术前康复训练对全膝关节置换的近期疗效

目的：探讨全膝关节置换术前开展功能训练对术后近期的康复效果。方法：回顾分析自2005年6月-2008年6月111例124膝接受全膝关节置换的患者临床资料,43例48膝在术前术后均进行康复训练,68例76膝仅在术后行康复训练。结果：将两组患者术后下床活动时间、术后并发症、以及术后膝关节功能恢复等方面进行比较,差异有显著性意义。结论：加强全膝关节置换患者术前的康复功能训练,有利于减少术后并发症的发生率,并能有效增加术后膝关节的活动度和肌力。     

人工全膝关节置换患者的康复训练

人工膝关节表面置换在治疗膝关节、骨关节等疾病中的应用不断增加,以达到减轻或解除疼痛、纠正畸形、改善关节活动及提高生活质量的目的。合理有效的康复训练对治疗效果具有重要意义。本文通过对人工全膝关节表面置换术后患者进行全程计划性功能康复训练,包括心理康复指导、围手术期的康复指导及出院指导,提高患者参与康复的积极性,使患者掌握康复训练的知识和技巧,最终使手术关节功能恢复较为满意。     

影响全膝关节置换早期功能恢复的因素

对１０例１４个全膝关节置换术后早期功能恢复情况及影响功能的一些因素进行了探讨。１０例平均随访时间１１．６个月；平均膝关节屈曲度为：９６．５°。平均ＨＳＳ为８２．８分。我们认为，要想获得全膝关节置换早期良好的功能结果，需注意以下几点：一是认真掌握手术指征，术前对病变的膝关节有一定客观的评判；二是术者需具备一定的手术技巧和临床经验，术中必须严格手术操作；三是术后合理使用ＣＰＭ，术后三个月和半年期间，更     

影响全膝关节置换早期功能恢复的因素

对10例14个全膝关节置换术后早期功能恢复情况及影响功能的一些因素进行了探讨。10例平均随访时间11.6个月;平均膝关节屈曲度为:96.5°。平均HSS为82.8分。我们认为,要想获得全膝关节置换早期良好的功能结果,需注意以下几点:一是认真掌握手术指征,术前对病变的膝关节有一定客观的评判;二是术者需具备一定的手术技巧和临床经验,术中必须严格手术操作;三是术后合理使用CPM,术后三个月和半年期间,要指导和督促病人进行院外的膝关节功能训练。     

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.     

全膝关节表面置换治疗严重膝关节畸形

目的探讨人工全膝关节表面置换术(TKA)治疗严重膝关节畸形临床疗效。方法应用全膝关节表面置换治疗严重膝关节畸形36例(48膝)。使用HSS评分标准评估分析术前、术后膝关节功能及术后疼痛、膝关节活动度的改善情况。43膝采用后稳定型人工全膝关节假体,5膝采用CCK型人工全膝关节假体。结果术后早期均无感染等并发症发生。术后X线片示假体位置良好,下肢力线良好。患者均获得随访,时间6～18个月。HSS评分术前为(41±5.3)分,术后6个月为(87.7±6.5)分。手术优良率为83.3%。患者疼痛、功能方面及活动度均有明显改善。结论全膝关节置换术对严重膝关节畸形的治疗效果满意。但应严格掌握手术适应证。     

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.     

NexGen LPS Flex全膝关节置换的近期疗效观察

目的探讨高屈曲型NexGen LPS—Flex人工全膝关节置换的近期疗效。方法41例（47膝）行高屈曲型NexGen LPS-Flex人工膝假体置换。术前、术后测量膝关节活动度,并根据HSS膝关节评分系统进行评估。结果获随访32例（38膝）,时间12～42（28．03±8．86）个月。活动度从术前平均67．45°±10．50°改善到术后平均125．68°±10．14°。各种并发症的发生率低。术前HSS评分平均为44．7分±11分,术后HSS评分平均为90．3分±12分;根据HSS评分系统评定疗效：优14例,良16例,中2例,优良率达93．75％。结论高屈曲型NexGen LPS—Flex全膝关节置换的近期临床效果满意,长期效果还需进一步观察。     

人工全膝关节置换

作者行人工全膝关节置换术22例,对12例患者进行随访。患者平均年龄54.6岁,平均随访时间4年10个月,疗效满意。作者认为TKR适应证取决于疾病种类和程度以及患者所面临的社会生活要求。只要手术适应证严格选择,正确的手术技术和术前、后处理,病人将获得预期的手术效果。     

全膝关节置换术髌骨置换与否的比较

目的回顾性分析、比较全膝关节置换术髌骨置换与否的疗效及优缺点,为临床治疗提供参考。方法自1994年1月～2000年12月间住院治疗的骨关节炎及类风湿性关节炎患者86例(109膝)。对髌骨置换和未置换的两组患者进行随访,膝关节评分采用美国HSS评分系统,髌骨评分采用Feller等的髌骨评分标准。随访时拍摄膝关节正、侧位及髌骨30°、90°轴位X线片。结果使用SPSS统计软件进行统计学分析。结果置换组与未置换组术后疗效及并发症的发生率无明显差异,髌骨功能评分差异有非常显著性意义(P<0.01)。置换组部分功能(上下楼梯及从椅子上坐起)略好于未置换组,未置换组术后膝前痛的发生率高于置换组,但多为轻度,差异有显著性意义(P<0.05)。术后髌骨不稳定和半脱位的发生率无统计学差异。结论髌骨不稳定的发生与术前畸形明显及术前髌骨外侧偏移倾向有关,是造成未置换组膝前痛的因素之一。未置换组髌骨不稳定与髌骨分型有关,建议如果术前拍摄髌骨轴位X线片时发现髌骨属于Ⅲ型者应置换髌骨。     

Educational Attainment Affects the Early Rehabilitation of Total Knee Arthroplasty in Southwest China

ObjectiveTo assess if the educational level of patients in Southwestern China will affect the functional recovery after total knee arthroplasty (TKA).MethodsThis retrospective study included a total of 334 patients (48 males, 286 females, with an average age of 68 years, range from 51 to 84 years) who had undergone primary unilateral TKA from March 2017 to April 2018. Patients were screened for enrollment and classified into four groups (illiterate group, the primary school group, high school group, and university group) according to their educational attainment. All patients were monitored for at least 2 years after TKA. The primary outcome was determined using the Hospital for Special Surgery knee (HSS) score at the time of follow‐up. The secondary outcomes were determined using the 12‐Item Short Form Health Survey (SF‐12) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, the satisfaction level, and complications of the surgery.ResultsThree hundred and thirty‐four patients were divided into four groups based on their highest educational level: 83 patients in the illiteracy group, 84 in the primary school group, 91 in the high school group, and 76 in the university group. They were followed up for at least 2 years. For the primary outcome, patients with high school and university education had noteworthy better HSS scores on the surgical‐side knee than those in the primary school and illiterate groups (illiteracy group 86.71 ± 5.94 vs primary school group 85.36 ± 5.88 vs high school group 89.48 ± 3.66 vs university group 88.95 ± 3.55; P < 0.05). For secondary outcomes, the mental component summary (MCS) in the university group was significantly lower than the other three groups (P < 0.05). The results of WOMAC scores were consistent with the results of the HSS score: patients in the university group and the high school group had better results when compared with the other two groups (P < 0.05). There were no statistical differences in the comparison of additional indicators and complications among the four groups, but more patients (12 peoples, 15.8%) in the university group were dissatisfied with knee function after TKA.ConclusionIn Southwest China, patients with high school education or above can achieve better joint function after TKA but do not get better postoperative satisfaction, which may be related to the patients'' higher surgical expectations for social and mental needs.     

人工全膝关节置换术治疗重症膝关节疾病的临床疗效

目的：探讨人工全膝关节置换术治疗严重膝关节疾病的临床疗效及方法。方法：2004年6月-2009年6月,对92例重症膝关节疾病（106膝）使用后稳定型TKA。其中9例（10膝）为类风湿性关节炎,3例（3膝）为创伤性关节炎,80例（93膝）为晚期严重骨性关节炎,5例（5膝）合并外翻畸形,50例（60膝）合并内翻畸形。所有患者进行10个月．5年（平均30个月）的随访,并应用HSS膝关节评分系统进行分析。结果：手术优良率为94．34％,患者术后在膝关节疼痛、功能及关节活动度等方面都有明显改善,提高了生活质量,各种并发症的发生率低。结论：人工全膝关节置换术是治疗严重膝关节疾病的有效方法,严格适应证的选择、正确进行TKA的手术操作、各种并发症的防治和积极术后康复锻炼是取得满意临床效果的保证。     

人工全膝置换在严重膝内翻畸形患者中的应用

目的观察保留后交叉韧带人工全膝置换治疗严重膝内翻畸形患者的临床结果.方法回顾性分析1990年1月～1995年7月间严重膝内翻畸形骨关节炎患者(≥20°)人工全膝置换后的临床结果.假体为Miller-Galante-Ⅰ人工全膝(MG-Ⅰ,Zimmer公司).采用KSS评分对临床结果进行评估.结果38人56膝获完整随访,平均随访6(4～9)年.术前至最后一次随访,平均膝评分从33分提高到91分,其中84%优秀;平均膝关节功能评分自39增加到76分;两者的改善均有统计学意义(P＜0.01).86%的患者膝关节活动度超过90°,多数病例(50/56)术后膝关节力线正常,6例残留5～10°内翻畸形.总翻修率21%(12/56),平均翻修时间为术后5.5年.其它并发症包括髌骨半脱位,膝前痛,浅表感染.无深部感染、假体松动及前后向不稳.结论保留后交叉韧带人工全膝可矫正严重膝内翻畸形,术后内、外向不稳问题常致假体早期失败.     

Effectiveness and Safety of Tourniquet Application Strategies in Total Knee Arthroplasty: a Meta-analysis

BackgroundWe conducted the present meta-analysis to assess the effectiveness and safety of long-duration tourniquet and short-duration tourniquet for patients with total knee arthroplasty (TKA).MethodsPublished randomized controlled trials (RCTs) were identified from the following electronic databases: PubMed, Embase, Web of Science and Cochrane Library from inception to January 1, 2021. Studies comparing long-duration tourniquet and short-duration tourniquet in total knee arthroplasty were included. Either a random-effects model or a fixed-effects model was used for meta-analysis depending on the heterogeneity. Statistical analysis was assessed using RevMan 5.3 software.ResultsA total of 8 RCTs with a total of 484 patients were eligible and ultimately included in the meta-analysis. Compared with patients in the long-duration tourniquet, those in the short-duration tourniquet were significantly correlated with postoperative drainage volume (WMD = -71.85, 95% CI − 76.52 to − 67.17, P = 0.31), but an increased risk of total blood loss (WMD = 68.13, 95% CI 5.15–131.12, P = 0.03) and intraoperative blood loss (WMD = 137.13, 95% CI 69.06–205.20, P < 0.00001). Two groups showed no significant difference in operation time, visual analogue scale score of knee in early, transfusion rate and incidence of deep venous thrombosis.ConclusionsOur meta-analysis suggested that the short-duration tourniquet in TKA significantly decreased the postoperative drainage volume, increased the total blood loss and intraoperative blood loss. However, it did not marked decrease the occurrence of transfusion rate. Although the incidence of deep venous thrombosis was reduced in some study, it was not statistically significant. Additional high quality RCTs are needed to identify the hypothesis. Therefore, we recommend prolonged use of tourniquets during TKA surgery.     

Preoperative Templating and Computer-Assisted Total Knee Arthroplasty for Arthritic Valgus Knee

We reported the functional outcomes, component alignment and optimal thickness of the tibial inserts and joint line changes of 21 arthritic valgus knee deformities using preoperative templating and computer-assisted total knee arthroplasty(TKA). The osseous cut was modified using a novel preoperative templating technique. Soft tissue balance and component implantation were implemented with the aid of a computed tomography-free navigation system. The arthritic valgus knees had clinical, and functional improvement of the knee Society scores and Lysholm scores postoperatively, at an average of 37.8 ± 7.2 months. The mean anatomic axis (15.2° ± 4.5° vs. 6.1° ± 1.4°) and mechanical axis (8.3° ± 5.2° vs. 0.28° ± 1.6°) were also significantly improved postoperatively. The mean thickness of tibial inserts and joint line changes was 10.7 ± 1.46 mm and 0.1 ± 1.4 mm. This computer-assisted technique with preoperative radiographic templating is an alternative strategy to improve TKA results in arthritic valgus knees.     

全髋关节置换及其康复治疗

康复治疗直接影响全髋关节置换术的疗效，它能帮助病人尽快恢复关节功能，防止手术后各种并发症的产生。为此，作者制定了一整套的人工全髋关节置换术围手术期康复治疗的方法。它包括康复前的评估，术前、术后康复治疗常规及术中影响康复治疗的一些因素。自１９９０年以来，作者对３１例全髋关节置换术病人采用康复治疗的方法，效果满意。