新型国产膝关节假体用于全膝关节置换术的临床研究

目的 通过随机对照临床试验,验证新型国产膝关节假体临床应用的安全性和有效性.方法 本研究采用多中心、随机、单盲、阳性平行对照设计,自2017年3月至2019年3月在全国6家医院共招募72例受试者,试验组和对照组各36例.试验组使用新型国产膝关节假体,对照组使用成熟的膝关节假体.所有受试者在术前和术后3个月、6个月、1年...     

膝关节置换术的围术期区域镇痛方式选择

高质量的围术期疼痛管理对于全膝关节置换术(TKA)后的快速康复和改善功能恢复都十分重要。随着区域麻醉技术的发展和超声在麻醉镇痛领域的应用,股神经阻滞、坐骨神经阻滞和收肌管阻滞等区域麻醉技术以其可靠的镇痛效果和较少的全身不良反应在术后镇痛中的应用比例逐渐提高。局部切口浸润的应用也越来越广泛。无论采用哪种方法,重要的临床需求都是改善功能锻炼期间的镇痛效果和充分保留下肢运动功能。临床实践一直在探索一种安全、持久、有效和无运动神经阻滞的镇痛方法,或多种方法的联合应用,因此,现阶段仍鼓励为TKA患者提供多模式镇痛。     

两种截骨顺序在全膝关节置换术中的应用比较

目的比较两种截骨顺序在全膝关节置换术（TKA）中的临床应用效果。方法回顾性分析2010年11月—2013年9月安徽医科大学附属省立医院行TKA的80例（80膝）膝关节骨性关节炎患者的临床资料,根据截骨顺序不同分成两组：观察组40膝,先行股骨截骨;对照组40膝,先行胫骨截骨。比较两组手术时间、术中胫骨内、外侧平台显露前后径范围、术后引流量、术前术后膝关节功能情况及HSS评分,并进行统计学分析。结果两组80例患者均获得随访6—14个月（平均11．3个月）。手术时间和术后引流量观察组分别为（53．4±13．8）min和（310±46）ml,对照组分别为（72．5±14．7）min和（425±40）ml,差异均有统计学意义（t值分别为5．99、11．93,P值均〈0．01）;胫骨外侧平台显露前后径观察组为（44．1±3．7）mm,对照组为（21．8±3．3）mm,差异有统计学意义（t=28．45,P〈0．01）;胫骨内侧平台显露前后径观察组为（45．6±3．5）mm,对照组为（43．5±4．2）mm,差异无统计学意义（t=2．43,P〉0．05）;观察组术后6周和12周的膝关节活动度分别为87．6°±14．2°和103．6°±7．4°,对照组分别为88．6°±13．6°和102．3°±6．8°,差异均无统计学意义（t值分别为0．32和0．82,P值均〉0．05）;观察组术后6周和12周的HSS评分分别为（90．12±8．6）分和（91．66±6．6）分,对照组术后6周和12周的HSS评分分别为（89．45±9．9）分和（91．87±7．5）分,差异均无统计学意义（t值分别为0．32和0．13,P值均〉0．05）。结论TKA中先行股骨截骨可以使胫骨的显露更为充分,起到简化手术操作,减少术中失血,缩短手术时间的作用。     

超声引导下股神经阻滞在膝关节置换术患者中的应用价值分析

目的探讨超声引导下股神经阻滞在膝关节置换术患者中的应用价值。方法选取2018年3月至2019年9月在我院行膝关节置换术的92例患者作为研究对象,采用随机数字表法将其分为对照组和观察组,每组各46例。对照组患者给予常规镇痛药物治疗,观察组患者给予超声引导下肢神经阻滞镇痛治疗。比较两者患者镇静满意度、静息8、12、24及48h的疼痛视觉模拟评分(VAS)和不良反应发生情况。结果观察组患者镇静满意度明显高于对照组,静息8、12、24及48h的VAS评分均明显低于对照组,不良反应发生率明显低于对照组,差异具有统计学意义(P0.05)。结论超声引导下股神经阻滞应用于膝关节置换术中,能提高患者镇静满意度,改善患者疼痛程度,减少不良反应的发生。     

连续股神经阻滞对全膝关节置换术后镇痛及早期康复的影响

目的评估全膝关节置换术后硬膜外镇痛和连续股神经阻滞镇痛的效果及对患膝关节功能恢复的影响。方法40例ASA Ⅰ～Ⅲ级拟行单侧全膝关节置换术的患者被随机分为两组,每组20人。第1组（CFB）采用全麻加股神经阻滞,第2组（EPI）采用全麻加硬膜外置管。两组均术后当天注射一次,术后每天早晚8点各注射一次,持续72 h,每次注入0.33%罗哌卡因30 ml。主要观察指标：术后4、8、12、24、48、72 h静止和运动时的疼痛视觉模拟评分（VAS）、术后疼痛分值、镇痛满意度、副作用及患肢膝关节术前/术后的活动度（ROM）。结果两组患者基线资料比较差异无统计学意义（P〉0.05）,具有可比性。术后两组在静息和运动时的疼痛直观可比较度（VAS）的分值、术后疼痛分值、镇痛满意度上无统计学意义（P〉0.05）。EPI组尿潴留发生率明显高于CFB组（P〈0.001）,而恶心、呕吐、搔痒、头痛发生率高于CFB组,但两组差异均无统计学意义（P〉0.05）。术后两周时CFB组患者膝关节的主、被动活动度均比EPI组高,但只有被动活动度差异有统计学意义（P〈0.001）,主动活动度差异无统计学意义（P〉0.05）。结论硬膜外镇痛和连续股神经阻滞都能充分缓解全膝关节置换术术后疼痛,能够加大患膝近期的活动度。但连续股神经阻滞副作用少,更利于患膝关节术后的功能恢复,值得推荐。     

收肌管阻滞不同输注方式对全膝关节置换术后镇痛的效果

目的:观察收肌管阻滞不同输注方式用于全膝关节置换术后的镇痛效果.方法:拟行全膝关节置换术患者60例,美国麻醉医师学会(American Society of Anesthesiologists,ASA)II或III级,年龄65～77岁,随机分为2组(n=30):程序间歇式输注组(P组)和恒速输注组(C组).术毕给予负荷...     

全膝关节置换术后膝关节屈曲角度的影响因素

膝关节屈曲角度是评定全膝关节置换手术效果的重要因素。本文回顾了近年来的相关文献,就影响全膝关节置换术后膝关节屈曲角度的几个因素如术前膝关节屈曲度、相关疾病和创伤、置换体类型、手术技巧、CPM的作用等进行了探讨,同时提出了一些待评估的可能的影响因素,从而为提高全膝关节置换术临床效果提供参考依据。     

人工膝关节表面置换术患者术后镇痛效果调查

目的对人工膝关节表面置换术患者术后镇痛效果进行评估。方法对2011年1月-2012年6月在北京协和医院行人工膝关节表面置换术的430名患者术后镇痛效果进行回顾性分析。结果连续股神经阻滞组视觉模拟评分低于静脉自控镇痛组。舒芬太尼和吗啡静脉自控镇痛效果类似,但舒芬太尼组恶心、呕吐不良反应发生率低于吗啡组。结论人工膝关节表面置换术术后疼痛评分高,单一的镇痛模式不能满足术后镇痛需求,应采用多模式镇痛方式,缓解术后疼痛,提高患者满意度。     

人工膝关节置换术的研究进展

人工膝关节置换术是关节外科领域一种常见的手术方式,它利用人工关节假体替代病变关节,消除膝关节疼痛,矫正关节畸形,改善关节功能,从而提高患者生活质量.随着科学技术和医学的发展进步,人工膝关节置换术在膝关节疾病的治疗中得到越来越广泛的应用.本综述对人工膝关节置换术手术方法选择及各种手术方式的优缺点进行归纳总结,以期为人工膝...     

Patient education and anesthesia choice for total knee arthroplasty

ObjectivesSpinal anesthesia (SA) for Total Knee Arthroplasty (TKA) may be associated with better patients’ outcomes. This study aims to assess the association between preoperative education about the advantage of SA over general anesthesia (GA) for TKA and the likelihood of patient choice of NA.MethodsPatients undergoing unilateral primary TKA were identified. Type of anesthesia (GA or SA), attendance of the (joints class), patient demographics, ASA status, anticoagulation status, and diagnosis of back problems were recoded. Regression analysis was used to assess the association between the type of anesthesia and attendance of the joints class.Results1010 patients were identified to have unilateral primary TKA. 31% of patients attended the joint class. Patients who attended the joints class were more likely to receive SA when compared to those who did not attend (OR = 1.7, CI: 1.2–2.5, P = 0.004) after adjusting for other variables.ConclusionPreoperative education about advantages of SA may be associated with an increase in patients receiving SA for TKA.Practice implicationsIncrease in patients receiving SA for TKA may improve outcomes.     

Early comparative outcomes of unicompartmental and total knee arthroplasty in severely obese patients

Background

Medial unicompartmental knee arthroplasty (UKA) may have advantages over total knee arthroplasty (TKA) in the setting of obesity. There has been no direct comparison between the two cohorts. This study compares outcomes and complications of severely obese patients undergoing medial UKA versus TKA.

Rating systems for total knee replacement

The objective assessment of outcome of surgical procedures is assuming increasing significance as the culture of audit and revalidation advances. There is a clear need for surgeons in all fields, but especially in Orthopaedics, to be familiar with the available scoring systems and their relative strengths and weaknesses. It is clear from a recent survey of BASK members’ practice that there is little consensus about which system to use (addendum). This review presents a summary of the scoring systems available for the assessment of patients undergoing total knee replacement. These scores are described in detail and their relative merits discussed. None of the systems reviewed is perfect but those developed most recently do appear to offer advantages over older systems. Overall, the Western Ontario and McMaster University Osteoarthritis Index, Short Form 36 and Oxford Knee Score have undergone the most thorough assessment of reliability and validity and are therefore appropriate for the assessment of outcome after total knee replacement.     

单侧全膝关节置换术后两下肢受力不对称性的影响因素

全膝关节置换术(total knee arthroplasty,TKA)是晚期膝骨关节炎最常见的手术治疗手段。已有研究发现,单侧TKA术后两下肢受力不对称,对侧膝关节承担更大载荷,从而使骨关节炎加重面临再次置换的风险。综述单侧TKA术后可能引起两下肢受力不对称的影响因素,主要介绍下肢力线、疼痛、肌肉、本体感受、心理原因等;同时探讨这些影响因素对人体总的影响效果、人体对不对称载荷的补偿机制以及临床干预手段。通过对单侧TKA术后两下肢受力影响因素的分析,可以制定针对性的临床干预手段,用以减小患者对侧膝关节发展为骨关节炎甚至置换的风险。     

The Genesis II in primary total knee replacement: a systematic literature review of clinical outcomes

Since its introduction in 1996, the Genesis II Total Knee System has produced good clinical results in patients undergoing primary total knee replacement. A systematic review of the literature-the first of its kind for this device-was undertaken to collect data on the Genesis II in order to provide a better understanding of its medium- to long-term performance. Of 124 Genesis II-related studies published in the literature, 11 met the eligibility criteria and were included in the final analysis. The included studies had a mean follow-up length of 38.1 months. Data from 1201 knees were available for review. Patients were an average of 70.5 years of age and predominantly female (63%). Findings indicated that the revision rate with this implant is low with up to 11.9 years of follow-up, with 14 revisions in total. The survival rate ranged from 100% at 1 and 2 years to 96.0% at 11.9 years. The mean Knee Society knee score improved 51.0 points from preoperative to postoperative evaluation. In conclusion, the Genesis II exhibited good clinical performance with up to 11 years follow-up, with an encouraging rate of survival and improvement in function. Additional studies with larger sample sizes and longer follow-up periods are needed to better understand the long-term performance of this implant.     

Preoperative proprioceptive training in patients with total knee arthroplasty

Proprioceptive deficiencies due to osteoarthritis and arthroplasty have been repeatedly reported. Proprioceptive training, which leads to an economisation of movements and supports energy-saving movement patterns, has become popular in athletes, but not in rehabilitation yet. The aim of this randomised phase IIb study was to evaluate whether preoperative proprioceptive training would influence postoperative balance and function in activities of daily life in patients undergoing total knee arthroplasty. Subjects with severe osteoarthritis of the knee scheduled for TKA were randomised to either a control group (CG) or a training group (TG). All patients were examined 6 weeks before and 6 weeks after TKA, patients of the TG also one day before surgery, i.e. after six weeks of preoperative proprioceptive training, in order to evaluate the influence of training without TKA. Evaluation included balance assessment using the Biodex Stability System, as well as measurements of gait speed and clinical outcome using the WOMAC and Knee Society Score. As opposed to the CG, stance stability improved significantly in the TG (Biodex OSI (p = 0.045), APSI (p = 0.029)) 6 weeks after TKA. There was a significant improvement in KSS, WOMAC pain and stiffness in both groups after TKA. Preoperative proprioceptive training in patients undergoing TKA resulted in improved standing balance, but no difference in clinical outcome was observed between the two groups.     

高海拔地区高龄患者全膝关节置换术后失血量评估和干预措施

目的调查高海拔地区高龄患者全膝关节置换术后失血情况及相应的干预时机、干预措施和干预效果。方法回顾性分析2017年5月至2018年5月在我院行初次单侧全膝关节置换术的62例60岁以上患者术后1 d、3 d、7 d的总体失血情况,并对失血相关的患者主诉症状、干预时机、干预措施和干预效果进行了评估。结果高海拔地区高龄患者全膝关节置换术后1 d、3 d、7 d的总失血量分别为(1 184.2±192.3)mL、(1 392.0±155.7)mL、(1 364.3±173.4)mL。以≥70岁行年龄分组,70岁区组中,术后1d、3d及7d的总失血量分别为(1181.8±192.3)mL、(1 398.4±148.1)mL、(1 437.4±173.6)mL。≥70岁区组中,术后1 d、3 d及7 d的总失血量分别为(1 174.2±167.4)mL、(1 277.5±172.6)mL、(1 298.0±141.9)mL,且两者间差异无统计学意义(P0.05)。18例患者术后主诉精神状态差,乏力明显,血红蛋白含量均高于80 g/L,但失血总量达(1 397.1±168.4)mL,予以中药补气血方后症状改善。结论高海拔地区高龄患者全膝关节置换术后总失血量与平原地区相比并无明显差异,术后常规使用中药补气血方对于改善术后失血及失血相关临床症状具有重要的临床价值。     

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。     

Component fracture in total knee arthroplasty

The records of 26 patients (27 knees) who sustained a fracture of a total condylar design total knee prosthesis were reviewed. Twenty-five fractures involved the tibial component and two involved the femoral component. Mean time to failure was 8.2 years for tibial components and 7.2 years for femoral components. The overall fracture prevalence rates were 0.33% and 0.03% for tibial and femoral components, respectively. Specific designs had increased fracture rates and revision arthroplasty increased the relative risk. Anatomic limb alignment exceeded 5 of varus or valgus in 24 of 25 knees with tibial component fractures. Lucencies were noted beneath all but one fractured tibial tray. However, 22 of 23 tibial components that had a keel or stem were well fixed distally and subsidence occurred only beneath the fractured portion of the prosthesis. Tibial component fractures are related to revision arthroplasty, prosthesis design, malalignment, and inadequate support beneath the tibial tray with good distal fixation.     

氨甲环酸在全膝关节置换中静脉应用的疗效对比

目的本文旨在比较氨甲环酸在全膝关节置换中不同时间静脉应用的止血疗效。方法自2015年6月至2017年6月,收录因晚期膝关节炎拟在我院行单侧全膝关节置换的患者,共180名,其中男性47名,女性133名。随机将病人分为A、B、C和D四组。A、B和C三组分别于上止血带前、后和缝合伤口松开止血带后静脉使用氨甲环酸(30 mg/kg),D组不做处理。记录并分析血红蛋白下降水平,术中失血量,术后失血量,输血人数和数量以及发生深静脉栓塞的病人数。结果 A组比B和C组静脉使用氨甲环酸在降低失血量,血红蛋白下降和减少输血率等方面更具优势(0.05)。B组和C组之间无明显差异,但是效果要优于D组(0.05)。结论在上止血带前使用氨甲环酸在降低失血量和减少输血方面更具有优势。