旋转平台全膝置换术治疗治疗重症膝关节炎34例的临床观察

目的探讨旋转平台全膝置换治疗重症膝关节骨性关节炎的临床疗效。方法对2007年1月～2009年10月我院34例（41膝）人工旋转平台全膝置换术进行临床分析和总结,行HSS[5,6]膝关节评分系统进行分析。结果术后平均随访17个月（5～31个月）,手术前HSS（thehospitalforspecialsurgery）评分平均51分,手术后评分平均92分,手术优良率为91%。病人术后在膝关节疼痛,功能和活动度方面有明显改善。结论旋转平台全膝置换术对治疗重症膝关节炎有良好的疗效。     

人工全髋关节置换术的康复护理

人工全髋关节置换术是解除髋关节疾病患者的疼痛、纠正畸形、重建髋关节功能的一种行之有效的方法，其围手术期的护理和术后的康复训练，对手术的疗效有很大影响。我院自2001年3月至2003年8月对26例患者进行了人工全髋关节置换术，通过精心护理和有效的康复训练，收到了良好的效果。     

人工膝关节置换术后的早期康复

目的探讨全膝关节置换术后进行早期功能康复的方法.方法应用骨水泥型全膝人工关节治疗骨关节炎、类风湿性关节炎等共48例(57个膝),术后早期实施康复训练.结果术后2周膝关节HSS评分60～81分(平均70.2分);术后半年膝关节HSS评分80～92分(平均87.1分).结论术后早期功能锻练可促进全膝关节置换术后患者的康复,并可有效预防并发症.     

人工膝关节置换术后的早期康复

目的　探讨全膝关节置换术后进行早期功能康复的方法 .方法　应用骨水泥型全膝人工关节治疗骨关节炎、类风湿性关节炎等共 4 8例 (5 7个膝 ) ,术后早期实施康复训练 .结果　术后 2周膝关节HSS评分 6 0～ 81分 (平均 70 .2分 ) ;术后半年膝关节HSS评分 80～ 92分 (平均 87.1分 ) .结论　术后早期功能锻练可促进全膝关节置换术后患者的康复 ,并可有效预防并发症 .     

人工全膝关节置换术的护理

目的 探讨人工全膝关节置换术的护理要点.方法 观察分析对16例全膝关节置换术病人的术前宣教心理疏导、术后护理措施及康复指导.结果 人工全膝关节置换术的患者在良好的系统护理和正确的功能锻炼下,可有效地预防并发症的发生,提高患者的生活质量.结论 规范护理是关系全膝关节置换术成败的重要环节.     

多关节同时置换术后康复训练的护理要点

人工全髋关节、全膝关节置换术是一种疗效确定的手术，而术后及时的康复治疗和有效的功能训练，不仅可以帮助患者及时恢复关节功能，提高术后疗效和患者的生活质量，而且可以减少和预防各种并发症。我科于2002年1O月至2003年1月成功地进行1例双膝人工关节置换术及1例3关节同时置换术(左髋、双膝)，经合理有序的康复训练取得了满意的效果，现报告如下。     

旋转铰链型人工膝关节假体的临床应用

目的：探讨旋转铰链型人工膝关节临床应用的近期疗效。方法：2003年2月～2012年4月,应用旋转铰链型人工膝关节假体进行全膝关节置换术治疗膝关节严重畸形和不稳定23例膝。其中骨性关节炎15例,类风湿性关节炎6例,左股骨骨折术后创伤性关节炎l例,左胫骨平台骨折术后创伤性关节炎合并前交叉韧带、内侧半月板损伤及内侧侧副韧带断裂l例。术前HSS（hospital for special surgery）评分36～58分,平均48．6分;术前膝关节屈曲活动度21°～80°,平均57.4°。结果：术后患者均获随访6个月～3年,平均23．6个月。无下肢静脉血栓形成、无腓总神经麻痹等并发症发生。23例患者随访时,HSS评分78～98分,平均91．1分,较术前平均增加45．5分,且差异有统计学意义（P〈0．05）;术后2周,膝关节屈曲活动度为75°～100°,平均85．2°,最后随访时膝关节屈曲活动度为85°～120°,平均108．3°,与术前比较差异有统计学意义（P〈0．05）。结论：旋转铰链型人工膝关节置换术近期疗效肯定,远期疗效尚待进一步随访。     

早期康复对人工全膝关节置换术后功能恢复影响

膝关节是全身最大、结构最复杂的关节，运动功能要求很高。人工膝关节置换术后，要求达到负重、伸屈、外展及旋转功能、稳定性好。2003年至2005年我院进行了45例人工全膝关节置换术，重视对术后患者采取系统的早期功能康复练习，取得满意疗效，现报告如下。     

全膝关节置换治疗晚期骨性关节炎

目的探讨全膝关节置换（totalknee arthroplasty,TKA）在膝关节骨性关节炎治疗中的疗效,手术要点及注意事项。方法对35例（41膝）晚期骨性关节炎患者行初次人工全膝关节置换术,采用膝前正中纵形切口和内侧髌旁入路,术后进行随访,对比术前术后膝关节功能评分（the Hospital for Special Surgery Knee Score,HSS）及膝关节活动度（range of motion,ROM）以观察疗效。结果全部病例均得到平均24个月的随访,均未出现感染、下肢静脉血栓等并发症。HSS评分由术前平均（69±7）分提高到术后平均（91±4．6）分。膝关节活动范围由术前平均95°提高到术后平均115°。结论全膝关节置换是治疗晚期膝关节骨性关节炎的最佳治疗手段。选择恰当的病例,良好的假体设计,精确的手术技术,术后积极的康复锻炼是影响术后结果的主要因素。     

人工全膝关节表面置换术术前术后护理措施的探讨

目的：探讨人工全膝关节表面置换术术前术后护理措施。方法通过对30例患有膝关节疾病的患者,采用人工全膝关节表面置换术治疗,在术前术后均予以一定的护理措施。结果所有患者均安全度过围手术期,无死亡及伤口感染病例,所有关节恢复良好。结论人工全膝关节表面置换术术前术后予以一定的有效护理护理措施能够大大提高手术的成功率和临床疗效,能够有效的避免并发症的发生。     

Telethermographic findings after uncomplicated and septic total knee replacement

Thermal imaging with infrared thermography is a noninvasive approach to monitoring surgical site healing and detecting septic complications. The aim of this study was to set reference values for telethermographic patterns of wound healing after total knee replacement (TKR) not complicated by infection and to compare them against thermograms from patients with knee prosthesis infection. Forty consecutive patients operated for TKR underwent telethermography of the operated and the contralateral knee before and up to 12 months after uncomplicated surgery. The imaging data sets were then compared against those obtained starting 8 months after TKR in 15 other patients with diagnosed periprosthetic infection. Presurgical assessment thermograms showed no difference between the affected and the healthy knees. At assessment 3 days postoperative, the temperature of the operated knee had increased markedly, with a peak differential temperature (operated minus non-operated knee joint temperature) of 3.4±0.7°C; measurement at 90 days after surgery showed a return to baseline knee joint temperature in the patients with uncomplicated surgery. In the patients with septic complications, the mean differential temperature was 1.6±0.6°C (range, 1.1-2.5°C). Thermal imaging showed a measurable, reproducible telethermographic pattern of surgical site healing in patients with uncomplicated TKR and an elevated mean differential temperature >1.0°C in those with persistent prosthesis infection.     

基于nmsBuilder和OpenSim建立个性化 骨肌模型及其验证

目的 利用nmsBuilder和OpenSim两款软件构建个性化全膝关节置换（total knee replacement, TKR）术后骨骼肌肉多体动力学模型,并用弹跳式和内推式两种步态对构建模型进行验证分析。方法 利用患者骨骼数据,通过nmsBuilder建立骨骼实体、骨标点和肌肉标点,从而自动生成对应参考系统和肌肉,将nmsBuilder生成的骨肌模型导入OpenSim先后执行逆向运动学、静态优化和膝关节接触力分析,最后通过弹跳式和内推式两种步态对模型进行模拟分析,并与实验测量值进行对比验证。结果 除了外侧关节接触力,模型预测的胫股关节接触力幅值和趋势与实验获得数据对比有很好的一致性,构建的骨骼肌肉多体动力学模型可以被用于膝关节研究。结论 利用患者骨骼信息建立的骨肌模型通过输入标记点位置和地面反作用力,可以同时预测出内侧、外侧以及总胫股关节接触力。研究思路可为TKR患者设计个性化膝关节假体提供参考。     

Revision knee replacement for prosthetic joint infection: Epidemiology,clinical outcomes and health-economic considerations

Prosthetic joint infection (PJI) is a devastating complication of knee replacement surgery. Recent evidence has shown that the burden of disease is increasing as more and more knee replacement procedures are performed. The current incidence of revision total knee replacement (TKR) for PJI is estimated at 7.5 cases per 1000 primary joint replacement procedures at 10 years. Revision TKR for PJI is complex surgery, and is associated to a high rate of post-operative complications. The 5-year patient mortality is comparable to some common cancer diagnoses, and more than 15% of patients require re-revision by 10 years. Patient-reported outcome measures (PROMs) including joint function may be worse following revision TKR for PJI than for aseptic indications. The complexity and extended length of the treatment pathway for PJI places a significant burden on the healthcare system, highlighting it as an area for future research to identify the most clinically and cost-effective interventions.     

Limited knee extension during gait after total knee arthroplasty is related to a low Oxford Knee Score

BackgroundAfter total knee replacement (TKR) some patients report low self-perceived function, which is clinically measured using patient reported outcome measures (PROMs). However, PROMs, e.g. the Oxford Knee Score (OKS), inherently lack objective parameters of knee function. Biomechanical gait analysis is an objective and reliable measurement to quantitatively assess joint function. Therefore, the aim of this study was to explore the relationship between biomechanical gait parameters and the OKS.MethodsGait analyses were recorded in 37 patients at least one year after primary TKR and in 24 healthy controls. Parameters from this analysis were calculated for hip, knee and ankle joint angles and joint moments in the sagittal and frontal plane including initial contact, early, late stance and swing. For the patients these parameters were expressed as its difference to control values at matched walking speed. Linear regression analyses were performed between the parameters from gait analysis and the OKS, with speed as covariate.ResultsThe difference in knee extension angle at initial contact and late stance between patients and controls was significantly related to the OKS. Per one degree knee extension difference increase, the OKS reduced with 1.0 to 1.6 points. Overall, patients extended their knee less than controls. Neither ankle and hip gait parameters, nor joint moments showed a relation with OKS.ConclusionsAll patients with a submaximal score on the OKS showed limited knee extension during gait, even without a mechanical constraint in knee extension. This could be related to motor control limitations in this patient group.     

下肢外骨骼康复机器人在膝关节活动受限康复治疗中的应用*

背景：下肢外骨骼康复机器人以持续主被动活动联合为理论基础,通过模拟人体运动,刺激机体的自然复原力,发挥组织代偿作用。 目的：动态观察并了解下肢外骨骼康复机器人在膝关节活动受限患者功能锻炼中的康复作用。 方法：将20例术后早期膝关节活动受限患者随机等分为实验组与对照组,实验组采用下肢外骨骼康复机器人行肢体功能锻炼,对照组采用被动训练装置CPM机行功能锻炼,治疗间隙2组均采用心理疏导、低频脉冲电疗和红外线等物理治疗。 结果与结论：治疗2个月后,实验组与对照组患者膝关节后屈、前伸活动度均较治疗前明显改善(P < 0.01),同时实验组股四头肌肌力较治疗前明显改善(P < 0.01)。2个月后的后续治疗,实验组患者膝关节后屈、前伸活动度有了进一步的改善(P < 0.05),对照组上述指标无明显改善。说明早期采用下肢外骨骼康复机器人或CPM机配合心理疏导、低频脉冲电疗和红外线等治疗均能明显提高膝关节活动受限患者膝关节活动度,同时下肢外骨骼康复机器人具有恢复患者股四头肌肌力的作用。     

Influence of posterior condylar offset on knee flexion after cruciate-sacrificing mobile-bearing total knee replacement: A prospective analysis of 410 consecutive cases

The range of motion of the knee joint after Total Knee Replacement (TKR) is a factor of great importance that determines the postoperative function of patients. Much enthusiasm has been recently directed towards the posterior condylar offset with some authors reporting increasing postoperative knee flexion with increasing posterior condylar offset and others who did not report any significant association. Patients undergoing primary total knee replacement were included in a prospective multicentre study and the effect of the posterior condylar offset on the postoperative knee flexion was assessed after adjusting for known influential factors. All knees were implanted by three senior orthopedist surgeons with the same cemented cruciate-sacrificing mobile-bearing implant and with identical surgical technique. Clinical data, active knee flexion and posterior condylar offset were recorded preoperatively and postoperatively at a minimal one year follow-up for all patients. Univariate and multivariate linear models were fitted to select independent predictors of the postoperative knee flexion.Four hundred and ten consecutive total knee replacements (379 patients) were included in the study. The mean preoperative knee flexion was 112°. The mean condylar offset was 28.3 mm preoperatively and 29.4 mm postoperatively. The mean postoperative knee flexion was 108°. No correlation was found between the posterior condylar offset or the tibial slope and the postoperative knee flexion. The most significant predictive factor for postoperative flexion after posterior-stabilized TKR without PCL retention was the preoperative range of flexion, with a linear effect.     

Deprivation and outcome of total knee replacement

Deprivation correlates with poor health and psychosocial variables can affect the symptoms of knee arthritis. Our aim was to determine the effect of deprivation on the level of knee function and health-related quality of life at the time of arthroplasty and 12 months after total knee replacement. From our database of over 2500 knee replacements, we analysed both clinical and quality of life outcome measures. We analysed the relationship between deprivation (by Townsend score), knee function (Knee Society Score) and health-related quality of life (Nottingham Health Profile) before total knee replacement (TKR) and at 12 months post-operation. There was no significant correlation between Townsend score, Knee Society Score and Nottingham Health Profile preoperatively or at 12 months after knee replacement, thus showing that there was no association between deprivation and the severity of knee arthritis at the time of joint replacement nor was there a relationship between deprivation and the short-term outcome from total knee replacement.     

Quantitative analysis of ultrahigh molecular weight polyethylene (UHMWPE) wear debris associated with total knee replacements

The size and morphology of particulate wear debris retrieved from tissues around 18 failed total knee replacements (TKR) were characterized. Interfacial membranes from nine cemented and nine uncemented TKR were harvested from below the tibial components during revision surgery. Wear debris were extracted using papain and potassium hydroxide digestion. Ultrahigh molecular weight polyethylene (UHMWPE) particles from around cemented or uncemented TKR were similar in size and morphology. The mean size was 1.7 +/- 0. 7 microm with a range of 0.1-18 microm. Thirty-six percent of the particles were less than 1 microm and 90% were less than 3 microm. Morphologically the particles were predominantly spherical with occasional fibrillar attachments and flakes. Particles from TKR were greater than threefold larger than previously characterized particles from total hip replacements, which were 0.5 microm in mean size. Differences in joint conformity and wear patterns between the hip and knee articulations may explain the disparity in size of the wear debris. Since particle size represents an important variable influencing the magnitude of the biological response, it is possible that in vivo the larger TKR debris results in a diminished mediator release, which in turn may account for the lower incidence of osteolysis and aseptic loosening in some designs of TKR.     

Total knee replacement: Is it really an effective procedure for all?

Total knee replacement (TKR) is considered an effective intervention for the treatment of chronic knee pain and disability. Yet there is increasing evidence, based on research using patient-based outcome measures, that a significant proportion of patients experience chronic knee pain, functional disability, a poor quality of life and dissatisfaction after TKR. Although some poor outcomes after TKR are due to surgical technique and implant factors, much of the pain and disability after surgery is medically unexplained. A range of possible patient factors could contribute to a poor outcome after TKR. Socio-demographic factors that have been found to correlate with a poor outcome after TKR include female gender, older age and low socio-economical status. Medical factors that are highly predictive of pain and disability after TKR are a greater number of co-morbidities and a worse pre-operative status. A range of psychological factors could be predictive of a poor outcome after surgery including depression, low self-efficacy, poor pain coping strategies, somatization, low social support and patient expectations. It is also proposed that a biological explanation for continuing pain after TKR could involve central sensitisation, a dysfunction of pain modulation by the central nervous system. To improve patient selection for TKR, future research needs to focus on developing a pre-operative screening protocol to identify those patients at risk of medically unexplained pain and disability after TKR.     

同伴教育联合加速康复外科在TKA患者日常生活能力改善中的应用

目的 探讨同伴教育联合加速康复外科对全膝关节置换术后患者日常生活能力的影响。方法 选取2015年3月~2018年3月我院收治的行人工膝关节置换患者80例,随机分为观察组和对照组,每组40例。两组患者均给予加速康复外科理念干预,观察组在此基础上结合同伴教育,两组患者均进行3个月干预治疗,采用HSS评分、膝关节活动范围、改良Barthel指数量表对所有患者术前、术后第1天、术后2周、术后3个月膝关节活动度及日常生活能力进行评估。结果 两组患者术后2周、3个月HSS评分、ADL评分及膝关节活动度均较术前改善,差异均有统计学意义（P＜0.05）;与对照组相比,观察组术后2周、3个月HSS评分、ADL评分及膝关节活动度改善更明显,术后第1天、第2天、第3天疼痛程度均低于对照组,差异均有统计学意义（P＜0.05）;但两组患者术后并发症发生率无统计学意义（P＞0.05）。结论 同伴教育联合加速康复外科可更好改善TKA患者的膝关节功能及日常生活能力,利于其早日无障碍或少障碍的回归家庭和社会。