Innex膝关节假体置换术后活动度与假体设计及手术技术的关系

目的 探讨Innex膝关节假体置换术后膝关节活动度与假体设计及手术技术的关系.方法 2003年9月至2005年12月使用CS型Innex假体行全膝关节置换88例(98膝),均患膝关节骨关节炎,体重指数20～30 kg/m2,内外翻畸形、屈曲畸形＜15°,为初次全膝关节置换并使用相同的手术技术.随访63例(70膝),随访时间4～6年,平均5.3年.分析活动度与股骨后髁偏心距和胫骨平台后倾角的相关性.根据术后、术前股骨后髁偏心距的差值大小将患者分为:1组,＜-2 mm;2组,-2～0 mm;3组,0～2 mm,4组,＞2 mm.分析各组术前体重指数、屈曲畸形、活动度、特种外科医院膝关节评分及术后活动度的差异.结果 随访患者术前膝关节活动度平均96.2°±11.9°,末次随访时平均109.8°±13.0°;术前股骨后髁偏心距平均(24.0±3.5)mm,术后平均(24.5±3.3)mm;术后胫骨平台后倾角平均5.5°±1.8°.膝关节活动度的差值与股骨后髁偏心距的差值相关,术后膝关节活动度与术后胫骨平台后倾角不相关.四组患者术前体重指数、屈曲畸形、活动度、特种外科医院膝关节评分差异无统计学意义,而术后活动度的差异有统计学意义.结论 Innex膝关节假体置换术后膝关节活动度良好.术中行股骨后方截骨时需注意恢复股骨后髁偏心距,以增加术后活动度.术后膝关节活动度与胫骨平台后倾角无关.

Abstract：

Objective To analysis the influence of component design and related surgical technique on knee range of motion (ROM) after total knee replacement using Innex knee system. Methods Between September 2003 and December 2005, 88 patients with 98 knees had consecutively undergone posterior cruciate-sacrificing TKA with Innex systems. The posterior condylar offset, post-operative tibial slope and knee ROM were measured in 63 patients (70 knees). The relationship of the change in posterior condylar offset and postoperative tibial slope with knee ROM was assessed using a scatterplot graph and Pearson's regression analysis. According to change of posterior condylar offset, which was measured by postoperative minus preoperative posterior condylar offset, patients were divided into 4 groups. The preoperative body mass index,flexion contracture, knee ROM, HSS score and the postoperative knee ROM of four groups were evaluated.Results The mean knee ROM had improved from 96.2°±11.9° preoperative to 109.8°±13.0° at final followup. The mean pre- and post-operative posterior condylar offset was (24.0±3.5) mm and (24.5±3.3) mm, respectively. The mean postoperative tibial slope was 5.5°±1.8°. There was statistical correlation between the difference in the posterior condylar offset and the change in knee ROM after TKA and no correlation between the postoperative tibial slope and knee ROM postoperatively. The preoperative body mass index, flexion contracture, knee ROM, HSS score did not show difference among four groups. There was a statistically difference in postoperative knee ROM among groups. Conclusion Restoration of posterior condylar offset is important to the maximum range of postoperative knee ROM when Orthopedic surgeons perform TKA with Innex systems.There was no correlation between the postoperative tibial slope and postoperative ROM.     

后稳定型全膝关节假体置换术后疗效分析

目的　分析后稳定型全膝关节假体置换术的处理方式、手术经验及疗效。方法　对 14例15膝行关节置换 ,使用Apollo后稳定型假体 ,单膝关节置换 13例 ,双膝同期置换 1例。原发疾病为类风湿性关节炎 3例 4膝 ,骨关节炎 11例 11膝。术后随访时间平均 11个月。结果　 15个膝关节术前伸曲活动度平均 75°,全膝关节置换术后 2个月关节活动度恢复至平均 10 0°。 14例患者均可自如行走、上下楼梯 ,膝关节稳定性好。 1膝术后脂肪液化致表层伤口裂开 ,清创后愈合 ,余膝术后伤口均愈合良好。结论　后稳定型假体植入的全膝关节置换手术方式简单、疗效肯定、术后并发症少。     

国产膝关节表面假体的临床应用初步报告

  目的 比较国产T-free膝关节假体与同类进口假体膝关节置换的早期疗效。方法 2008年7月至2009年12月采用国产T-free膝关节表面假体施行膝 关节置换25例35膝,单侧15例、双侧10例;屈曲挛缩19例25膝、内翻畸形11例18膝、外翻畸形4例5膝。膝关节活动度75.11°±27.68°,美国膝关节协会评分系 统（Knee Society Score,KSS）膝评分（17.88±14.37）分,KSS功能评分（21.62±21.27）分。同期同一术者施行的同类进口膝关节假体置换27例39膝做为对 照进行回顾性研究。两组患者年龄、体重指数、随访时间、术前膝关节活动度的差异无统计学意义;术前KSS膝评分及KSS功能评分的差异有统计学意义。结果 国产假体组24例平均随访（14.92±8.32）个月,与进口假体组26例（15.42±9.87）个月的差异无统计学意义。末次随访时国产假体组的膝关节活动度平均 107.53°±18.32°,与进口假体组112.84°±9.76°的差异无统计学意义;KSS膝评分平均（86.71±9.78）分,与进口假体组（86.68±6.01）分的差异无统计 学意义;KSS功能评分平均（65.88±25.01）分,与进口假体组（71.35±16.74）分的差异无统计学意义。国产假体组患者的满意率为95.8%（23/24）。结论 国 产T-free膝关节表面假体与同类进口产品的近期疗效相当。     

多尺寸人工全膝关节系统的临床应用分析及随访结果

目的 探讨应用多尺寸膝关节假体系统的临床应用优势及早期随访结果.方法 回顾性分析自2010年12月至2012年12月78例应用Vanguard膝关节系统进行人工全膝表面关节置换患者.术中记录应用股骨假体型号,术后定期门诊随访,拍摄X线片,应用KSS评分和WOMAC评分评估手术效果.结果 78例患者平均随访15.8个月.术前KSS评分（34.68±8.07）分,WOMAC评分（62.40±3.74）分,术后末次随访KSS评分（84.99±3.64）分,WOMAC评分（25.86±3.31）分.术前患者膝关节平均屈曲度（95.83°±13.83°）,术后末次随访时患者膝关节平均屈曲度（122.63°±9.93°）.患者术后膝关节功能明显改善,评分具有统计学差异（P〈0.01）.常用股骨假体型号在55～70 mm之间,并且70%以上集中在60～65 mm.结论 Vanguard膝关节假体能满足不同个体的需求,适应性强,有利于伸屈间隙的平衡,假体覆盖好,早期随访临床效果满意.     

全膝关节置换治疗僵硬膝关节的早期疗效分析

目的 评价人工全膝关节置换治疗僵硬膝关节的疗效,探讨术中操作和术后康复的要点.方法 2005年2月至2009年4月,采用人工全膝关节置换治疗僵硬膝关节患者23例34膝,男3例4膝,女20例30膝;年龄25～73岁,平均为56.9岁.临床评价指标包括美国特种外科医院评分(hospital for special surgery knee score,HSS)及关节活动范围,并统计术后并发症.结果 平均随访时间为32.2个月(24～40个月),无失访病例.HSS评分术前平均(42.9±5.2)分(24～66分),术后1个月时平均为(72.4±7.1)分(58～82分),末次随访时平均为(85.7±4.3)分(66～94分),较术前增加42.8分.膝关节屈伸活动范围术前平均为42.6°±5.7°(25°～50°),术后1个月时平均为80.2°±9.2°(60°～105°),末次随访时平均为89.2°±40.5°(60°～110°),较术前增加46.6°.12例16膝因术后活动范围不足90°,在术后3～8周进行静脉麻醉下的手法松解.末次随访时仍有6例8膝活动范围不足90°.结论 术中大范围的软组织松解、术后充分的肌力和活动范围训练是获得良好疗效的关键,对于术后关节活动范围不足的病例应及时采取静脉麻醉下的手法按摩松解.     

无性别差异假体全膝关节置换术后的疗效分析

目的 探讨采用无性别差异假体行全膝关节置换术后男性患者与女性患者的疗效差异.方法 回顾性分析2001年1月至2004年12月行全膝关节置换患者的临床资料.病例入选标准:手术时年龄在53～77岁之间,屈曲畸形＜40°,内、外翻畸形＜20°,单侧膝关节置换,符合骨关节炎诊断标准,膝关节局部无手术史.用随机数字表法选取40例...     

使用DELUXE假体及REVOLU截骨器行膝关节置换术的初步临床报告

目的探讨选用DELUXE假体及REVOLU截骨器行膝关节置换术的近期结果。方法对2008年2月至2009年4月,本组采用后稳定型固定衬垫DELUXE假体及REVOLU五合一截骨安装系统行TKA的26例31侧膝关节病变患者进行临床随访、分析。结果随访时间8～22个月,平均12.5个月。全组优良率为90.3%,HSS评分平均为（80.74±5.45）分;单侧手术时间为（74.5±5.8）min,术后切口均Ⅰ期愈合,无深部感染。X线检查证实未发现有骨溶解、假体松动或衬垫脱位等并发症。患者主观感觉满意。结论 DELUXE膝关节假体是根据国人膝关节解剖特点设计的新一代膝关节假体,改进了国外假体对国人膝关节尺寸不匹配及覆盖率不良的问题REVOLU作为一种新型五合一截骨系统,可一次同时完成股骨远端五个面的截骨,提高了截骨精确度,减少了手术时间,操作简便,近期临床疗效满意,其长期效果需要进一步观察。     

不同组配式全膝关节假体治疗中重度外翻膝的疗效分析

目的探讨不同组配式全膝关节假体治疗中、重度外翻膝的临床疗效。 方法回顾性分析2012年3月至2016年8月因中、重度膝外翻畸形行全膝关节表面置换术患者,排除轻度外翻膝及下肢解剖轴线明显异常者,根据手术方式及假体的不同分为A组：常规膝假体＋延长杆TKA术;B组：髁限制假体＋延长杆TKA术;C组：股骨髁上截骨＋延长杆TKA术。通过测量股胫关节角,视觉模拟评分,膝关节功能评分评价患肢关节功能和手术疗效。组内手术前后比较采用配对样本t检验,组间采用重复测量资料方差分析。 结果43例患者(59膝)均获得术后随访,平均时间为(16±3)个月;男12例14膝,女31例45膝;年龄平均(56.5±1.7)岁。其中A组19例(27膝),B组13例(18膝),C组11例(14膝),术后所有病例均未出现感染、关节不稳、假体松动等并发症,末次随访各组患肢股胫关节角(t＝22.544,20.221,12.841)、视觉模拟评分(t＝17.979,16.398,13.962),膝关节功能评分(t＝－35.159,－29.649,－25.410)较术前明显改善,各组手术前后疗效评价差异有统计学意义(P <0.05);三组间手术前后患膝股胫关节角,视觉模拟评分,膝关节功能评分差异无统计学意义(P >0.05)。 结论根据膝外翻畸形的病理特点和临床分型,灵活优化组配不同假体均能获得满意疗效,兼顾矫形的同时也最大限度地增加假体把持力和关节稳定性,对于关节外畸形行髁上截骨＋生物延长杆固定是不错选择。     

全膝关节置换治疗僵硬膝关节的早期疗效分析

Objective To evaluate the outcome of primary total knee arthroplasty (TKA) in treatment of stiff knee, and discuss the key points of operative technique and rehabilitation. Methods From February 2005 to April 2009, 23 patients with 34 stiff knees were treated with primary TKA. The study included 3 males (4 knees) and 20 females (30 knees), with the mean age of 56.9 years. Primary disease of the patients included rheumatoid arthritis (26 knees in 15 cases) and osteoarthritis (8 knees in 8 cases). Varus deformity was found in 10 knees (5°-15°), and valgus was found in 5 knees (5°-10°). Evaluations included preoperative and postoperative range of motion (ROM) measurement, hospital for special surgery knee score (HSS), blood loss, operative time and assessment of postoperative complications. Results All patients were followed up. The mean follow-up time was 32.2 (range, 24 to 40) months. At the final follow-up visit, the HSS score increased from 42.9±5.2 preoperatively to 85.7±4.3, the range of motion increased from 42.6°±5.7° preoperatively to 89.2°±10.5°. Sixteen knees in 12 cases underwent manipulation at 3 to 8 weeks postoperatively for unsatisfied ROM, but ROM was still less than 90° in 8 knees at the last follow-up. The average blood loss were (632.4±180.2) ml in first 24 hours (450-850 ml) and the operative time were (98.1±18.6) min (80-150 min). Deep venous thrombosis was found in 3 patients. All the symptoms relieved after anticoagulant therapy. Postoperative varus deformity was seen in one patient, but the function of knee was good. No revision was needed. Conclusion Primary total knee arthroplasty is reliable method in treatment of stiff knees. Sufficient soft tissue release during the operation, postoperative muscle strength exercise and essential manipulation are key points for satisfactory outcomes.     

人工髋膝关节置换术后假体周围慢性感染病原菌培养方法及结果分析

目的 分析人工髋、膝关节置换术后假体周围慢性感染病原菌培养方法及效果.方法 回顾性分析自2010年9月至2014年3月收治的全膝关节置换术(TKA)及全髋关节置换术(THA)术后被明确诊断为假体周围慢性感染的23例患者资料.其中TKA 15例,THA 8例;男性12例,女性11例;年龄32 ～ 79岁,平均62岁;伴有窦道患者9例.患者均在关节腔穿刺前至少2周停用抗生素治疗,翻修术前及术中分别取关节液予以病原菌培养及药敏试验.术中组织行一般病原菌培养及病理活检,培养结果为阴性的样本延长培养时间至2周.结果 本组患者共23例,术前培养1周阳性率30.4％ (7/23),阴性样本延长至2周阳性率39.1％(9/23).术中培养1周阳性率60.9％(14/23),阴性样本延长至2周阳性率82.6％(19/23),7例(30.4％)术前及术中培养结果相符.结论 对TKA、THA术后假体周围慢性感染行病原菌培养,在明确诊断前应停用抗生素至少2周.     

Five-year results of the Innex total knee arthroplasty system

The clinical and radiographic results of 174 female and 86 male Innex (Zimmer, Warsaw, Indiana) mobile bearing total knee arthroplasty systems (245 patients) were evaluated, with particular emphasis on gender-related differences at five-year follow-up. Pre-operative Knee Society (KS) function and total scores were lower in women than in men. All KS scores showed a significant improvement at follow-up, but women still obtained lower KS function scores than men. Self-reported function was significantly better for male knees. No gender differences were observed for component alignment, while the occurrence of radiolucent lines, endosteal cavitations, and wear was significantly greater in male knees. Male Innex mobile bearing knees exhibited better clinical function and satisfaction than their female peers at five-year follow-up, despite inferior radiographic findings and higher revision rates.     

Preoperative knee stiffness and total knee arthroplasty outcomes

A retrospective case-control study was conducted to evaluate 1-year total knee arthroplasty (TKA) outcomes among preoperative stiff knees, range of motion (ROM) 80° or less, compared with nonstiff preoperative knees, ROM 100° or greater. A total of 134 stiff knee cases were compared with a matched cohort of 134 non-stiff knee controls. Knee Society Score and Oxford Knee Score change scores from baseline to 1 year were similar between the groups. Stiff knees experienced a significantly greater mean improvement in ROM from baseline to 1 year (30.8° ± 18.8°) as compared with nonstiff knees (1.1° ± 12.8°) (P < .0001). Although ultimate ROM of a TKA can be restricted secondary to preoperative stiffness, improvements in outcomes and ROM are not affected. We conclude that progression of stiffness should not in and of itself lead to earlier intervention of TKA in most cases.     

Assessing short-term functional outcomes and knee alignment of computer-assisted navigated total knee arthroplasty

This retrospective study examined the relationship between the mechanical axis of the knee throughout its functional arc and functional outcomes in patients with computer-assisted navigation total knee arthroplasty. Data on final intraoperative functional arc alignment were obtained on 76 patients who had computer-assisted navigation total knee arthroplasty over a 2-year period and correlated with scores from postoperative Short Form 12 and Western Ontario and McMaster Universities functional outcome surveys. No correlation was found between functional arc alignment and outcomes from Western Ontario and McMaster Universities or Short Form 12 surveys; however, subgroup analysis of patients with more than 3° average final intraoperative alignment throughout the functional arc of motion demonstrated increased difficulty with daily activities (P = .05). The results indicate that patients with more than 3° average alignment throughout the functional arc of motion perform more poorly with daily activities postoperatively.     

The role of flexion contracture on outcomes in primary total knee arthroplasty

This study examined the role that flexion contracture plays in postoperative outcomes after total knee arthroplasty using a retrospective database review. The relationships between preoperative and postoperative knee extension, walking ability, stair climbing ability, Knee Society scores, pain scores, and knee function scores were studied in 5,622 knees. A preoperative flexion contracture was associated with an increased incidence of a persistent postoperative flexion deformity. A postoperative flexion contracture was associated with poorer postoperative results. Furthermore, a postoperative hyperextension deformity of greater than 10 degrees was associated with an increased risk of suboptimal pain and Knee Society scores. Knee extension deformities play a substantial detrimental role in the functional outcome of primary total knee arthroplasty.     

固定平台型和移动平台型假体全膝关节置换术后临床效果的分析比较

[目的]对应用移动平台型假体和固定平台后稳定型假体全膝关节置换术(total knee arthroplasty,TKA)后进行随访对照研究,分析这两种假体TKA术后的临床效果.[方法]对2003年1月～2004年12月间诊断为膝骨性关节炎的患者,随机应用固定平台后稳定型假体(scorpio)和移动平台型假体(Gemini MK Ⅱ)行TKA手术.记录术前及随访时术膝的膝关节评分、疼痛评分、功能评分、髌骨评分和膝关节活动度,及股骨角、胫骨角、膝外翻角、胫骨平台后倾角、髌骨高度.[结果]术前固定平台组和移动平台组的年龄、体重指数、患膝内翻畸形、最大屈曲度及屈曲挛缩度均无统计学差异(P＞0.05).术后平均随访31个月,固定平台组和移动平台组的术前术后膝关节评分、疼痛评分、功能评分、髌骨评分均无统计学差异(P＞0.05),都明显改善了患膝的症状和功能.固定平台组和移动平台组的术后最大屈曲度(108°±9.3°,99.5°±10.1°)间存在显著性差异(P＜0.05).两组的股骨角、胫骨角、膝外翻角、胫骨平台后倾角、术前术后髌骨高度无显著性差异(P＞0.05).[结论]平均随访31个月时固定平台后稳定型假体和移动平台假体TKA均明显改善了患膝的症状和功能,两组的膝关节评分、功能评分、疼痛评分、髌骨评分及X线片检查评价均无显著性差异.固定平台组的术后最大屈曲度大于移动平台组的术后最大屈曲度.     

Randomized trial of computer-assisted knee arthroplasty: impact on clinical and radiographic outcomes

Computer-assisted surgery in knee arthroplasty is gaining popularity; however, the resulting outcome improvement is controversial. A double-blinded trial was performed with subjects randomized to undergo surgery with either computer-assisted or nonassisted instruments. Postoperatively, limb and implant alignment and rotation were assessed using both full-length radiographs and computed tomography in addition to clinical scores. One hundred twenty patients (141 knees) were randomized. No differences in Western Ontario MacMaster Osteoarthritis Score, Short Form-36, or flexion were seen. More varus limb alignment was seen in the computer-assisted group (1.9°) vs the nonassisted group (0.9°, P = .04) with no improvement in alignment precision. Rotational alignment of the components did not differ between groups. Computer-assisted surgery appeared to have minimal effect on knee implant arthroplasty with no improvement in limb alignment or early functional outcome.     

全膝关节表面置换术的初步体会

目的探讨全膝关节表面置换术治疗膝骨性关节炎的近期疗效。方法采取全膝关节表面置换术治疗6例7膝骨性关节炎。结果6例均获随访，最短随访8个月，最长17个月。HSS评分从术前平均33分提高到术后92分，全部膝关节术后力线正常，其中6膝优，1膝良。结论全膝关节表面置换术是治疗晚期膝关节骨性关节炎理想方法。     

Improvements in knee range and symptomatic and functional behavior after knee arthroplasty based on preoperative restriction in range

Recovery of knee range and Oxford Knee Score post knee arthroplasty based on preoperative knee range is described. A total of 191 patients recruited across 5 hospitals were assessed preoperatively, at 8 weeks postoperatively and 1 year. Preoperative knee range was categorized into "low" (≤ 109), "moderate" (> 109 to ≤ 120), and "high" (> 120°) flexion and "normal" (± -5) and "restricted" (> +5°) terminal extension. Recovery was analyzed using MIXED modeling procedures. The low-flexion group gained flexion across time. The moderate-flexion and high-flexion groups lost flexion initially then recovered, but 1-year flexion remained lower than preoperative values. The restricted terminal extension group gained extension across time. The normal terminal extension group lost extension initially then recovered to preoperative values at 1 year. Recovery in Oxford score was independent of preoperative knee range limitation. Improvement in knee range postoperatively, but not self-reported behavior, is highly dependent on the initial restriction in range.     

单髁置换术与全膝关节置换术治疗膝单间室骨性关节炎近中期疗效的对比研究

目的探讨膝单髁置换术(UKA)和全膝关节置换术(TKA)治疗膝单间室重度骨性关节炎(KOA)的近中期临床疗效。方法随访本研究中因患膝单间室重度KOA接受单髁置换术的患者23例(23膝),同时期同术者施行的全膝关节置换术50例(56膝)。UKA组23位患者22名获得到了较为完整的临床随访,1例死亡。平均时间为28.6个月(4个月～7年),TKA组50位患者均获得随访,平均时间为32.9个月(2个月～7年)。对手术前后HSS评分,疼痛缓解,术中出血量及术后3d血红蛋白下降量,关节屈曲大于90°时间及屈曲大于120°膝关节数进行比较。结果UKA组与TKA组均获得满意疗效,两组患者均无假体松动,无关节翻修等严重并发症,HSS评分UKA组术前(64±5.75)分,术后末次随访(86±7.85)分(t=11.53,P0.001);TKA组术前(61±6.53)分,术后末次随访(84±7.92)分(t=18.64,P0.001)。与TKA组比较,UKA组术中出血(t=12.47,P0.001)及术后3d天血红蛋白下降少(t=13.61,P0.001),疼痛缓解相似(2=0.007,P0.05),术后膝关节屈曲到90°时间短(t=3.97,P0.05),术后能屈曲到120°的比率高。结论在严格掌握适应证的前提下,对于膝单间室重度KOA患者的手术治疗,UKA的近中期疗效可与TKA相媲美,而且UKA具有创伤小,出血少,患者耐受性好,术后恢复快的优点。     

Surgical accuracy and clinical outcomes of image-free robotic-assisted total knee arthroplasty

Background

The development of total knee arthroplasty (TKA) for knee osteoarthritis (OA) has a good reputation for its effectiveness in reducing joint pain and improving range of motion. We aimed to review our early results using the image-free robotic-assisted technology in knee arthroplasty.

Methods

A total of 71 patients suffering from end-stage OA knee receiving TKA operated by robotic-assisted surgery between the years 2018 and mid-2021 were recruited. Clinical and radiological outcomes were compared with age and sex-matched control group (conventional TKA).

Results

The radiological outcome showed significantly more postoperative lower limb alignment outliers in conventional side than robotic-assisted sides. Postoperative knee scores were similar among both groups. Robotic-assisted TKA required a longer implantation time but a shorter hospital stay.

Conclusion

Robotic-assisted TKA achieved a lower rate of mechanical axis Outlier in the coronal and sagittal plane with a shorter hospital stay. Yet both methods achieve a similar functional outcome.