胫骨高位截骨对胫骨近端解剖形态的影响

[目的]测量胫骨高位截骨术后胫骨近端解剖形态,并与术前比较,探讨其变化的临床意义.[方法]2001～2005年,35例(59膝)因膝关节内侧室骨性关节炎接受胫骨高位截骨术患者的完整影像学资料,在术前、术后标准正侧位X线片中测量胫骨角;胫骨后倾角度;胫骨近端关节面外移;关节线高度.所得资料采用配对t检验进行统计学分析,以P＜0.01为差异有显著性意义.[结果]胫骨角术前平均为99.1°±4.3°,术后平均为91.1°±3.8°;胫骨后倾角度术前平均为8.9°±2.6°,术后平均为5.0°±2.3°;胫骨近端关节面外移术前平均为(46.2±3.6)%,术后平均为(53.1±3.9)%;关节线高度术前平均(41.2±3.6)mm,术后平均(38.0±3.2)mm.手术前后差异均有显著性意义(P＜0.01).[结论]胫骨近端解剖形态在胫骨高位截骨术后会发生明显变化,如胫骨角变小,后倾角度变小,胫骨近端关节面外移,关节线高度相对下降等,将对转行全膝关节置换术产生不良影响.     

全膝表面置换治疗膝骨性关节炎合并胫骨平台骨缺损

[目的]探讨骨性关节炎合并胫骨平台骨缺损在全膝表面置换术中的处理方法。[方法]膝关节骨性关节炎内翻畸形伴胫骨平台骨缺损22例27膝行全膝表面置换术,分别记录手术前后膝关节内翻畸形程度,HSS评分,活动范围,并进行比较。[结果]所有患者均获得平均(27.6±7.2)个月(6个月⁶年)随访,膝关节HSS评分由术前的45.6分提高到末次随访时的平均89.7分,下肢畸形及关节功能明显改善。[结论]胫骨平台骨缺损性膝关节骨性关节炎行TKA,对骨缺损行有效处理和植骨可取得良好疗效。     

胫骨高位截骨术治疗膝关节骨性关节炎

自１９９０年５月－１９９５年１２月，应用膝关节外固定加压融合器行高位径骨截骨术治疗伴有膝内翻畸形的骨性关节炎１０例１０膝，并随访６个月－５年半，平均３年９个月。术后结果，股胫角由术前平均１８４．７°矫正到平均１７０．３°。评分由术前平均４７分，增加到平均８５分。手术采用胫骨楔形截骨，双期氏针加压外固定。术中同时行胫骨远端前移１ｃｍ，以改善髌股关节的负重关系。     

全膝关节置换术治疗晚期膝骨性关节炎

目的 探讨全膝关节置换术(TKA)治疗晚期膝骨性关节炎的临床疗效.方法 采用TKA治疗30例晚期膝骨性关节炎老年患者(33膝).比较手术前后膝关节最大被动屈曲度、HSS评分、疼痛VAS评分,采用HSS评分标准评价膝关节功能恢复情况.结果 患者均获得随访,时间6～24个月.未出现术后切口感染、深静脉血栓、假体松动等并发症...     

膝骨性关节炎分级治疗的疗效分析

目的评价非手术治疗、关节镜和全膝关节置换术治疗不同严重程度的膝骨性关节炎的效果.方法对采用这三种方法治疗的213例(304膝)患者,依据膝骨性关节炎严重性指数(ISOA)及Kellgren-Lawrance(K-L)X线分级标准不同进行分组,对治疗前后的ISOA进行回顾性分析.结果经3～62个月(平均20.6个月)的随访,K-L分级Ⅰ、Ⅱ和Ⅲ级且ISOA＜14者,非手术治疗组和关节镜组治疗前后ISOA均有显著性差异;K-L分级Ⅲ级且ISOA≥14、Ⅳ级者,全膝关节置换术组治疗前后ISOA有显著性差异.结论K-L分级Ⅰ、Ⅱ和Ⅲ级且ISOA＜14者,应选择非手术治疗或关节镜治疗;K-L分级Ⅲ级且ISOA≥14、Ⅳ级者,全膝关节置换术是唯一有效的方法.     

单髁置换治疗膝关节骨性关节炎效果观察

目的分析单髁置换术治疗膝关节骨性关节炎的效果。方法将60例单间室骨性关节炎患者按治疗方法的不同分为2组,每组30例。对照组接受全膝关节置换术,观察组接受单髁置换术。比较2组患者手术情况、术前术后关节活动度(ROM)及HSS评分等。结果 2组患者术前HSS评分、ROM活动度比较,差异无统计学意义(P0.05)。观察组手术时间、术中出血量、术后住院时间、术后HSS评分及ROM活动度优于对照组,差异具有统计学意义(P0.05)。结论运用单髁置换术治疗膝关节骨性关节炎,创伤小,安全,患者术后恢复快,疗效满意。     

全膝表面置换术治疗骨性关节炎的体会

自2001年9月-2005年6月手术治疗膝关节骨性关节炎182例，行全膝表面置换术治疗的14例，总结如下。     

胫骨高位截骨治疗膝关节骨性关节炎并内翻畸形

我科于１９８３年在应用胫骨“Ｕ”形截骨术及复位固定器治疗膝内翻［１］的基础上开展了胫骨高位“Ｕ”形截骨、胫骨结节骨端前移及复位固定器固定术治疗膝关节骨性关节炎并内翻畸形，取得了较满意的疗效，现将１９８３～１９９５年治疗的３０例（３５侧膝）中随诊资料完整的２１例（２４侧膝）报告如下。临床资料１．一般资料：本组共２１例（２４侧膝），男４例，女１７例；年龄４８～６９岁。左侧８例，右侧１０例，双侧３例。膝关节痛均以膝前及膝关节内侧疼痛为主，膝关节屈曲挛缩＜１０°。２．站立位膝关节Ｘ线片示膝关节退行性改变…     

Observations of the proximal tibia in total knee arthroplasty

Relatively little has been written concerning the proximal tibia in total knee arthroplasty. Few authors have looked at landmarks and guidelines for tibial tray preparation and tibial tray orientation. The current study showed that a line drawn 1 mm medial to the medial border of the tibial tubercle and going through the midsulcus of the tibial spines (the midsulcus line) provided a reproducible landmark for the tibia, and when a perpendicular cut was made relative to this line, 46 of 50 knees were cut in appropriate alignment. In addition, it has been said that the tibial tray should be rotated externally to approximately the medial 1/3 of the tubercle to maximize function. The current study showed that when the tibia is allowed to float in a functional position relative to the femoral implant, the tibial external rotation was only 2 mm lateral from the medial age of the tibial tubercle; this is far less than the medial 1/3 of the tubercle and close to the starting point of the midsulcus line.     

Primary total knee arthroplasty for supracondylar/condylar femoral fracture in osteoarthritic knees

Supracondylar or condylar femoral fractures require extended treatment and often result in loss of knee range of motion. We present 3 cases in which femoral fractures and preexisting painful knees secondary to osteoarthritis were treated using total knee arthroplasty with a stemmed femoral implant. The patients were all women aged 83, 84, and 87 years old. All fractures united within 3 months, and the patients could walk with 1 cane within 2 months. Primary total knee arthroplasty should be considered as a treatment for supracondylar/condylar femoral fractures in osteoarthritic knees.     

The anteroposterior axis of the tibia in total knee arthroplasty for chinese knees

The goal of this study was to corroborate the use of Akagi's anteroposterior (AP) axis as a rotation reference axis for the tibial component. Transverse computed tomography (CT) scans of the knees of 20 healthy Chinese men (mean age, 34.2±7.9 years; range, 20-43 years) and 20 healthy Chinese women (mean age, 36.7±5.8 years; range, 25-48 years) were obtained. Measurements taken from CT slices at the level of the tibial plateau revealed a mean percentage of the patellar tendon intersected by the AP axis from its medial border of 8%±8.1% (range, 8.1%-23.5%). When the defined AP axis was superimposed on CT slices at the level of the patellar tendon attachment, mean percentage of the width of the patellar tendon intersected by the AP axis from its medial border was 0.2%±10%. Mean angle measurement of angle α was 0.1°±2.7° (range, -5.1° to 5.8°). Mean angle measurement of angle β, or the angle created by the AP axis and the medial third of the patellar tendon from the middle of the posterior cruciate ligament, was 10.3°±3.6° (range, 2.4°-18.8°). The study confirms that Akagi's AP line is reproducible and reliable. The AP line can be used as a rotation reference axis for the tibial component during preoperative CT scanning of the knee.     

Intraoperative passive kinematics of osteoarthritic knees before and after total knee arthroplasty.

Total knee arthroplasty is a successful procedure to treat pain and functional disability due to osteoarthritis. However, precisely how a total knee arthroplasty changes the kinematics of an osteoarthritic knee is unknown. We used a surgical navigation system to measure normal passive kinematics from 7 embalmed cadaver lower extremities and in vivo intraoperative passive kinematics on 17 patients undergoing primary total knee arthroplasty to address two questions: How do the kinematics of knees with advanced osteoarthritis differ from normal knees?; and, Does posterior substituting total knee arthroplasty restore kinematics towards normal? Osteoarthritic knees displayed a decreased screw‐home motion and abnormal varus/valgus rotations between 10° and 90° of knee flexion when compared to normal knees. The anterior–posterior motion of the femur in osteoarthritic knees was not different than in normal knees. Following total knee arthroplasty, we found abnormal varus/valgus rotations in early flexion, a reduced screw‐home motion when compared to the osteoarthritic knees, and an abnormal anterior translation of the femur during the first 60° of flexion. Posterior substituting total knee arthroplasty does not appear to restore normal passive varus/valgus rotations or the screw motion and introduces an abnormal anterior translation of the femur during intraoperative evaluation. © 2006 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 24:1607–1614, 2006     

Early primary total knee replacement for complex proximal tibia fractures in elderly and osteoarthritic patients

Complex intra-articular fractures of the proximal tibia are difficult to treat, especially in the elderly osteoporotic patient. Pre-existing osteoarthritis, cartilage damage during trauma, suboptimal reduction and fixation due to poor bone stock and/or secondary displacement frequently lead to poor outcome. After osteosynthesis rehabilitation is cumbersome as patients have been non-weight bearing for long periods of time and secondary total knee arthroplasty can be challenging. For these reasons, we investigated the possibility to perform a total knee arthroplasty with or without adjuvant osteosynthesis as a primary treatment in elderly and/or osteoarthritic patients with complex tibial plateau fractures. Between 2002 and 2009, 12 patients (mean age: 73 years (58-81)) with an AO-41 fracture type B1 (1), B3 (8) and C3 (3) were treated with a primary total knee arthroplasty within three weeks from their trauma. Most patients (7/12) were allowed early full-weight bearing. One patient died due to an unrelated cause; the remaining eleven were reviewed at a mean follow-up period of 31 months (5 w-81 m). At final follow-up the median knee score was 78 (50-100) and the function score 58 (0-100): 7/11 patients had an excellent result, while 1/11 had a fair and 3/11 a poor result. Fair and poor results were mostly related to pre-existing poor general condition and/or concomitant disease. Most patients were satisfied and only minor short- and long-term complications were noted. There was no need for revision surgery. Our limited series of well-selected elderly and/or osteoarthritic patients with a complex tibial plateau fracture treated with primary total knee arthroplasty yielded encouraging results.     

全膝关节置换术中胫骨近端倾斜型骨缺损的重建

目的 通过对全膝关节置换术中腔骨近端倾斜型骨缺损的重建，介绍应用自体胫骨进行胫骨平台重建的方法和体会。方法 1992年11月～2000年9月．对22例(29膝)有胫骨近端倾斜型骨缺损的膝关节行全膝关节置换及自体胫骨移植术，男5例(5膝)，女17例(24膝)；年龄43～78岁，平均61．2岁。手术前诊断：骨关节炎13例(14膝)，其中膝内翻12例(13膝)，膝外翻1例(1膝)；类风湿关节炎7例(12膝)；滑膜软骨瘤病1例(1膝)；大骨节病1例(2膝)。术中将胫骨平台倾斜型骨缺损修整成台阶状水平型骨缺损。将截下的胫骨平台骨块修整后使其厚度和形状与缺损处匹配，并将带有皮质骨的部分尽量放置在台阶状缺损的外缘，以承受平台的压力。术中植骨厚度为8～15mm，平均10mm在置入假体以及在骨水泥固化之前，应在植骨块侧方加压。所有膝关节假体均采用抗生素骨水泥固定。结果 术后随访1～9年，平均4．2年，除1例因迟发性感染和植骨吸收再次出现膝内翻畸形和假体松动而行Ⅰ B-Ⅱ楔形假体翻修外．其它病例未发现自体移植骨的不愈合、移位、骨折、骨吸收和胫骨假体松动，HSS膝关节评分由术前10～26分提高到术后76～94分。结论 在胫骨近端倾斜型骨缺损的全膝关节置换术中，采用自体胫骨移植可恢复胫骨平台的完整性．防止平台塌陷．并为假体提供良好的初始稳定性，提高手术的成功率。     

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     

Changes in bone mineral density of the proximal tibia after uncemented total knee arthroplasty: A 3-year follow-up of 25 knees

We measured bone remodeling of the proximal tibia prospectively for 3 years after uncemented total knee arthroplasty (TKA) in 25 knees with primary arthrosis. in the trabecular bone below the tibial component, bone mineral density (BMD) was measured in 6 different regions of interest (ROI), using dual photon absorptiometry (DPA). in the tibial condyles, where the change in knee alignment indicated that the load was reduced postoperatively, a fast bone loss of 7-20% was seen during the first 6 months after surgery. A small, but significant increase in BMD of 2-7% was seen in the tibial condyles, where the load was increased. on average, the density for all ROI below the tibial component showed a significant and progressive decrease in BMD, reaching 22% at 3 years follow-up.     

Bony landmarks and rotational alignment in total knee arthroplasty for Chinese osteoarthritic knees with varus or valgus deformities

The purpose of this study was to investigate the rotational mismatch of total knee arthroplasty when taking the medial one third of the tibial tuberosity as a rotational landmark in Chinese osteoarthritic knees. Computed tomographic images of 49 osteoarthritic knees (42 with varus and 7 with valgus deformities) and 10 healthy knees were analyzed. The angle (alpha) between the 2 baselines for the anteroposterior axis of the femoral and tibial components was measured. The mean value of alpha in healthy knees was +6.45 degrees, which increased significantly to +11.53 degrees in varus knees (P = .002) and +12.17 degrees in valgus knees (P = .04). It showed that there is a tendency for the tibial component to be externally rotated when the medial one third of the tibial tuberosity is defined as a rotational landmark. This finding is particularly prominent in Chinese osteoarthritic knees with varus or valgus deformities.     

Predictive risk factors for stiff knees in total knee arthroplasty

Retrospective review of 1216 primary total knee arthroplasties (TKAs) to evaluate incidence and predictors of arthrofibrosis, defined as flexion less than 90 degrees 1 year post-TKA. Incidence of stiffness post-TKA was 3.7% (45/1216). A matched case-control study was then conducted to identify predictive factors for this outcome. Preoperative flexion and intraoperative flexion were predictive of ultimate postoperative flexion (P = .001 and P = .039, respectively). There was no correlation between postoperative stiffness and specific medical comorbidities, including diabetes. Preoperative and postoperative relative decreased patellar height and stiffness postoperative were significantly correlated (P = .001). Although stiffness post-TKA is multifactorial, careful attention to surgical exposure, restoring gap kinematics, minimizing surgical trauma to the patellar ligament/extensor mechanism, appropriate implant selection, and physiotherapy combined with a well-motivated patient may all serve to reduce the incidence of stiffness post-TKA.