白细胞介素-6在初次人工关节置换术后的变化规律及意义

目的探讨人工关节置换前后血清炎性指标IL-6的变化规律,结合CRP、ESR变化规律进一步分析三者的变化异同,并为人工关节置换术后感染早期发现提供参考依据。方法选取2011年10月至2012年04月本组204例初次置换患者为研究对象,分别于术前、术后1d、2d、3d及5d时对患者的血清IL-6,术前、术后1d、3d及5d时患者的血清CRP、ESR进行检测分析,并加以比较。结果测量数据显示,所有患者的血清IL-6、CRP、ESR水平均呈先升高后下降的趋势,其中血清IL-6在人工关节置换术后2d达到高峰,术后2d开始下降,5d下降到正常范围内,术后1、2及3d的IL-6均高于术前,有统计学差异（t1d=11.24,t2d=10.83,t3d=2.63,P〈0.05）;术后5d与术前比较,无统计学差异（t5d=0.47,P〉0.05）。CRP在关节置换后2～3d达到高峰,随后回落,但第5天时未回落到术前水平。ESR在关节置换后4～5d达到高峰,随后回落,但5d时未回落到术前水平。结果 IL-6在人工关节置换术后患者中呈现一定变化规律,先迅速升高后快速下降,变化速度最快,恢复到正常值的速度也快,比CRP及ESR更敏感。结论 IL-6、CRP、ESR三者联合应用更能提高人工关节周围感染的早期诊断率。患者术前髋、膝关节血清IL-6有统计学差异,可能与关节的自身生理结构导致的关节炎机制不同或者髋、膝关节IL-6的受体表达方式不同有关。     

Serum concentrations of interleukin-6 in patients following unilateral versus bilateral total knee arthroplasty

Background  Surgical stress is known to affect body temperature, white blood cell (WBC) count, C-reactive protein (CRP), and interleukin-6 (IL-6). The aim of the present study was to investigate which parameter is most suitable for quantitative analysis of surgical stress. Methods  Unilateral total knee arthroplasty (U-TKA) and bilateral TKA (B-TKA) were selected for the subjects of this study because the B-TKA creates approximately double the surgical stress of the U-TKA. The temperature, WBC count, CRP, and IL-6 in the blood were measured pre- and postoperatively in both groups. The IL-6 in the drainage fluid was also measured after the operation. Results  The temperature, WBC count, CRP, and IL-6 in the blood significantly increased on the first day after the operation in both groups. There were significant differences between the two groups in the WBC count (P < 0.05) and the IL-6 level in the blood (P < 0.05) on the first day after the surgery. There were no significant differences between the two groups for the CRP and IL-6 levels in the drainage fluid. The relative proportions — (B-TKA/U-TKA) × 100 (%) — were 170.4% for the operating time, 219.4 % for total blood loss, 200.0% for blood transfusion, 100.3% for temperature, 128.9% for WBC count, 127.4% for CRP, and 246.5% for the IL-6 level in the blood. Conclusions  The serum IL-6 level may best reflect surgical stress and could therefore be a quantitative marker of surgical stress.     

Infection surveillance in transsphenoidal pituitary surgery - comparison of lipopolysaccharide-binding-protein, interleukin 6, C-reactive protein, white blood cell count, erythrocyte sedimentation rate and body temperature

Background

One of the major concerns in transsphenoidal surgery are infections because the approach to the pituitary includes a route of microbial colonization. To minimize the associated morbidity and mortality, a surveillance program is crucial to monitor for perioperative infections.

Methods

For 1 year, we analysed body temperature (BT), erythrocyte sedimentation rate (ESR), white blood cell count (WBC), C-reactive protein (CRP), interleukin 6 (IL-6) and lipopolysaccharide-binding-protein (LBP) following elective transsphenoidal pituitary surgery. Samples were collected on admission, day 1, 3 and 7 as well as 3 months postoperatively.

Results

In 116 patients, all data were available. No postoperative infections occurred within the first postoperative week. BT (37.6?±?0.6, baseline 37.0?±?0.5 °C), WBC (11,366?±?2,541, baseline 6,861?±?2,123/μl), CRP (25.3?±?22.6, baseline 3.1?±?6 mg/l), IL-6 (12?±?13, baseline 2.7?±?2.6 pg/ml), and LBP (11.3?±?4.9, baseline 5.7?±?2.7 μg/ml) peaked on day 1 postoperatively (each p?=?0.001), while ESR peaked on day 3 (25?±?16, baseline 13?±?11 mm/h, p?=?0.001). BT and IL-6 normalized by day 3 and CRP by day 7, while ESR (23?±?16 mm/h, p?=?0.001), WBC (7,807?±?2,750/μl, p?=?0.001) and LBP (7.3?±?2.6 μg/ml, p?=?0.028) were still increased by day 7.

Conclusion

The present study establishes normative values for an infection surveillance following transsphenoidal pituitary surgery. CRP, a convenient and reasonable priced parameter, is affected by the procedure for the first postoperative week. IL-6 is more robust and allows a close monitoring on the expense of additional pricing. ESR, WBC and LBP are sustained affected by surgery, and do not offer any advantage. Since no infections were observed, we were unable to calculate the respective sensitivity and specificity.     

清创保留假体联合抗生素治疗膝关节置换术后急性感染

目的探讨采用清创保留假体联合抗生素(DAIR)治疗人工膝关节置换术后急性期感染的临床疗效。 方法回顾性分析解放军联勤保障部队第九四〇医院关节外科自2008年12月1日至2018年11月30日收治的，根据美国肌肉与感染协会(MSIS)诊断标准确诊为急性人工关节感染(PJI)的26例膝关节置换术后急性感染患者的临床资料。所有患者均采用一期彻底清创，更换膝关节聚乙烯衬垫，术后膝关节腔持续冲洗引流及足疗程敏感抗生素治疗。用t检验比较患膝术前、术后的膝关节疼痛视觉模拟评分(VAS评分)，美国特种外科医院膝关节评分(HSS评分)，入院及末次随访红细胞沉降率(ESR)、C反应蛋白(CRP)、白细胞介素-6(IL-6)。 结果纳入26例患者，失访3例，随访时间平均(44±28)个月。其中治愈17例，感染控制率73.9%。术后的膝关节VAS评分较术前降低(t＝24.815，P<0.05)，术后的HSS评分较术前升高(t＝41.966，P<0.05)。末次随访ESR(t＝14.140)、CRP(t＝3.503)、IL-6(t＝2.999)均较入院时降低(均为P<0.05)。 结论DAIR治疗人工膝关节置换术后急性感染，严格把握手术时机及手术适应证，可有效控制感染，恢复关节功能，临床效果满意。     

Early migration characteristics of a hydroxyapatite-coated femoral stem: an RSA study

Measurement of early stem subsidence can be used to predict the likelihood of long-term femoral component loosening and clinical failure. Data that examines the early migration pattern of clinically proven stems will provide clinicians with useful baseline data with which to compare new stem designs. This study was performed to evaluate the early migration pattern of a hydroxyapatite-coated press-fit femoral component that has been in use for over ten years. We enrolled 30 patients who underwent THA for osteoarthritis. The median age was 70 years (range, 55–80 years). Patients were clinically assessed using the Harris hip score. Radiostereometric analysis was used to evaluate stem migration at three to four days, six months, one year and two years. We observed a mean subsidence of 0.73 mm at six months, 0.62 mm at one year and 0.58 mm at two years and a mean retroversion of 1.82° at six months, 1.90° at one year and 1.59° at two years. This data suggests that subsidence is confined to the first six months after which there was no further subsidence. The results from this study can be compared with those from novel cementless stem designs to help predict the long-term outcome one may expect from new cementless stem designs.     

Intraoperative patellar tendon strain: predicting the range of knee flexion after total knee arthroplasty

Background  The preoperative range of motion is an important factor that influences the range of motion after total knee arthroplasty. Because the length and tightness of the extensor mechanism are extracapsular elements with an influence on knee flexion, it is reasonable to assume that the tension of the knee extensor mechanism during surgery has a considerable impact on the postoperative range of motion. The purpose of this study was to determine the influence of the tightness of knee extensor mechanism on postoperative knee flexion. Methods  In 18 knees undergoing posterior-stabilized type total knee arthroplasty, we measured the longitudinal strain on the patellar tendon with all the components in position during passive knee flexion up to 135°. The patellar tendon strains measured during surgery were compared with the preoperative maximum knee flexion angle and postoperative maximum knee flexion angle at 1 year. Results  There was a significant inverse correlation between the patellar tendon strain during surgery at 60° (r = -0.54, P < 0.05), 90° (r = -0.55, P < 0.05), or 135° of flexion (r = -0.65, P < 0.05) and postoperative knee flexion. Conclusions  The results indicated that subjects with high intraoperative patellar tendon strain during passive flexion of the knee had more restricted postoperative knee flexion. Therefore, the tightness of the knee extensor mechanism measured at total knee arthroplasty is a good predictor of maximum postoperative range of flexion.     

Delayed normalization of C-Reactive protein and erythrocyte sedimentation rate was not associated with inferior clinical outcomes after total knee arthroplasty

BackgroundThe purpose of this study aimed to identify the proportion of patients with delayed normalization of C-reactive protein (CRP) and Erythrocyte sedimentation rate (ESR) after TKA, to determine postoperative thresholds predictive of prolonged elevation. Further, we aimed to determine if the clinical outcomes of patients with prolonged elevation were inferior to those without prolonged elevation.MethodsThe records of 211 unilateral and 320 bilateral TKA were reviewed. Patients were divided into the normal and elevation group based on CRP and ESR levels at 6 weeks and 3 months. The temporal pattern of CRP and ESR change in both groups was compared, and thresholds predictive of elevation at 6 weeks and 3 months were identified. Further, the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index and Tegner activity scale of both groups at 6 months, 1 year, and 2 years after TKA were compared.ResultsThe proportion of patients with elevated CRP and ESR at 6 weeks and 3 months was CRP: 24.2%, 10%, ESR: 51.6%, 29.9% in unilateral and CRP: 31.5%, 10.6%, ESR: 58.1%, 42.7% in bilateral TKA. The thresholds for elevation at 6 weeks and 3 months were 9.5 mg/dL, 11.4 mg/dL (CRP at 6 weeks) and 81.5 mm/h, 74.5 mm/h (ESR at 3 months). There was no difference in the WOMAC score and Tegner activity scale between both groups.ConclusionsCRP and ESR are often elevated for a prolonged period even in the absence of infection after TKA. Such cases show distinct temporal patterns, which are predictable, and do not appear to have a significant effect on clinical outcome     

不同冲洗时间对关节镜治疗老年化脓性膝关节炎的疗效分析

目的 :探讨不同冲洗时间对于关节镜治疗老年化脓性膝关节炎的疗效。方法 :选取2012年10月至2014年10月收治的23例老年化脓性膝关节炎病例作为研究对象,采用关节镜下清理、置管及术后灌洗方法治疗,根据不同冲洗时间将患者分为冲洗1周组(10例)及冲洗2周组(13例),通过比较术后皮温恢复时间、C-反应蛋白(CRP)、血沉、关节活动度以及膝关节功能等评价两组治疗效果。结果 :23例均获随访,平均随访时间(13.3±2.3)个月,无一例复发。术后两组患者CRP均在2周时恢复正常;冲洗2周组血沉在术后2周恢复正常,1周组术后2周血沉仍高,在术后3周恢复正常,两组差异有统计学意义。术后膝关节皮温恢复正常时间1周组为10~20 d,平均(15.5±1.9)d;2周组8~17 d,平均(13.4±1.2)d,两组差异有统计学意义。术后1、3、6个月,患者膝关节活动度均较术前明显好转(P0.05);术后1个月,2周组膝关节活动度较1周组明显好转(P0.05);术后3、6个月,两组膝关节活动度差异无统计学意义。术后1、3、6个月,患者膝关节Lysholm评分均较术前明显好转(P0.05);术后1个月,2周组膝关节Lysholm评分较1周组高(P0.05);术后3、6个月,两周组膝关节Lysholm差异无统计学意义。所有患者术后3个月膝关节功能均已稳定,根据Lysholm评分,术后6个月1周组优3例,良6例,可1例;2周组优5例,良7例,可1例;两组差异无统计学意义。结论:采用关节镜技术治疗老年膝关节化脓性关节炎创伤小,清创彻底,有利于炎症的消除和膝关节功能的恢复,术后推荐冲洗2周,有利于患者膝关节功能早期康复。     

一期人工关节置换治疗晚期活动性膝关节结核

目的探讨一期病灶清除人工关节置换术治疗晚期活动性膝关节结核的可行性及疗效。方法回顾性分析2009年3月至2019年3月在我院骨科中心行一期人工膝关节置换术治疗晚期活动性膝关节结核的15例病人的临床资料,其中男5例(6膝),女10例(10膝),平均年龄为53.9岁(26~77岁),入院时均有膝关节疼痛,膝关节不同程度出现畸形、活动受限,4例出现膝关节强直。术中均采用骨水泥型膝关节假体。收集15例病人入院后首次、术前、术后1周、术后1个月、术后6个月、末次随访时的C反应蛋白(C-reactive protein,CRP)、红细胞沉降率(erythrocyte sedimentation rate,ESR),术前和末次随访时的美国特种外科医院(Hospital for Special Surgery,HSS)膝关节评分和膝关节活动度(range of motion,ROM),以及假体稳定性、结核复发情况。结果所有病人获得12~88个月随访,术后规律抗结核治疗12~18个月。12例术后病理检查见典型的结核性肉芽肿,3例抗酸染色阳性。随访期间1例复发,进行病灶清除术后治愈。ESR和CRP均在术后6个月内基本恢复正常,不同时间的数值整体比较,差异均有统计学意义(P均<0.05)。末次随访时,所有病人未见结核复发,X线检查未见假体松动,膝关节HSS评分由术前的(43.4±9.4)分增加至(82.7±7.5)分,ROM由49.3°±31.3°增加至86.0°±32.5°,手术前后的数值比较,差异均有统计学意义(t=-13.231,P<0.001;t=-5.500,P<0.001)。结论在手术前后规律抗结核治疗、术中彻底病灶清除的前提下,一期人工关节置换治疗晚期活动性膝关节结核可以控制感染,解除疼痛,重建膝关节功能,复发率较低,远期疗效仍需进一步观察研究。     

Effect of perioperative parecoxib on postoperative pain and local inflammation factors PGE2 and IL-6 for total knee arthroplasty: a randomized,double-blind,placebo-controlled study

To assess the efficacy of postoperative pain management and the concentration change of PGE-2 and IL-6 of joint fluid with parecoxib after postoperative total knee arthroplasty. In the study, 100 patients experiencing primary TKA were randomly divided into study group, receiving parecoxib sodium (40 mg) intravenously (IV) at the completion of surgery and once every 12 h for totally 6 times postoperatively, and placebo group, receiving normal saline 2 mL IV at the same time points. Efficacy was assessed by total amount of morphine consumed, pain intensity, range of motion (ROM), the concentration change of PGE-2 and IL-6 of joint fluid, and postoperative nausea and vomiting (PONV) postoperatively. Patients in study group consumed significantly less morphine, experienced significant less pain scores, and obtained significantly more ROM (P < 0.01) compared with that in placebo group during 3 days postoperatively. The concentration of PGE-2 and IL-6 of joint fluid in study group are significantly lower than that in placebo group (P < 0.01) during 24 h postoperatively. The overall incidence of PONV was low and was not significantly different between the two groups. The present study demonstrated that the perioperative administration of parecoxib after primary TKA resulted in significantly improved postoperative analgesic management as defined by reduction in opioid requirement, lower pain scores and ROM, and significantly lowered local inflammation factors PGE2 and IL-6.     

经皮神经电刺激在全膝关节置换术后多模式镇痛中的应用研究

目的：观察经皮神经电刺激治疗在全膝关节置换术后多模式镇痛方案中的应用疗效.方法：2009年3月至2012年5月在浙江省中医院骨伤科就诊,诊断为膝骨性关节炎需行单侧全膝关节置换术的患者60例,分为试验组和对照组,每组30例.所有患者术前口服塞来昔布,术中行膝关节腔周围注射,术后口服塞来昔布、硫酸吗啡控释片.试验组术后增加使用经皮神经电刺激治疗,每日1次.患者于术后24h开始做膝关节功能锻炼.记录患者术后各时间点疼痛视觉模拟评分、膝关节活动角度、不良反应等.结果：术后24、48、72 h及术后1周,试验组患者的疼痛评分分别为3.39±0.69,2.79±0.51,2.16±±0.52,1.07±0.57,均低于对照组患者的3.80±0.86,3.22±0.58,2.53±0.54,1.38±0.52.术后24、48、72 h及术后1周、2周,试验组患者的膝关节被动活动角度分别为（30.67±3.65）°,（39.17±3.96）°,（47.83±4.86）°,（93.67±7.30）°,（107.67±7.51）°;术后72 h及1、2周主动活动角度分别为（29.83±5.33）°,（78.33±8.24）°,（95.17±5.94）°;均高于对照组的（28.67±3.92）°,（36.83±4.25）°,（45.17±5.17）°,（89.83±7.25）°,（103.17±7.37）°和（24.17±10.26）°,（73.83±9.07）°,（91.33±7.42）°.试验组19例膝部皮肤出现不同程度环形瘀血性压迹,5例出现局部水泡.结论：将经皮神经电刺激治疗应用于全膝关节置换术后多模式镇痛可以降低患者术后疼痛评分,促进术后膝关节功能尽早恢复.     

Range of motion and function are similar in patients undergoing TKA with posterior stabilised and high-flexion inserts

It is debatable whether high-flexion (HF) total knee arthroplasty (TKA) designs will improve postoperative flexion and function or will diminish the need for manipulation under anaesthesia (MUA). We retrospectively analysed range of motion (ROM), flexion, Knee Society Score (KSS), and rate of MUA in a consecutive group of patients who underwent TKA with a conventional posterior stabilised (PS) insert or an HF insert using identical surgical technique, implant design, and postoperative care. Fifty TKAs with a standard PS insert were matched for patient’s age, gender, preoperative ROM, and KSS with 50 TKA performed with an HF insert. The patient’s ROM and KSS were evaluated at six weeks, four months, and one year postoperatively. The outcome variables (flexion, ROM, KSS, and manipulation rate) in both groups were compared using the generalised estimating equations method. A second analysis of patients with preoperative flexion ≥120° was performed. The ROM, flexion, and patient-reported KSS was similar in both groups at each time period. The rate of MUA was also similar. Patients with a preoperative ROM of at least 120° showed similar results. Our study found that one year after surgery, patients who underwent TKA with a PS or an HF insert achieved similar flexion, ROM, and function.     

Arthroscopically assisted treatment of adolescent knee joint tuberculosis

Objective: To evaluate the role of knee arthroscopy in diagnosis and treatment of knee joint synovitis and total joint tuberculosis (TB) of adolescence. Methods: Forty‐one patients with knee TB, aged 7–16 years, were treated using knee arthroscopy from June 2002 to December 2006. Clinical data were reviewed at followed up and evaluated using the Lysholm score. Results: Among the 41 patients, 36 were diagnosed as having TB on the basis of preoperative clinical manifestations and laboratory results, and the remaining 5 as synovitis preoperatively, TB being confirmed postoperatively by arthroscopy and pathological examination. Specimens from 37 patients were confirmed as tuberculosis by pathological examination, while the other 4 were reported as chronic synovitis and necrotic tissue. Patients were followed‐up for 6–58 months postoperatively (average, 43.5 months). All patients were treated with knee arthroscopy surgery and postoperative medication and no relapses occurred over the duration of follow‐up. The mean Lysholm score was 91.4 points. The range of movement of the knee joint in 6 patients remained at 70°–110°. Two patients retained an extension lag of 10° and 25°, respectively. Conclusion: Diagnosis and treatment of adolescent TB is different from that of other TB patients. Arthroscopically assisted treatment of adolescent knee joint TB has the advantages of early diagnosis, minimization of trauma, thorough clearance and rapid recovery. Early treatment with arthroscopically assisted debridement, early rehabilitation and postoperative medication can preserve maximal function of knee joint and avoid arthrodesis. This is an ideal method for the treatment of adolescent knee TB.     

C-reactive protein levels after 4 types of arthroplasty

Background and purpose Postoperative C-reactive protein (CRP) levels in serum appear to reflect surgical trauma. We examined CRP levels after 4 types of arthroplasty.

Material and methods We investigated 102 patients who had total knee arthroplasty (TKA), computer navigation-assisted total knee arthroplasty (NAV-TKA), hip resurfacing arthroplasty (metal on metal, MMSA) and total hip arthroplasty (THA), respectively. CRP levels were estimated before surgery and postoperatively at 2 and 7 days.

Results Postoperatively, the peak CRP levels were highest on the second day after surgery in each of the groups. The peak CPR levels after hip resurfacing were lower than those after conventional primary THA. The peak CRP levels after computer navigation-assisted TKA were lower than those after conventional primary TKA.

Interpretation The extent of bone and bone marrow injury rather than the region of surgery or the amount of soft tissue damage appears to determine the extent of the postoperative CRP response.     

Characteristics of anterior tibial translation with active and isokinetic knee extension exercise before and after ACL reconstruction

 The aim of this study was to investigate the biomechanical characteristics of anterior tibial translation (ATT) in anterior cruciate ligament (ACL)-deficient or -reconstructed knees with active and isokinetic knee extension exercise. Forty-nine patients with unilateral isolated ACL-deficient knees were enrolled. Follow-up examinations were carried out at a mean of 24 months postoperatively. An electrogoniometer system was applied to compare the amount of ATT in ACL-deficient and -reconstructed knees. For both active and isokinetic knee extension, the mean ATT of ACL-deficient knees was considerably greater than that for the normal side, within a range of flexion 0°–70° and 0°–60°, respectively. In contrast, no mean ATT differences were seen during both active and isokinetic exercise from 90° to 0° at follow-up. Within a range of flexion between 50° and 70°, the side-to-side difference in ATT with active knee extension was significantly greater than that with isokinetic extension in ACL-reconstructed knees. These results suggest that the amount of ATT is significantly improved with both active and isokinetic exercise, postoperatively. However, postoperative ATT with isokinetic extension is smaller than that with active knee extension from 50° to 70°. Received: October 17, 2001 / Accepted: December 26, 2001     

Operative treatment of distal radial fractures with locking plate system-a prospective study

The aim of this study was to determine the results of operative treatment of distal radial fractures with a 2.4-mm locking plate system in a single tertiary teaching hospital. Seventy-five patients were recruited into the study between May 2004 and November 2006. There were 41 males and 34 females, with a mean age of 51. Seventy-five percent of patients had AO type C fractures. All patients were allowed free active mobilisation of the wrist joint immediately after surgery. They were followed up at two weeks, three months, six months, one year and two years. Assessments of pain, motion, grip strength, and standard radiographs were performed. The Gartland and Werley functional scores, the modified Green and O’Brien score, and the disabilities of the arm, shoulder and hand (DASH) scores were recorded. The radiographic results at the final follow-up showed a mean of 18° of radial inclination, 5° of volar tilt, 1.3-mm radial shortening, and no articular incongruity. Twenty-nine percent of patients showed grade 1 osteoarthritic changes and 6% had grade 2 changes in their final follow-up radiographs. An excellent or good result was obtained in 98% and 96% of patients according to the Gartland and Werley, and modified Green and O’Brien scores, respectively. The mean DASH score was 11.6, indicating a high level of patient satisfaction. Internal fixation of distal radial fractures with a 2.4-mm locking plate system provided a stable fixation with good clinical outcomes and patient satisfaction.     

Functional and radiological outcome after total knee replacement performed with mini-midvastus or conventional arthrotomy: controlled randomised trial

The results of minimally invasive techniques used for total knee replacement are controversial. Despite reported advantages such as faster recovery, there are some concerns regarding component positioning. We compared mini-midvastus versus medial parapatellar arthrotomy with respect to component position and functional results. We included 70 osteoarthritis total knee replacement patients in our study. Patients were randomised for the approach. We recorded Knee Society scores before and after the surgery and radiological component position. Patients were followed up to 12 weeks after the surgery. We found that the mini-midvastus approach was associated with better Knee Society scores six weeks after surgery; after 12 weeks the difference was not statistically significant. We found no difference related to the approach in radiological component position. The mini-midvastus approach is associated with faster recovery and reproduces the same accuracy in component positioning as the medial parapatellar approach.     

Three-dimensional analysis of accuracy of patient-matched instrumentation in total knee arthroplasty: Evaluation of intraoperative techniques and postoperative alignment

BackgroundIt is questionable that the accuracies of patient-matched instrumentation (PMI) have been controversial, even though many surgeons follow manufacturers' recommendations. The purpose of this study was to evaluate the accuracy of intraoperative procedures and the postoperative alignment of the femoral side using PMI with 3-dimensional (3D) analysis.MethodsEighteen knees that underwent total knee arthroplasty using MRI-based PMI were assessed. Intraoperative alignment and bone resection errors of the femoral side were evaluated with a CT-based navigation system. A conventional adjustable guide was used to compare cartilage data with that derived by PMI intraoperatively. Postoperative alignment was assessed using a 3D coordinate system with a computer-assisted design software. We also measured the postoperative alignments using conventional alignment guides with the 3D evaluation.ResultsIntraoperative coronal alignment with PMI was 90.9° ± 1.6°. Seventeen knees (94.4%) were within 3° of the optimal alignment. Intraoperative rotational alignment of the femoral guide position of PMI was 0.2° ± 1.6°compared with the adjustable guide, with 17 knees (94.4%) differing by 3° or less between the two methods. Maximum differences in coronal and rotation alignment before and after bone cutting were 2.0° and 2.8°, respectively. Postoperative coronal and rotational alignments were 89.4° ± 1.8° and −1.1° ± 1.3°, respectively. In both alignments, 94.4% of cases were within 3° of the optimal value. The PMI group had less outliers than conventional group in rotational alignment (p = 0.018).ConclusionsOur 3D analysis provided evidence that PMI system resulted in reasonably satisfactory alignments both intraoperatively and postoperatively. Surgeons should be aware that certain surgical techniques including bone cutting, and the associated errors may affect postoperative alignment despite accurate PMI positioning.     

胫骨高位嵌插截骨与传统高位截骨治疗高龄屈曲型膝内侧间隙骨关节炎的对比研究

目的:报告胫骨高位嵌插截骨治疗高龄屈曲型膝内侧间隙骨关节炎的方法疗效,并与传统高位胫骨截骨的疗效进行比较。方法:2003年7月至2007年7月对年龄60～82岁,病史3～20年,屈曲度7°～19°的膝内侧间隙骨关节炎的30例患者随机分成2组,分别进行胫骨高位嵌插截骨和传统高位截骨手术治疗。术后观察骨折愈合时间、膝关节内翻畸形和屈曲畸形恢复、膝关节功能恢复等情况。要求患者术后第4、6、8、9、10、12、14、16周及5、7、9、12个月复查,记录骨折愈合时间及内翻、屈曲角度纠正情况。术后12个月时根据Lysholm膝关节评分标准进行评分,并对2组的疗效进行比较。结果:胫骨高位嵌插截骨组平均骨折愈合时间(9.26±2.23)周,传统高位截骨组平均(11.53±3.15)周,2组相比差异有统计学意义(P0.05)。膝关节功能恢复方面,术后1年,根据Lysholm评分标准进行评分,胫骨高位嵌插截骨平均(88.5±4.4)分,优14例,良1例;传统高位截骨组平均(78.1±5.7)分,优8例,良5例,可2例。胫骨高位嵌插截骨组术后膝关节伸直位角度0°～-1.1°,术后平均矫正(13±3.3)°;传统高位截骨组术后膝关节伸直位角度与术前相同,为(14°±3.3)°。两组术后站立位X线测量,FTA平均170.2°(l69.1°～172.3°),平均矫正12.3°～12.5°。结论:胫骨高位嵌插截骨手术治疗膝关节内侧间隙骨关节炎缩短了骨折愈合时间,同时矫正了膝关节内翻畸形和屈曲畸形,更好地恢复了膝关节的功能,此手术方式明显优于传统的高位截骨术。     

Structural allografting in revision total knee arthroplasty

Between 1985 and 1991, 15 patients underwent structural allografting as part of revision total knee arthroplasty. All patients had large segmental, cavitary, or combination defects of the femur and/or tibia. Seven distal femurs and 12 proximal tibias required allografting. Patients were evaluated with physical examination, radiographs, and The Hospital for Special Surgery knee rating scale. Three patients died, leaving 15 allografts for follow-up study. The average age at surgery was 63 years. The follow-up period averaged 47 months (range, 30–101 months). Average range of motion before surgery was 4° to 93°, and after surgery, 2° to 104°. Average knee score was 47 before and 86 after surgery. Preoperative alignment averaged 5° varus, ranging from 25° valgus to 20° varus, and postoperative alignment averaged 4° valgus, ranging from neutral to 6° valgus. All patients, except one, had improvement of pain and stability. All of the 15 allografts healed to host—bone and 13 showed evidence of incorporation. There were no infections or fractures of the allografts. One complication directly related to the allograft occurred; that patient had a tibial component fracture over a proximal tibial allograft 3 years after surgery. Three other complications occurred. One was tibial loosening in a patient who received a distal femoral allograft, the second was a proximal tibial fracture in a patient who received a distal femoral allograft, and the third was an intraoperative patellar tendon avulsion. These results suggest that structural allografting can provide a satisfactory method of managing large bone defects in the failed total knee arthroplasty.