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。     

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。     

全膝关节置换术中髌骨置换与髌骨成形对膝关节功能的影响

 目的 探讨髌骨置换与髌骨成形对全膝关节置换术后膝关节功能的影响。方法 对2010年8月至11月拟行全膝关节置换术的48例(69膝)膝关节骨关节炎患者进行随机分组,髌骨置换组24例(35膝)、髌骨成形组24例(34膝)。两组患者年龄、体重、身高、体重指数、美国膝关节协会(Knee Society Score,KSS)膝评分及功能评分、髌骨评分的差异均无统计学意义。比较两组术后6周、3个月、6个月、12个月、24个月的KSS膝评分及功能评分、髌骨评分、术后膝前痛发生率及影像学表现。结果 髌骨置换组20例(30膝)与髌骨成形组20例(29膝)获得随访。术后各时点两组KSS膝评分的差异无统计学意义;6个月以后髌骨置换组KSS功能评分高于髌骨成形组,12个月以后髌骨置换组髌骨评分高于髌骨成形组,差异有统计学意义。术后各时点髌骨置换组膝前痛发生率与髌骨成形组的差异有统计学意义。术后24个月髌骨置换组与髌骨成形组术后胫股角(174.25°±0.97°与173.63°±0.48°)、髌韧带比值(1.01±0.09与1.09±0.07)、髌骨倾斜角(4.58°±0.18°与4.41°±0.19°)、髌骨适合角(2.69°±4.15°与2.56°±3.72°)、髌骨移位距离[(1.53±1.34) mm与(1.68±1.23) mm]的差异均无统计学意义。结论 全膝关节置换术中行髌骨置换可以改善膝关节和髌骨功能,降低术后膝前痛的发生率。     

全膝关节置换术中髌骨置换与否对早期疗效及膝前痛的影响

 目的 探讨全膝关节置换术中髌骨置换与否对早期疗效及膝前痛发生率的影响。方法 2010年6月至2011年6月拟行全膝关节置换术患者100例,随机分为两组：髌骨置换组43例50膝,髌骨未置换组57例66膝。比较术后6个月、12个月两组患者的西安大略和麦克马斯特大学(West Ontario and McMaster Universities,WOMAC)骨关节炎指数、美国膝关节外科协会(Knee Surgery Society,KSS)膝评分和功能评分、膝前痛视觉模拟评分(visual analogue scale,VAS)。结果 髌骨置换组与髌骨未置换组患者术后膝前痛VAS评分均较术前明显降低,两组间VAS评分及膝前痛发生率的差异无统计学意义。WOMAC骨关节炎指数6个月分别为28.8±11.2和18.6±7.2、术后12个月分别为20.7±6.2和16.0±5.5,KSS膝评分6个月分别为(87.0±8.3)分和(90.9±7.2)分、术后12个月分别为(84.2±10.6)分和(88.8±9.2)分,KSS功能评分术后6个月分别为(86.6±21.6)分和(84.9±16.5)分、术后12个月分别为(85.2±16.4)分和(91.0±10.0)分,组间差异均无统计学意义。髌骨轴位X线片示髌骨与股骨假体滑车吻合度良好,无不稳及脱位表现。术后1年内无翻修、髌骨表面再置换病例。结论 全膝关节置换术对改善因骨关节炎或类风湿关节炎导致的膝关节疼痛、功能受限有效;髌骨置换与否对术后短期疗效及膝前痛发生率没有影响。     

髁限制性假体置换治疗膝骨关节炎

目的 探讨髁限制性假体(LCCK假体)置换治疗膝骨关节炎的疗效。方法 采用LCCK假体置换治疗40例膝骨关节炎患者。记录手术情况以及术后膝关节活动度。采用膝关节HSS评分评价膝关节功能改善情况。结果 患者均获得随访，时间12～60个月。手术时间75～120 min,总出血量110～400 ml。术后X线片显示膝关节力线均明显改善，畸形完全矫正。膝关节HSS评分：由术前23～56(47.11±5.70)分提高到术后1周75～90(84.79±4.70)分(P<0.05)。膝关节活动度：34例术后1周屈曲可达130°、伸直0°;6例类风湿关节炎患者术后1个月膝关节屈曲仅达90°、伸直0°。末次随访时，患者均可独自正常步态行走。结论 LCCK假体置换治疗膝骨关节炎，能有效缓解患者症状，改善膝关节功能，维持膝关节的稳定。     

人工膝关节表面置换治疗类风湿性关节炎屈膝畸形

目的探讨人工全膝关节置换术治疗类风湿性关节炎屈膝畸形的临床效果。方法选用后稳定型钴合金假体对21例类风湿性关节炎屈膝畸形患者进行人工全膝关节置换术,其中单侧膝关节置换5例,双侧膝关节置换16例,手术前后对患者的膝关节功能进行评分。结果随访1~5年,术前患者平均膝评分(22.84±6.06)分,平均功能评分(12.86±16.09)分;术后2周平均膝评分(70.16±2.71)分,平均功能评分(58.10±8.14)分;术后12周随访平均膝评分(86.14±3.12)分,平均功能评分(89.05±3.01)分。结论人工全膝关节置换术能显著纠正类风湿性关节炎屈膝畸形患者膝关节的畸形,解除疼痛,改善患膝的功能。     

类风湿性关节炎全膝关节置换术中膝外侧支持带松解的应用

目的:类风湿性关节炎病人髌骨凹陷性缺损、髌骨中央磨损如何处理,是全膝关节置换手术的难点。本文报道该手术技术及早期临床效果,并总结对此类病例手术时髌骨处理的经验。方法:自1997年1月至2002年11月选择49例(49膝)类风湿性关节炎病人,对术中髌骨有中央凹陷性缺损者常规行髌骨假体置换,置换后髌骨厚度大于置换前,所有病例均行髌外侧支持带松解。手术后随访时间最长6年,最短4个月,平均2.7年、结果:病人术前HSS疼痛评分平均为2.4分,功能评分平均为6.22分,膝关节活动评分平均为6.5分。术后48膝疼痛评分平均为30分,1膝于1年后手术探查。49膝功能评分平均为22分,活动评分平均为10分。所有病例均未发生髌骨骨折及髌骨坏死。结论:重症类风湿性关节炎病人在全膝关节置换术中常会出现一些比较特殊的困难,其髌骨常表现为中央凹陷性缺损,行髌骨假体置换后髌骨厚度将会增加。应用股骨假体外旋、外移放置及胫骨假体外旋放置、髌骨假体内置等方法后,仍需通过髌外侧韧带松解来改善髌骨的压力及髌股关节的对合关系。     

人工全膝表面关节置换治疗骨性膝关节炎47例

目的　分析总结人工全膝表面关节置换治疗骨性膝关节炎的临床效果及经验。方法　对 4 7例 5 3膝的骨性膝关节炎病例行人工膝关节置换术 ,单膝关节置换 4 1例 ,双膝关节置换 6例 1 2膝。应用后方稳定型假体 2 1例 2 5个膝关节 ,保留后交叉韧带型假体 2 6例 2 8个膝关节。结果　 39例 4 5个膝关节获 1年以上随访 ,采用HSS评分标准 ,膝关节评分从术前 35分提高到术后 89分 ,术后 4 0个膝关节活动度≥ 90°,4 2 / 4 5膝关节术后膝关节力线正常 ,3例残留 5°～ 7°内翻。结论　人工全膝表面关节置换治疗骨性膝关节炎可取得良好效果。术中精确的截骨操作与正确的软组织松解获得的软组织平衡是手术治疗成功的关键。     

人工全膝关节置换术后感染的临床分析

目的　探讨全膝关节置换术后感染的原因、处理方法及临床效果。　方法　对 1987年～ 1999年 13例全膝关节置换术后感染患者的病因以及清创、一期或二期再置换等治疗方法进行总结分析。 13例患者术前膝关节平均活动度为 5 5°,HSS评分为 36 5分 ;平均随访 3年 5个月。　结果　13例感染患者经治疗后均未复发 ,80 %的患者对手术满意 ;膝关节活动度恢复至平均 85° ,HSS评分为73 5分。　结论　类风湿关节炎 (RA)、服用激素、合并糖尿病、使用铰链式假体及初次置换术前膝关节曾行其它手术是膝关节术后感染的高危因素 ;感染明确后 ,应积极进行清创合并应用敏感抗生素 ;二期置换的临床效果优于单纯清创及一期置换     

旋转铰链型人工膝关节临床应用近期疗效观察

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2002年7月～2005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17例17膝。其中男8例，女9例；年龄41～79岁，平均59岁。左侧10例，右侧7例。患者均因膝关节疼痛人院，病程1～7年。其中骨性关节炎10例，类风湿性关节炎5例，左股骨骨折术后创伤性关节炎1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1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7个月～3年，平均23．6个月。无下肢静脉血栓形成或肺栓塞，无腓总神经麻痹、骨折或伸膝装置断裂等并发症发生。1例患者术后3个月出现迟发感染，再次手术取出假体，应用抗生素骨水泥间隔行膝关节旷置待二期置换。其余16例最后随访时，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85～123°，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。     

Total knee arthroplasty using cruciate-retaining kinematic condylar prosthesis.

The purpose of the current study was to evaluate the long-term results of the Kinematic I condylar prosthesis with retention of the posterior cruciate ligament. One hundred sixty-eight total knee arthroplasties in 118 patients (mean age, 65.2 years; range, 21-88 years) were inserted with cement, an all-polyethylene patella, metal-backed tibia, and posterior cruciate ligament retention. Sixty-one patients (86 knees) died, one patient had an above-knee amputation, and three patients (five knees) were lost to followup; therefore, 66 knees (excluding revisions) in 50 patients were available for followup at a mean of 15.7 +/- 1.1 years (range, 14-20 years). Of the entire cohort of 168 knees, 13 have been revised: one for medial femoral condyle fracture, one for tibiofemoral instability, one for femoral and two for tibial component aseptic loosening, four for tibial polyethylene wear, and four for patellar component aseptic loosening. The 15-year survivorship free of any component revision excluding infections was 88.7% (confidence interval, 82%-95%). The 15-year survivorship free of radiographic loosening and/or revision of any component was 85.1% (confidence interval, 78%-92%). The current study shows good function and survivorship of the posterior cruciate-sparing Kinematic I condylar prosthesis at a mean of 15.7 +/- 1.1 years.     

Long-Term Follow-Up of Cemented Fixed-Bearing Total Knee Arthroplasty in a Chinese Population: A Survival Analysis of More Than 10 Years

The aims of this study were to evaluate the long term clinical outcomes and survival rate of total knee arthroplasty (TKA) in Chinese population and the risk factors for failure. Between 1985 to 2001, 297 patients underwent primary TKAs with cemented fixed bearing platform in our center. Survival rate was 92.7% at 10 years, with reoperation of the implant as the endpoint, and 90.4% at 15 years. Main reasons for failure were infection and aseptic loosening. Clinical evaluation of 96 knees with HSS knee score showed the mean scores increased from 56.58 ± 11.05 preoperatively to 92.29 ± 10.95 postoperatively. RA patients had lower long-term survivorship compared with OA patients. Younger patients had better HSS scores. Patella strategy and posterior-cruciate-ligament (PCL) strategy had no effect on implant survivorship and clinical outcome. In conclusion, this was one of first studies showing valid long-term outcomes of primary TKA in Chinese.     

Joint line and patellar height restoration after revision total knee arthroplasty

Background:

Restoration of proper joint line (JL) position and patellar height in revision total knee arthroplasty (TKA) is essential in the recovery of knee function and kinematics. We determined whether the JL position and patellar height could be restored in patients undergoing septic and aseptic revision TKA.

Materials and Methods:

We retrospectively reviewed 70 patients (74 knees) who had revision TKA between September 2004 and December 2010. Forty seven knees had a two stage revision for infected TKA and 27 knees for aseptic failure. The JL position, patellar height and patellar tendon (PT) length were measured and compared between primary TKA and post revision. The clinical scores including a hospital for special surgery (HSS), Knee Society Score (KSS), Western Ontario and McMaster Universities (WOMAC) and range of motion (ROM) were compared.

Results:

The overall JL increased from 17.51 mm to 18.37 mm post revision, the Insall-Salvati (IS) ratio declined from 0.98 to 0.92, and the PT length declined from 42.92 mm to 39.45 mm. 9 of the 21 patellar baja knees improved to normal patellar height. After revision, the JL in the septic group (17.02 mm) was significantly lower than the aseptic group (20.74 mm). The changes of the JL position and IS ratio in the septic group were significantly larger than the aseptic groups (P < 0.05). JL position had a positive correlation to the IS ratio and PT length post revision. The knee function scores including HSS, KSS, WOMAC scores, and ROM all improved post revision compared to pre revision (P < 0.05), and the septic group had a lower knee function compared to the aseptic group. JL position and IS ratio post revision had no correlation to the HSS, KSS, WOMAC scores, and ROM.

Conclusions:

JL position can be sufficiently restored with appropriate distal femoral augment reconstruction after revision TKA, but the patellar height cannot be well improved, especially in the septic revision with obvious PT contracture. No correlation was found between the JL position and patellar height to the knee function post revision TKA.     

固定平台与旋转平台假体用于外翻膝的早期疗效观察

目的:比较外翻膝人工全膝关节置换术应用旋转平台和固定平台两型假体的早期临床疗效。方法:选取2011年1月至2013年12月吉林大学第一医院骨关节外科由同一医师进行初次人工膝关节置换的17例(23膝)进行回顾性随访研究,其中男2例,女15例;年龄48～75岁,平均61.5岁。术前诊断为骨性关节炎14例(19膝),类风湿性关节炎3例(4膝),所有膝关节有外翻畸形。其中9例(12膝)使用固定平台型假体(PFC Sigma),8例(11膝)使用旋转平台型假体(PFC Sigma RP).术前和术后随访行KSS、HSS、WOMAC评分,测量关节活动度、胫股角等指标,进行统计学分析。结果:所有患者获随访,时间6～36个月,平均25个月。两组患者膝外翻畸形均得到矫正,术后末次随访的KSS、HSS、WOMAC评分及膝关节活动度、胫股角较术前明显改善(P<0.01).其中固定平台组和旋转平台组在术后KSS、HSS、WOMAC评分以及胫骨角、膝关节活范围改善度方面比较,差异无统计学意义(P>0.05);而术后末次随访膝关活动范围固定平台组(101.8±8.8)°与旋转平台组(108.4±7.2)°差异有统计学意义(P<0.05).旋转平台组没有发现垫片脱位,两组术后均无感染、腓总神经麻痹、脱位、膝关节不稳等并发症发生,X线检查未见假体骨溶解及松动发生。结论:外翻膝人工全膝关节置换术使用旋转平台和固定平台型假体均能获得满意的早期临床效果,两者的近期临床疗效比较无明显差异。     

Clinical Survivorship of Aseptic Revision Total Knee Arthroplasty Using Hinged Knees and Tantalum Cones at Minimum 10-Year Follow-Up

BackgroundThe reconstruction of severe bone loss utilizing porous tantalum cones in patients undergoing revision total knee arthroplasty (TKA) has been established in the last years. However, reports on a long-term follow-up to assess the durability of such implants when combined with hinged knee designs are lacking. The current study aimed to evaluate the results of a previous study cohort at a minimum follow-up of 10 years.MethodsA retrospective review was performed. The initial study cohort comprised of 38 patients who underwent aseptic revision TKA between 2007 and 2009 at a single institution. After exclusion of the deceased patients and patients who were lost to follow-up, 25 patients with hinged knees and 32 cones implanted were included with a minimum follow-up of 10 years (mean = 126.5 months, range 120-142, standard deviation [SD] = 5.92). Survivorship was determined, and re-revisions were observed. Functional Knee Society Score was assessed.ResultsAfter a minimum of 10 years, 24 of 32 cones (75%) had survived without any exchange in 18 patients. Reasons for cone revision included aseptic loosening (5/32 cones; 15.6%) and periprosthetic joint infection (3/32 cones; 9.4%). In 4 of the five revisions due to aseptic loosening, pure hinged knees had been implanted. The mean functional Knee Society Score of the survivors was 69.6 points (range 10-100, SD = 30.85), and the average flexion ability of the knee was 92° (range 30°-120°, SD = 22.09).ConclusionPorous tantalum cones in revision TKA exhibited no favorable but reasonable long-term durability. Rotating-hinge designs should be used whenever possible to reduce the risk of aseptic loosening. Further comparative long-term analyses with other techniques or implants could inform us about the best treatment method.     

Long-term follow-up and survivorship of single-radius,posterior-stabilized total knee arthroplasty

Background

We sought to determine the 10-year survivorship of single-radius, posterior-stabilized total knee arthroplasty (TKA) in Asian patients. We also aimed to determine whether the long-term clinical and radiographic results differed between patients with and without patellar resurfacing.

Average 7-Year Survivorship and Clinical Results of a Newer Primary Posterior Stabilized Total Knee Arthroplasty

We evaluated the average 7-year survivorship and clinical results of a newer primary posterior stabilized total knee arthroplasty (TKA). The modifications in this design included a deeper patellar sulcus aimed at reducing contact stresses, improving patellar tracking, and achieving greater maximum flexion. A consecutive group of 137 patients (171 knees) who underwent TKAs using the Optetrak PS knee prosthesis between October 1997 and March 2004 were followed for an average of 6.8?years (range 4.0-11.5?years). Preoperative range of motion (ROM) and Knee Society scores were obtained and compared to that of the patients' most recent follow-up. Manipulation under anesthesia (MUA) and revision of the implant for any reason were considered endpoints for Kaplan-Meier survival analysis of all knees. Twenty-one knees (12.3%) underwent MUA. Three knees (1.8%) underwent revision, resulting in a 97.2% survival at a mean 10?years follow-up. Pain scores and ROM significantly improved after surgery (from preoperative average of 5.3 and 105° respectively to 44.6 and 120° postoperatively). These findings suggest that this posterior stabilized knee design is both a safe and effective option for patients undergoing primary TKA.     

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.     

Kinematics of medial osteoarthritic knees before and after posterior cruciate ligament retaining total knee arthroplasty

Total knee arthroplasty (TKA) is a widely accepted surgical procedure for the treatment of patients with end‐stage osteoarthritis (OA). However, the function of the knee is not always fully recovered after TKA. We used a dual fluoroscopic imaging system to evaluate the in vivo kinematics of the knee with medial compartment OA before and after a posterior cruciate ligament‐retaining TKA (PCR‐TKA) during weight‐bearing knee flexion, and compared the results to those of normal knees. The OA knees displayed similar internal/external tibial rotation to normal knees. However, the OA knees had less overall posterior femoral translation relative to the tibia between 0° and 105° flexion and more varus knee rotation between 0° and 45° flexion, than in the normal knees. Additionally, in the OA knees the femur was located more medially than in the normal knees, particularly between 30° and 60° flexion. After PCR‐TKA, the knee kinematics were not restored to normal. The overall internal tibial rotation and posterior femoral translation between 0° and 105° knee flexion were dramatically reduced. Additionally, PCR‐TKA introduced an abnormal anterior femoral translation during early knee flexion, and the femur was located lateral to the tibia throughout weight‐bearing flexion. The data help understand the biomechanical functions of the knee with medial compartment OA before and after contemporary PCR‐TKA. They may also be useful for improvement of future prostheses designs and surgical techniques in treatment of knees with end‐stage OA. © 2010 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 29:40–46, 2011     

重度膝关节外翻畸形的全膝关节置换术

 目的 探讨重度膝关节外翻畸形全膝关节置换术的手术方法及临床效果。方法 对2007年1月至2012年12月采用全膝关节置换治疗的重度膝关节外翻畸形患者22例（23膝）进行回顾性分析。男7例,女15例;年龄41~78岁,平均65岁。股胫角（股骨和胫骨解剖轴线的夹角）22°~50°,平均为34.6°。骨关节炎17例,类风湿关节炎5例。髌骨完全脱位3例3膝,内侧不稳定1例1膝,屈曲挛缩畸形3例4膝。21例22膝采用后稳定型假体,1例1膝采用限制型假体。髌旁内侧入路、常规截骨及单纯外侧软组织松解,术中行髌骨置换5例。以膝关节活动度、X线股胫角及美国特种外科医院（Hospital for Special Surgery,HSS）膝关节评分评价术后疗效。结果 全部病例随访时间1~5年,平均2.5年。膝关节活动度由术前平均43.7°±5.8°（0°~80°）提高至末次随访时110.6°±7.5°（80°~130°）,HSS膝关节评分由术前平均（19.6±4.7）分（6~34分）提高至末次随访时（89.7±3.6）分（84~96分）,手术前后的差异有统计学意义。外翻畸形基本得到矫正,末次随访时股胫角平均为8.6°±0.8°（0°~12°）,较术前34.6°±2.4°（22°~50°）明显改善,手术前后的差异有统计学意义。术后2例2膝有膝关节内侧不稳症状,给予膝关节支具保护;1例1膝术前严重髌骨脱位患者术后存在半脱位,未予特殊处理;2例2膝术后出现腓总神经麻痹,未予特殊处理。随访期间未发生感染、松动及深静脉血栓形成等并发症。结论 对重度膝关节外翻畸形患者可采用常规截骨、单纯外侧软组织松解及后稳定型假体植入,能较好地矫正外翻畸形,近期疗效满意。