values: a group with Ccr values ⩾50 but <100 ml/min (group 1; n=77) and a group with Ccr values of ⩾20 to <50 ml/min (group 2; n=14). Preoperative patient characteristics, intraoperative parameters (including operation time and blood loss), and postoperative management and complications were evaluated. The preoperative evaluation showed no differences in liver function between the two groups, and there were no statistically significant differences between the two groups in intraoperative blood loss (522 ml in group 1 and 806 ml in group 2) or intraoperative urine volume (1.01 ml/kg per hour in group 1 and 0.75 ml/kg per hour in group 2). The difference between the two groups in postoperative complications was not statistically significant. None of the patients in group 2 required dialysis therapy, and no patients died as a result of hepatectomy or hepatectomy-related causes. Adequate indications, appropriate operative procedures, and perioperative management can enable hepatectomy to be performed safely in patients with nonuremic minimal renal failure.     

术前活动度对人工全膝关节置换术后功能影响的观察

目的回顾性分析患者手术前的活动度对人工全膝关节置换(TKA)术后功能的影响。方法随访2000年1月—2003年12月在我科行TKA的患者65例(97膝),年龄64．8±9．9岁(35～85岁)。其中骨性关节炎55例(81膝),类风湿关节炎10例(16膝)。单膝置换33例,双膝同时置换32例。所有患者按术前膝关节活动度数(ROM)分成两组,≤90°(5°～90°)49膝,>90°(95°～140°)48膝。对两组患者进行疗效(最大屈膝度、活动度、KSS评分及功能评分)对比。所有患者均采用Scorpio后稳定型骨水泥固定的假体,均为初期置换,全部手术由同一组医师完成。术后3 d在同一康复师指导下行患肢CPM及主动功能锻炼至出院。结果平均随访时间29个月(10～44个月)。所有膝关节的活动度从术前的平均84．2°(5°～140°)提高到术后的平均101．6°(40°～140°) (P=0．000);而最大屈膝度数术前的平均103．5°(25°～140°)与术后的平均101．6°(40°～140°)无显著差异(P=0．439);KSS膝关节评分从术前平均19．5分(-24～62分)提高到术后平均78．8分(50～95分)(P=0．000)。所有患者的总满意度为93．8％(61／65)。两个分组比较,ROM≤90°的膝关节ROM及最大屈膝度术后均较术前有提高,而ROM>90°的膝关节平均最大屈膝度术后反而下降。没有翻修及深部感染。结论(1)在影响TKA术后膝关节功能的多种因素中,手术技术是关键因素。(2)在其他因素相同的情况下,术前膝关节的活动度对TKA术后的功能也有很大的影响,术前活动度大的膝关节比那些术前活动度小的膝关节术后能获得更好的功能。     

Movement Mapping as dynamic preoperative surgical planning in total hip replacement

The purpose of the present study was to develop and present a computer program for preoperative simulation of implant components placement in total hip alloarthroplasty, and its influence on the possible range of motion (ROM). We evaluated a computer simulation for preoperative estimation of range of motion (movement mapping) in total hip replacement. The computer program was based on Borland C++. The system had an open data port, so the data could be transferred to an Excel spreadsheet for statistical evaluation. With the developed virtual computer simulation, a practical model was established. The model showed range of motion patterns which correspond to clinical experience. ROM was best at a shaft anteversion between 20 degrees and 30 degrees. ROM had its maximum with a CCD angle of 120 degrees -130 degrees. Acetabular cup anteversion was optimal between 10 degrees and 20 degrees, and cup inclinations were optimal below 40 degrees. The presented movement mapping system seems to be a reliable option for dynamic preoperative planning, which may be a prerequisite for the use of intraoperative navigation systems.     

Randomized study on the effect of collagen impregnation of knitted Dacron velour aortoiliac prostheses on blood loss during aortic reconstruction.

Intraoperative blood loss is an important factor in reconstructive surgery for aortoiliac disease because it is clearly associated with an increase in the operative morbidity and mortality rates. To minimize intraoperative blood loss, a blood-tight vascular prosthesis has been developed by impregnating a knitted Dacron prosthesis with bovine collagen. To study a potential reduction of intraoperative blood loss using these collagen-impregnated prostheses, we conducted a prospective randomized trial involving the collagen-impregnated prosthesis and its non-impregnated substrate, the Dacron knitted non-impregnated prosthesis. During a 2.5-year period, 123 consecutive patients (undergoing 81 procedures for aneurysmal disease and 43 procedures for occlusive disease) were admitted for elective aortic reconstructive surgery. Equal numbers of the two prostheses were randomly implanted. Various parameters were monitored: intraoperative blood loss before aortic cross-clamping (phase 1), during implantation of the prosthesis (phase 2) and after release of aorta cross-clamping (phase 3); the number of intraoperative and postoperative blood transfusions; and, finally, all preoperative and intraoperative factors that might contribute to intraoperative blood loss. A significant overall difference in intraoperative blood loss between the collagen-impregnated (1907 ml) and the non-impregnated (2425 ml) group was found (P = 0.003) [corrected]. However, this difference could not be attributed to collagen impregnation because no statistically significant difference in blood loss was found in the relevant period of operation (phase 3). Similar results were observed in patients operated on for both aneurysmal and occlusive disease (2600 versus 2195 ml and 2105 versus 1344 ml respectively).     

Long-term flexion-extension range of motion of the prodisc total disc replacement

The rationale for total disc replacement is avoidance of the junctional degeneration seen after arthrodesis by preservation of segmental motion. To justify the use of disc prostheses, it is essential to document maintained range of motion (ROM) and sagittal alignment at long-term follow-up. This is a retrospective radiographic study of 42 patients who had placement of 58 first-generation Prodisc prostheses at a mean follow-up of 8.7 years. Flexion-extension ROM was measured by Cobb's method. Junctional levels were evaluated for junctional degeneration. Pre- and postoperative global and segmental lordosis were measured. Prognostic patient factors predicting ROM of <2 degrees were evaluated. We observed ROM of at least 2 degrees in 66% of Prodisc prostheses at 8.7-year follow-up, although ROM was less than that reported in asymptomatic normal individuals. Mean ROM for disc prostheses with motion was 7.5 degrees at L3-L4, 6.2 degrees at L4-L5, and 4.1 degrees at L5-S1. Mean ROM for all prostheses was 3.8 degrees. The incidence of radiographic junctional degeneration was 24%, although no patients required surgery for symptomatic junctional degeneration. Mean ROM of prostheses below a degenerated junctional disc was 1.6 degrees compared with 4.7 degrees below a normal junctional disc (P < 0.035). Females were 3.5 times more likely to have ROM of <2 degrees. This is the longest published follow-up study of a lumbar disc replacement. The data show that ROM is preserved at long-term follow-up in the majority of patients. Global and segmental sagittal alignment improve after surgery. Furthermore, there is an association between ROM of disc prostheses and the development of junctional degeneration.     

Impact of age on complications and outcome in meningioma surgery

BACKGROUND: Surgery for benign brain tumors in elderly patients without severe general health problems is an acceptable practice, as results are comparable with the ones of younger patients. Nevertheless, the hypothesis that operative complications and perioperative incidents could differ between the 2 age groups should be controlled; and age-specific strategies in operative technique and perioperative care may be useful. METHODS: Medical records of 348 patients were reviewed. Demographic data (age, sex), rate of excision, complications of the immediate postoperative period, neurological outcome, and mortality were recorded; and statistical evaluation comparing 2 age groups (19-64 and 65-84 years of age) was performed. RESULTS: The "young" age group consisted of 240 patients, whereas the "elderly" one had 108. Tumor removal rate was not significantly different in the 2 groups. The elderly age group included significantly more "complicated cases." Regarding each complication, postoperative hematoma, infections, and deep vein thrombosis were more frequent in elderly patients, presenting various degrees of statistical significance, whereas postoperative brain edema, hydrocephalus, and cardiorespiratory incidents presented no statistically significant difference. Finally, more elderly patients presented neurological deterioration, although mortality was not significantly different. CONCLUSIONS: Operation for intracranial meningioma in elderly patients is justified as long as detailed preoperative evaluation is performed. Planning of modified protocols including intraoperative technical aspects, careful use of steroids antibiotics, and prophylactic low molecular weight heparin, and early mobilization is necessary for optimizing operative outcome of elderly patients.     

The effect of anticoagulation on the restoration of range of motion after total knee arthroplasty: enoxaparin versus aspirin

Anticoagulation used for thromboembolic prophylaxis following total knee arthroplasty (TKA) could interfere with movement. This study compares the effect of 2 anticoagulants, enoxaparin and aspirin, on restoration of range of motion (ROM) after TKA. Two groups of 75 consecutive patients, matched for age, arthritic severity, and preoperative ROM, underwent TKA. Flexion and extension milestone measures were recorded daily. Results show a highly statistically significant difference (P<.001) between the 2 groups when comparing the days on which these milestones were achieved. Group 1 (enoxaparin) reached 90 degrees, 100 degrees and 110 degrees of flexion in 8.4, 10.4, and 12.4 days, respectively. Group 2 (aspirin) reached the same goals in 6.8, 8.5, and 10.6 days, respectively. At 15 months after surgery, no statistically significant difference in flexion was seen between the groups (122 degrees vs 121 degrees ). Enoxaparin delayed the return of early but not long-term flexion after TKA.     

Smoking behavior and perceived stress in cigarette smokers undergoing elective surgery

BACKGROUND: The forced abstinence from cigarettes accompanying surgery in smoke-free facilities may increase psychological stress by removing a coping mechanism and by nicotine withdrawal. The authors tested the hypothesis that abstinence from cigarette smoking contributes to psychological stress in the perioperative period. METHODS: The authors assessed measures of nicotine withdrawal (Hughes-Hatsukami nicotine withdrawal scale) and perceived stress (including the Perceived Stress Scale) in 141 cigarette smokers scheduled to undergo elective surgery. To separate the effects of stress arising from tobacco abstinence from the effects of other perioperative stressors, such as pain, these measures were also obtained in 150 surgical patients who did not use tobacco. Assessments were performed at intervals beginning at the time of preoperative medical evaluation and ending 30 days postoperatively. RESULTS: Perceived Stress Scale scores were significantly (P < 0.001) higher in smokers throughout the study period. There was little significant interaction between smoking status and time, indicating that changes in Perceived Stress Scale score during the perioperative period did not differ between smokers and nonsmokers. The same result was found if analysis was restricted to data collected before hospital discharge (and thus during assured abstinence). Similar results were found for the nicotine withdrawal scale, suggesting that smokers did not experience more withdrawal symptoms relative to nonsmokers. CONCLUSIONS: Although smokers report increased baseline stress, smoking status does not affect changes in perceived stress over the perioperative period. Nicotine withdrawal symptoms do not seem to be a clinically significant problem in the perioperative period for most smokers.     

Wiltse入路Dynesys内固定术与TLIF治疗老年腰椎椎管狭窄症的早期疗效对比分析

目的评估Wiltse入路Dynesys内固定术及Wiltse入路经椎间孔腰椎椎间融合术(TLIF)治疗老年单节段腰椎椎管狭窄症的临床疗效。方法回顾性分析2013年1月—2015年1月本院收治的35例老年单节段腰椎椎管狭窄患者的临床资料,其中采用Wiltse入路Dynesys内固定术15例(Dynesys组),Wiltse入路TLIF 20例(TLIF组);随访时间12~18个月,平均16个月。比较两组患者围术期指标(手术时间、术中出血量、术后引流量),术前及术后疼痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)、手术节段和邻近节段活动度(ROM)。结果 Dynesys组手术时间、术中出血量、术后引流量均低于TLIF组,差异有统计学意义(P0.05)。Dynesys组术后5 d腰背痛VAS评分及ODI均优于TLIF组,差异有统计学意义(P0.05);腿痛VAS评分两组间差异无统计学意义(P0.05)。末次随访时两组患者腰痛和腿痛VAS评分及ODI均较术前明显改善,差异有统计学意义(P0.05);两组间比较,差异无统计学意义(P0.05)。Dynesys组固定节段ROM较术前减小,TLIF组固定节段ROM降至0°,与术前相比差异均有统计学意义(P0.05)。Dynesys组上下邻近节段末次随访时的ROM较术前无明显改变,TLIF组上下邻近节段末次随访时ROM均较术前升高,差异均有统计学意义(P0.05);两组间比较,差异有统计学意义(P0.05)。结论 Wiltse入路具有出血量少、手术创伤小、术后恢复快的优点。相较于TLIF,Dynesys技术不需要支具外固定,允许早期活动,因不需植骨融合而避免了假关节的形成,能够保留固定节段部分ROM,减少邻近节段的过度活动,在治疗老年腰椎椎管狭窄症中具有独特优势。     

Influence of stability on range of motion after cruciate-retaining TKA

BACKGROUND: A loosely balanced total knee arthroplasty (TKA) is reported to produce a good postoperative range of motion (ROM), but too much laxity is thought to be the cause of persistent pain and worsened functionality. METHODS: The anteroposterior and mediolateral laxity values were measured to evaluate the influence of stability after cruciate-retaining (CR) TKA on ROM and the modified Knee Society score at 4-8 years after the operation. Twenty-one knees in 15 patients with an average age of 68 years who had undergone a CR TKA for osteoarthrosis were examined. The mean preoperative and postoperative ROM was 124 degrees and 112 degrees, respectively. The mean anteroposterior and mediolateral laxity values were 9.7 mm and 10.6 degrees, respectively. RESULTS: No correlation was found between the postoperative ROM and laxity or between the modified Knee Society score and laxity. A loosely balanced TKA did not produce a good postoperative ROM. No parameters suggested that lax knees showed a higher pain score and lower functional score than stable knees.