人工全膝关节置换术中髌骨置换的临床研究

目的探讨人工全膝关节置换术中髌骨置换之后的临床疗效,为临床上是否要进行髌骨置换提供参考依据。方法选择2009年12月—2012年2月于我院急诊科、骨科就诊并拟行人工全膝关节置换术的骨关节炎患者84例,按随机数字随机将所有入选患者分为对照组42例和研究组42例,研究组患者在关节置换术中接受髌骨置换的治疗,对照组则不进行髌骨置换,治疗后所有患者接受为期1年的随访,对两组疗效进行比较。结果两组术后2、3个月的美国膝关节协会评分系统(KSS)临床评分差异均无统计学意义(P>0.05),术后6、12个月KSS临床评分差异有统计学意义(P<0.05);两组术后2、3、6个月的Feller髌骨评分差异均无统计学意义(P>0.05),术后12个月Feller髌骨评分差异有统计学意义(P<0.05)。结论人工全膝关节置换术中行髌骨置换能在一定程度上改善膝关节功能评分和髌骨评分。     

人工全膝关节置换术治疗膝关节骨关节炎36例疗效观察

目的：分析研究人工全膝关节置换术治疗膝关节骨关节炎的临床效果。方法：回顾性分析2009—03～2010—03期间本院行人工全膝关节置换术治疗的36例膝关节骨关节炎患者的临床资料。结果：所有患者均随访12～24个月,根据HSS膝关节评分系统进行疗效评价：优27膝（67．5％）,良10膝（25％）,一般3膝（7．5％）,无1例出现效果差的病例,优良率为92．5％;术前平均HSS评分为（44．5±5．7）分,术后平均HSS评分为（86．7±6．1）分,治疗后较治疗前明显提高,差异有统计学意义（P〈0．05）。结论：人工全膝关节置换术是治疗严重膝关节骨关节炎的有效方法．可改善膝关节功能,近期疗效满意,但其远期疗效尚需进一步观察。     

全膝关节置换术后髌腱断裂1例

患者,女,76岁。因右膝关节疼痛20年加重并行走困难2年收住。查体:右膝关节内翻畸形(25°),关节伸屈活动受限(10°~70°),X线示关节增生骨赘形成并关节内翻,关节外侧间隙变窄,内侧间隙消失。既往糖尿病史10年余。入院行全膝关节置换术(InnexTM固定衬垫型膝关节系统),术后3 d开始膝关节功能锻炼,1周扶步行器下地行走,2周出院时膝关节伸屈活动0°~90°,6周行走基本正常,膝关节伸屈活动0°~100°,关节无肿胀,拍片假体位置良好。术后2月余不慎滑倒,膝关节半屈曲位受力,即出现膝关节肿胀疼痛,伸膝无力。查膝局部肿胀压痛,髌腱正常轮廓消失,髌腱…     

全膝关节置换术中保留髌下脂肪垫对髌腱短缩的影响

目的探讨保留髌下脂肪垫在全膝关节置换术中对髌腱短缩的影响。方法将邯郸市第一医院骨科86例(86膝)行全膝关节置换术的骨性关节炎患者按手术方式分为保留组(保留大部分髌下脂肪垫及滑膜)与切除组(切除髌下脂肪垫,选择假体进行置换)各43例。保留组男性13例,女性30例,平均年龄(60.95±5.34)岁。切除组男性15例,女性28例,平均年龄(61.27±5.51)岁。对比两组术前、术后1年HSS膝关节功能评分(疼痛、功能、活动度、肌力、屈膝畸形、稳定性),膝关节活动度(屈膝度、屈曲挛缩),并记录髌腱短缩的发生率、膝前痛发生率及术后并发症发生率。结果保留组髌腱短缩的发生率低于切除组(25.58%vs.46.51%),差异有统计学意义(P=0.043)。两组术后1年疼痛、功能、活动度、肌力、屈膝畸形、稳定性评分均高于术前,差异有统计学意义(P0.05);组间各项目评分比较差异均无统计学意义(P0.05)。两组术后1年屈膝度、屈曲挛缩均低于术前,差异有统计学意义(P0.05);但组间比较差异无统计学意义(P0.05)。所有患者术后均未发生髌腱损伤。保留组术后1年膝前痛发生率低于切除组(2.33%vs.20.93%),差异有统计学意义(P=0.007)。结论保留与切除髌下脂肪垫用于全膝关节置换术在改善膝关节功能、膝关节活动度方面疗效相当,但前者可明显降低髌腱短缩及膝前痛发生率,且并未增加髌腱损伤风险,临床应用价值较高。     

全膝关节置换术中髌骨置换对骨性关节炎患者早期疗效及膝前痛的影响

目的：探讨全膝关节置换术中是否进行髌骨置换对骨性关节炎患者的临床疗效及术后疼痛的影响。方法笔者采用随机数字表法将骨科2011年5月～2013年7月收治的93例行人工全膝关节置换术患者分为髌骨置换组43例和未置换组50例,比较两组患者治疗前与治疗后不同时间的相关指标变化差异。结果术前髌骨置换组与非置换组的膝关节KSS（美国膝关节协会）评分、Feller评分差异不显著（ P＞0．05）;术后第3、6、12个月髌骨置换组膝关节KSS评分、Feller评分显著高于非置换组（P＜0．05）;术前髌骨置换组与非置换组的膝关节视觉模拟评分（VAS）差异不显著（P＞0．05）;术后第3、6、12个月髌骨置换组膝关节VAS评分显著低于非置换组（P＜0．05）;两组患者术前、术后的胫股角,髌韧带比值,关节活动度ROM屈、伸值在两组间比较差异均不显著（ P＞0．05）;术后第12个月两组患者的胫股角、髌韧带比值,关节活动度ROM屈、伸值较治疗前均显著好转（ P＜0．05）。结论全膝关节置换术中进行髌骨置换对改善膝关节功能评分、髌骨评分、术后疼痛评分均有显著的效果。     

2011KSS评分对全膝关节置换术后的短期临床疗效评价

目的:探讨2011膝关节协会评分(Knee Socirty score,KSS)对全膝关节置换术后的短期临床疗效评价.方法:对在我院初次行全膝关节置换术的膝骨关节炎患者45人(57膝)术后平均随访2.3年(2-4年),根据术前及术后的2011KSS评分来评价全膝关节置换术的疗效.并探讨在不同民族间2011KSS评分有无差异.结果:所有评分(除患者期望值评分以外)术后较术前均有显著改善,而期望值评分术后明显低于术前.不同民族间术前BMI值、症状、满意度、期望值及总得分之间有差异,术前膝关节活动度、疼痛年限间无差异.结论:TKA是治疗中晚期膝骨关节炎的有效方法,期望值在评估TKA疗效时有重要作用.     

壤塘地区全膝关节置换术治疗大骨节病性膝骨关节炎的疗效分析

目的 探讨采用初次全膝关节置换术治疗壤塘地区膝关节大骨节病(KBD)患者的近期临床效果。方法 回顾性分析2017-01至2019-09四川省壤塘县人民医院骨科收治膝关节大骨节病患者88例,男32例,女56例,年龄34～67岁,平均(53.57±10.40)岁。Ⅰ期35例,Ⅱ期53例。全部膝关节大骨节病患者行人工全膝关节置换术,分别在术前,术后1、3、6、12、36个月,采用疼痛视觉模拟评分(VAS)评估膝关节疼痛严重程度、美国膝关节协会评分(KSS评分)、美国特种外科医院膝关节评分(HSS评分)系统评估膝关节功能,简明健康状况量表(SF-36)评分评估生活质量,测量膝关节活动度(ROM),治疗前和末次随访时拍摄双下肢负重全长X光片测量髋-膝-踝角及胫股角评估下肢力线情况。结果 随访36～54个月,平均随访(39.85±6.89)个月。VAS疼痛评分、HSS临床评分、KSS功能评分、SF-36评分、生理职能、躯体疼痛、活力、社会功能、情感职能、精神健康评分得到明显改善(P<0.05)。下肢力线髋膝踝角(HKA)、ROM得到改善(P<0.05)。结论 高原地区膝关节大骨节病Ⅰ期...     

全膝关节置换术两种入路效果比较

 目的  比较经股内侧肌入路与内侧髌旁入路行全膝关节置换术的临床疗效。 方法 25例行同期双侧全膝关节置换术,每例患者随机一侧采用经股内侧肌入路,另一侧采用内侧髌旁入路,观察两组手术时间、术后引流量、术后6周关节活动度、直腿抬高恢复时间,术后第1、2、3、6天对每例患者双侧膝关节进行视觉模拟疼痛评分（visual analog scale,VAS）。 结果 经股内侧肌入路组在直腿抬高恢复时间［（2.2±0.8） d vs （4.4±1.4）d］、VAS评分方面明显优于内侧髌旁入路组( P <0．05 ),两组在术后引流量、手术时间、术后6周膝关节活动度方面差异无统计学意义( P >0．05)。 结论 经股内侧肌入路行全膝关节置换术与髌旁入路相比,可以减轻术后的疼痛,减少直腿抬高恢复时间,较早恢复膝关节功能,值得临床推广和应用。     

The effects of McConnell patellofemoral joint and tibial internal rotation limitation taping techniques in people with Patellofemoral pain syndrome

BackgroundTaping is frequently used as part of the multi-modal management for patellofemoral pain syndrome (PFPS). McConnell Patellofemoral Joint Taping (PFJT) and Tibial Internal Rotation Limitation Taping (TIRLT) are proposed to be useful adjuncts to the management of PFPS. However, it is unclear if TIRLT offers similar benefits to PFJT, and its effect on pain and lower limb kinematics have not been investigated previously.Research questionWhat are the effects of TIRLT, PFJT and no taping on perceived pain and lower limb kinematics during a lunge and single leg squat (SLS) in people with PFPS?MethodsThis cross-sectional study compared the effects of TIRLT, PFJT and no taping, on knee pain and lower limb kinematics during two pain-provoking movements in people with PFPS. Participants with PFPS (n = 23) performed a lunge and SLS under three randomised conditions: TIRLT, PFJT and no taping. The Codamotion system captured and analysed lower limb kinematic data in the sagittal, transverse and coronal planes. Peak knee pain intensity during the movement was assessed using the Numerical Rating Scale (NRS).ResultsParticipants reported significantly less pain with the TIRLT and PFJT techniques compared with no tape during the lunge (p = 0.005 and p = 0.011, respectively) and SLS (p= 0.002 and p = 0.001, respectively). There was no evidence of altered lower limb kinematics accompanying pain reductions with either taping technique.SignificanceBoth forms of taping may be useful adjuncts as the short-term benefit of pain relief may enable participation in more active forms of rehabilitation.     

综合运动训练对全膝关节置换术功能及预后的影响

目的研究综合运动训练对全膝关节置换术功能及预后的影响,为临床治疗提供一定的理论依据。方法按照入院先后顺序入选64例全膝关节置换术患者,根据随机数字方法分成两组,每组32例,其中对照组予以单纯的持续被动运动训练,而研究组在持续被动运动的基础上再综合其它的运动训练以及超短波和超声波治疗。治疗随访6周后,分析两组患者的相关临床资料。结果与对照组相比较,研究组在膝关节的功能、活动度、稳定度、疼痛、肌力及屈曲畸形等方面的HSS评分明显改善(P<0.05)。同时,通过统计发现,对照组的优良率为53.13%,而研究组的优良率为84.38%,明显高于对照组(P<0.05)。结论综合运动训练的康复治疗方式可以很好的改善全膝关节置换术患者的膝关节功能及其预后。     

Trunk,pelvis, and knee kinematics during running in females with and without patellofemoral pain

BackgroundFemales are two times more likely to develop patellofemoral pain (PFP) than males. Abnormal trunk and pelvis kinematics are thought to contribute to the pathomechanics of this condition. However, there is a scarcity of evidence investigating proximal segments kinematics in females with PFP.Research questionThe purpose of this study was to investigate whether females with PFP demonstrate altered trunk, pelvis, and knee joint kinematics compared with healthy controls during running.MethodsThirty-four females (17 PFP, 17 controls) underwent a 3-dimensional motion analysis during treadmill running at preferred and fixed speeds, each trial for 30 s. Variables of interest included magnitudes of peak angles for trunk (forward flexion, ipsilateral trunk lean), pelvis (anterior tilt, contralateral drop), knee (flexion, valgus, internal rotation), range of motion (RoM) of trunk and pelvis in sagittal and frontal planes and RoM of knee joint in the three cardinal planes of motion. Kinematic data were compared between groups using mixed model repeated measure analysis of variance with the trial as the repeated measure.ResultsThe PFP group displayed significantly less pelvis frontal plane RoM, greater knee frontal plane RoM, and less knee sagittal plane RoM during running compared with controls, irrespective of running trial. No differences were found in peak kinematic variables between PFP and healthy groups.SignificanceThese results may suggest a rigid stabilization strategy at the pelvis, which the body has adapted to prevent further frontal plane knee malalignment. Less knee sagittal plane RoM may be indicative of another protective strategy in the PFP group to avoid patellofemoral joint reaction force. Clinical assessments and rehabilitative treatments may benefit from considering a global program with focus on pelvis kinematics in addition to the knee joint in females with PFP.     

Influence of the exacerbation of patellofemoral pain on trunk kinematics and lower limb mechanics during stair negotiation

BackgroundAlthough it is assumed that the presence of patellofemoral pain (PFP) may result in compensatory behaviors that can alter trunk kinematics and lower limb mechanics, the influence of the exacerbation of patellofemoral pain on trunk kinematics and lower limb mechanics during stair negotiation has not been established.Research questionDoes the exacerbation of PFP symptoms lead to altered trunk kinematics and lower limb mechanics during stair negotiation?MethodsThree-dimensional kinematics and kinetics were obtained from 45 women with PFP during stair descent and ascent. Data were obtained before and after a pain exacerbation protocol. The variables of interest were peak trunk, hip, and knee flexion, and ankle dorsiflexion; peak hip, and knee extensor, and ankle plantarflexor moments. Paired t-tests were used to compare the variables of interest before and after pain exacerbation.ResultsFollowing pain exacerbation, there was a decrease in peak knee extensor moment during stair descent (Effect size = −0.68; p = 0.01) and stair ascent (Effect size = −0.56; p = 0.02); as well as in peak ankle dorsiflexion during stair descent (Effect size = −0.33; p = 0.01) and stair ascent (Effect size = −0.30; p = 0.01). An increase in ankle plantarflexor moment during stair descent (Effect size = 0.79; p < 0.01) and stair ascent (Effect size = 0.89; p < 0.01) was also observed. No significant differences were observed for peak trunk, hip, and knee flexion or hip extensor moment (p > 0.05).SignificanceOur findings show compensatory strategies used by people with PFP in response to symptoms exacerbation that may have a negative impact on knee and ankle mechanics. Our findings also suggest that people with PFP do not seem to change their trunk, hip, and knee flexion or hip extensor moment during stair negotiation in response to symptom exacerbation.     

The influence of patellar bracing on patellar and knee load-distribution and kinematics: an experimental cadaver study

The aim of this study was to analyze the biomechanical consequences of patella bracing in order to evaluate possible mechanisms supporting its clinical application. The hypothesis is that the patellar bracing reduces patellofemoral pressure by influencing patellar and knee kinematics, and load distribution. Physiologic isokinetic knee extension motions were simulated on ten human knee cadaver specimens using a knee kinematic simulator. Joint kinematics were evaluated using an ultrasound-based motion analysis system and patellofemoral contact pressure was measured using a thin-film piezoresistive pressure measuring system. Infrapatellar tissue pressure was analyzed using a closed sensor-cell. Three different patella braces were fitted to the knee cadavers and their influence on the kinematic and kinetic biomechanical parameters were evaluated and compared to the physiologic situation. Patellar bracing resulted in a significant (p = 0.05) proximalization of the patella up to 3 mm. Depending on the type of brace used, a decrease in the infrapatellar fat pad pressure was found and the patellofemoral contact area was decreased significantly (p = 0.05) between 60° of knee flexion and full extension (maximum 22%). Patella bracing significantly (p = 0.05) reduced the patellofemoral contact pressure an average of 10%, as well as the peak contact pressure which occurred. Patellar bracing significantly influences patella biomechanics in a reduction of the patellofemoral contact area and contact pressure as well as a decrease in the infrapatellar tissue pressure. The application of infrapatellar straps is suggested for the treatment and prevention of anterior knee pain, especially in high level sports.     

Y-Balance Test Asymmetry and Frontal Plane Knee Projection Angle During Single-leg squat as Predictors of Patellofemoral Pain in Male Military Recruits

ObjectivesInvestigate prospectively whether dynamic balance and frontal plane knee projection angle (FPKPA) are risk factors for the development of patellofemoral pain (PFP) in male military recruits.Study designProspective cohort.SettingMilitary training center.Participants135 male military recruits were followed prospectively for six weeks and the incidence of PFP was documented.Main outcomesBaseline measures of the Y-Balance test (YBT) and two-dimensional FPKPA during single-leg squatting were recorded. Mann–Whitney U tests and logistic regression analysis were utilized to identify possible variables associated with the development of PFP.ResultsA total of 14 male recruits developed PFP during the follow up period. The PFP group had significantly greater asymmetry on the YBT posterolateral direction (mean difference = 3.44 ± 0.57 cm; 95% Confidence Interval [CI] = 2.38–4.51 cm) and greater FPKPA during single-leg squat (mean difference = 5.55°±1.78°; [CI] = 1.81–9.28°) at baseline when compared to controls. Binary logistic regression models revealed that YBT posterolateral asymmetry ≥4.08 cm (Nagelkerke R² = 0.304; X² = 21.63; p < 0.001; OR = 5.46; [CI] = 4.47–8.06) and FPKPA ≥ 4.81° (Nagelkerke R² = 0.249; X² = 17.46; p < 0.001; OR = 4.65; [CI] = 3.32–9.06) were significantly associated with PFP.ConclusionsMale military recruits with greater asymmetry on the YBT posterolateral direction and FPKPA were at a greater risk of developing PFP.