骨水泥型与非骨水泥型全膝关节置换后的步态差异

背景:全膝关节置换已经被证明是一种有效治疗膝骨性关节炎的方法,但是不同类型的全膝关节置换假体固定方式术后所产生的膝关节下肢生物力学差异至今仍不明确。目的:通过三维步态分析骨水泥固定和非骨水泥固定两种不同的全膝关节置换术后患者的膝关节生物力学差异。方法:分别选取骨水泥型全膝关节置换以及非骨水泥型全膝关节置换患者各16例,通过测力台以及三维步态分析系统比较2组患者术前以及术后3个月的膝关节生物力学变化并进行对比。结果与结论:与手术前相比两组患者术后步速及步长均明显增加,支撑相在整个步态周期中的百分比明显减小,膝关节屈在支撑相及摆动相中最大屈曲角度均明显增加,膝关节外翻角度增加。两种患者术后膝关节内翻角度以及膝关节内收力矩均明显减小。提示,骨水泥型与非骨水泥型全膝关节置换术均能有效改善膝骨性关节炎患者的步行能力以及下肢关节功能,两者间未见明显生物力学差异。     

单侧全膝关节置换术前两下肢步态差异性分析

目的:比较在单侧全膝关节置换术(TKR)前以美国膝关节协会评分(KSS)为依据确定的手术侧和非手术侧在步态上的差异性。方法:筛选16例即将做单侧TKR手术的患者,使用KSS评分、WOMAC、SF-36评判患者健康状况,并将KSS得分较低的一侧确定为手术侧。使用三维步态分析系统采集患者以自选步速赤脚穿袜行走时的步态数据,比较患者手术侧和非手术侧在时空、运动学和动力学参数上的差异。结果:KSS评分手术侧和非手术侧存在显著差异(P0.001),支撑期非手术侧显著长于手术侧(P=0.002),患者手术侧和非手术侧在矢状面及冠状面上膝、踝、髋关节转角曲线及关节力矩曲线总体相似,关节转角幅值和关节力矩峰值均为未表现出显著差异(P0.05)。结论:单侧TKR术前患者行走时偏向于使用非手术侧,手术侧和非手术侧在关节活动能力和关节受载方面并无明显差异。     

骨水泥型与非骨水泥型假体的置换应用特征

目的:概述骨水泥型与非骨水泥型假体置换在骨折治疗中的应用。资料来源:检索Pubmed1993-01/2004-10关于骨水泥型与非骨水泥型假体用于人工髋关节置换及治疗其他骨折疾病中的应用,以及骨水泥型人工髋关节置换的生物力学分析有关的文章。检索词为"bone cement,cementless,arthroplasty,biomechanics"并限定语言种类为英文。同时检索中国期刊全文数据库2003-01/2006-12的相关文章,检索词"骨水泥,非骨水泥,关节置换术,生物力学"。资料选择:对资料进行初审,纳入标准:①关于骨水泥型和非骨水泥型人工髋关节置换的临床应用。②骨水泥型人工髋关节置换的生物力学分析。③骨水泥在除髋部骨折外治疗中的应用。排除标准:重复性研究。资料提炼:共收集到120篇文章,排除94篇重复性研究,纳入26篇与纳入标准最为贴近的文章。资料综合:骨水泥型假体的应用在治疗老年股骨颈骨折方面取得满意效果,可改善患者Harris髋部评分,并发症也较少。非骨水泥型假体表面为多孔,植入人体后,依靠骨组织反应生长能力,使骨与假体表面形成紧密地生物固定,其具有手术时间短,术中患者安全、假体固定为生物学固定、手术创伤小等优点,避免了骨水泥在注入过程中产生的不良反应以及术后假体返修所带来的取出麻烦、骨质破坏过多现象。应用非骨水泥人工全髋关节进行全髋关节置换术优良率达92%。人工全髋关节置换术后假体松动是临床病例中常出现的问题。在众多的相关因素中,机械力学因素是造成假体松动的主要原因之一。磷酸钙骨水泥在多种骨折:桡骨远端关节内骨折、胫骨平台压缩性骨折、跟骨骨折等中也有应用。结论:骨水泥与非骨水泥型假体置换已在临床广泛开展,并已取得了较满意的效果。     

全膝置换术后的系统康复

20例患者均为在我院骨科接受全膝关节置换术（total knee replacement，TKA），其中男性6例，女性14例；均为单膝置换；年龄59—79岁，平均69±5岁；病程2-19年．平均9．5±4．5年；骨性关节炎17例，风湿性关节炎3例。20例患者均未使用骨水泥。[第一段]     

全膝关节置换器械骨水泥去除与清洗流程改进效果评价

目的 观察全膝关节置换器械清洗方法改进后对器械整体清洁度的影响和残留骨水泥的去除效果.方法 以2019年3-10月的全膝关节置换术器械包中的器械作为研究对象,改进前为对照组,改进后为试验组,对比流程改进前后对照组和试验组的清洗质量.结果 改进前和改进后回收后器械上骨水泥残留率分别为11.20％和3.94％,目测清洗合格...     

全膝关节置换后三维步态分析:病例-对照的随访观察

背景：长期以来，针对步行运动中神经肌肉骨骼系统与运动功能客观精确的评估方式较缺乏。三维步态分析技术可将骨科和康复治疗中沿用已久的定性分析和直观描述转换为客观、精确的定量评定。 目的：基于三维步态分析，以12个月的随访资料为背景，评价全膝关节置换后患者步态模式改变。 设计、时间及地点：前后对比，病例一对照，随访观察于2007—01／2008—05在上海第六人民医院康复医学科步态分析室完成。 对象：选取单侧膝关节骨性关节炎行全膝关节置换的患者10例纳入治疗组，同时选择基线资料比之匹配的无神经、肌肉、骨骼系统及平衡问题者10例为对照组。 方法：治疗组患者行康复训练，并于膝关节置换后3，6，12个月应用三维步态分析系统对时间-空间参数、膝关节运动学参数、膝关节力学参数进行测量，并与对照组进行对比。 主要观察指标：时间一空间参数，膝关节运动学参数，膝关节力学参数，膝关节功能评分。 结果：治疗组步幅、步频、步速、患侧单腿支撑时间均较对照组明显减低；健侧单腿支撑时间、步态周期持续时间较对照组明显延长（P〈0．05）。治疗组支撑相最大伸膝、足尖离地屈膝及摆动相最大屈膝角度均较对照组明显减小（P〈0．05）。治疗组第1次、第2次外部伸膝力矩以及第1次最大膝内收力矩峰值均较对照组明显下降（P〈0．01）。 结论：行关节置换患者步态模式以步速减慢并伴有步幅减小、负重反应期及摆动相屈膝角度减小为主要特征，步态参数未达到正常人群标准。     

单髁置换和全膝关节置换治疗膝关节骨性关节炎的临床效果比较

目的探讨单髁置换术(UKA)治疗膝关节骨性关节炎的临床疗效,为该手术方法在临床推广使用提供理论依据。方法对30例接受UKA治疗的患者和30例接受全膝关节置换术(TKA)治疗的患者进行回顾性对照研究,比较两组术中指标,术前、术后关节活动度(ROM)、HSS评分及术后随访疗效指数。结果按照不同的置换术治疗后,两组患者术中指标:手术时间(t=9.25,P=0.00)、术中出血量(t=12.47,P=0.00)、术后住院时间(t=6.99,P=0.00);术后ROM评分(t=2.15,P=0.04);随访疗效步行速度(t=2.24,P=0.03)、左右步幅(t=4.08,P=0.00)、活动积分(t=11.06,P=0.00)、平衡积分(t=2.82,P=0.01)及治疗指数(t=6.49,P=0.04)比较差异均有统计学意义(P<0.05)。结论临床运用单髁置换术治疗膝关节骨性关节炎,具有微创、安全、患者术后恢复快等优点,值得临床推广应用。     

全膝人工关节置换术治疗膝关节骨性关节炎1例

1病例报告 患者,男,59岁,职业：保安。主诉：左膝关节酸痛、活动不利半年。患者半年前无明显诱因出现左膝关节酸痛、活动不利,疼痛于上下楼梯、久站、步行200m即出现疼痛,久行时明显,休息后稍缓解,曾到当地医院就诊,诊断为＂左膝骨性关节炎＂,给予口服药物治疗,症状无缓解。遂来我院门诊就诊,     

全膝关节置换术后康复治疗的研究进展

全膝关节置换术被认为是当前最有效的手术之一,对晚期膝骨性关节炎患者关节活动度、疼痛及关节僵硬的改善作用显著,但仍有19%的患者术后效果较差。现有大量文献报道康复治疗在提高全膝关节置换术后关节活动度、平衡功能及改善日常生活能力等方面均具有显著疗效。本文就近年来全膝关节置换术后康复方面的研究进展情况进行回顾性总结,为全膝关节置换术后康复干预及相关研究提供参考资料。     

骨水泥与非骨水泥型全膝关节假体置换效果的系统评价

背景：国外研究调查显示,在全膝关节置换中有95-2％采用骨水泥进行假体固定,但是也有专家学者认为使用骨水泥固定假体风险高。目的：应用Cochrane系统评价的方法评价膝关节置换中骨水泥型与非骨水泥型假体置换的效果差异。方法：检索Medtine（1996年1月至2011年8月1、Embase（1960年1月至2011年8月1、Cochranelibrary（2011年8月）、中国生物医学文献数据库（CBM,1990年1月至2011年8月）及相关参考文献,收集骨水泥型和非骨水泥型假体全膝关节置换的随机对照试验,采用Cochrane的方法学评价文献质量,应用RevMan5．1．2进行Meta分析。比较骨水泥型和非骨水泥型假体在术后生存率、稳定性、相关并发症、翻修率、异位骨化的差异。并使用GRADEproversion3．2．2软件对纳入研究进行证据评级。结果与结论：纳入8个随机对照试验,共1381例患者,实验组（骨水泥组）676例,对照组（非骨水泥组）705例。4个研究比较了骨水泥组和非骨水泥组假体置换后≤5年组的膝关节生存率,两组差异有显著性意义,说明置换后≤5年骨水泥组生存率高。4个研究比较了置换后〉5年组膝关节生存率,两组差异有显著性意义,说明置换后〉5年组骨水泥假体组生存率高。3个研究在不同随访时间比较了置换后假体稳定性,结果显示两组间在假体稳定性上差异无显著性。4个研究在不同随访时间比较了置换后假体相关的并发症,两组问在假体相关并发症上比较差异无显著性意义。5个研究在不同随访时间比较了置换后翻修率,两组间在假体翻修率上差异无显著性意义。3个研究在不同随访时间比较了置换后假体异位骨化,两组间在置换后假体异位骨化上差异无显著性意义。两组置换后疗效均较术前明显提高,组间比较的Meta分析结果显示,不论是≤5年组还是〉5年组,均是骨水泥型假体生存率均高于非骨水泥型假体生存率,两组在稳定性、相关并发症、翻修率、异位骨化等方面差异均无显著性意义（P〉0．05）。     

Gait analysis of elderly women after total knee arthroplasty

[Purpose] The purpose of this study was to investigate ability and muscle activities of elderly women after total knee arthroplasty (TKA) and compare them with those of healthy ones. [Subjects and Methods] Fifteen female patients with TKA due to advanced degenerative arthritis of the measured on knee joint and 19 healthy elderly females participated. Tibiofemoral angles of TKA patients were using a gait analysis system anterioposterior X-rays of the weight-bearing knee. The knee flexion angle and gait parameters were measured. Muscle activities and prolongation time were EMG system. The gait of the treated limb of each participant was evaluated in three consecutive trials at fast speed and comfortable speed. [Results] The knee flexion angle %stance phase, stride length, step length, speed, cadence, and gait cycle significantly decreased at both the fast speed and comfortable speeds, and the onset and duration time of rectus femoris activity was significantly increased at the comfortable speed in the TKA group. [Conclusion] In conclusion, elderly women who received TKA showed decreased gait ability and muscle activity compared to the healthy elderly women.Key words: Arthroplasty, Gait, Electromyography     

Use of densitometric examination after cemented total knee arthroplasty

Background. Dual energy X-ray absorptiometry (DXA, DEXA) is one of many ways of measuring bone mineral density (BMD). Considering the fact that it is possible using DXA analysis to distinguish metal elements from bone, this method seems to be optimal in the assessment of bone mineral density in the area of an inserted implant. The aim of our study was to examine the usefulness of DXA examination of the knee joint area after cement arthroplasty. Material and methods. A BMD analysis of four areas surrounding the knee prosthesis was performed using the author's own method. Results. After a series of densitometry analyses, the coefficient of variation (CV) and the least significant difference (LSD) were determined. Conclusions. DXA analysis of the knee joint after arthroplasty using the method described here shows high repeatability. Periodic DXA analysis of the vicinity of the knee prosthesis may be useful in assessing the dynamics of change occurring around the implant.     

Gait during hydrokinesitherapy following total knee arthroplasty

Purpose. To obtain gait parameters during hydrotherapy (HT) in patients who were referred for rehabilitation after primary total knee arthroplasty (TKA).

Method. The study had a cohort prospective design. Patients who had undergone TKA followed a HT rehabilitation programme. Twenty-two consecutive patients were enrolled. Four of them dropped out for various reasons, independently of HT. Therefore 18 patients could be evaluated (5 men and 13 women). Eighteen age-matched healthy volunteers were the control subjects. Nine patients had a right TKA and nine a left TKA. On the average HT duration was 18.4 days (SD 1.4).

Results. The patients presented with a mean speed of 912 (SD 275) meters per hour (m/h) at the baseline. At the last session the mean speed was 1330 (SD 416) m/h. The mean stance duration was 1.75 s (SD 0.34) on the operated side and 1.83 s (SD 0.41) on the non-operated side. By contrast, the mean swing duration was 1.10 s (SD 0.25) on the operated side and 1.13 s (SD 0.34) on the non-operated side. The step duration was the same on both sides. At the beginning of HT the mean stance/swing ratio was 1.94 on the operated side, whereas it was 1.77 on the non-operated side. In the controls the ratio was 1.46. At the beginning the mean stride length was 0.526 m (SD 0.147) and the value became 0.556 (SD 0.138) after 18 training sessions. At the individual level, recovery occurred in a non-linear fashion (Best Fitting, 7th-grade Fourier finite series).

Conclusions. The study design permits accurate definition of stride parameters during rehabilitation which allows optimization of the programme. Increase in speed and regain of balance are the main targets of a HT programme and are monitored on a daily basis.     

Gait during hydrokinesitherapy following total knee arthroplasty

Purpose.?To obtain gait parameters during hydrotherapy (HT) in patients who were referred for rehabilitation after primary total knee arthroplasty (TKA).

Method.?The study had a cohort prospective design. Patients who had undergone TKA followed a HT rehabilitation programme. Twenty-two consecutive patients were enrolled. Four of them dropped out for various reasons, independently of HT. Therefore 18 patients could be evaluated (5 men and 13 women). Eighteen age-matched healthy volunteers were the control subjects. Nine patients had a right TKA and nine a left TKA. On the average HT duration was 18.4 days (SD 1.4).

Results.?The patients presented with a mean speed of 912 (SD 275) meters per hour (m/h) at the baseline. At the last session the mean speed was 1330 (SD 416) m/h. The mean stance duration was 1.75 s (SD 0.34) on the operated side and 1.83 s (SD 0.41) on the non-operated side. By contrast, the mean swing duration was 1.10 s (SD 0.25) on the operated side and 1.13 s (SD 0.34) on the non-operated side. The step duration was the same on both sides. At the beginning of HT the mean stance/swing ratio was 1.94 on the operated side, whereas it was 1.77 on the non-operated side. In the controls the ratio was 1.46. At the beginning the mean stride length was 0.526 m (SD 0.147) and the value became 0.556 (SD 0.138) after 18 training sessions. At the individual level, recovery occurred in a non-linear fashion (Best Fitting, 7th-grade Fourier finite series).

Conclusions.?The study design permits accurate definition of stride parameters during rehabilitation which allows optimization of the programme. Increase in speed and regain of balance are the main targets of a HT programme and are monitored on a daily basis.     

导航和传统全膝关节置换后肢体和假体力线恢复对比的Meta分析

背景：目前计算机辅助导航技术已经越来越多地应用于全膝关节置换中。计算机辅助导航全膝关节置换是否比传统全膝关节置换更具优势目前尚无定论。目的：系统评价计算机辅助导航和传统全膝关节置换后肢体和假体力线的恢复情况。方法：计算机检索2013年6月前PubMed/Medline、EMBASE、Cochrane CENTRAL、ScienceDirect数据库,纳入计算机辅助导航和传统全膝关节置换的随机对照试验,应用Cochrane协作网提供的RevMan 5.2.5软件进行Meta分析。选取髋-膝-踝机械轴或胫股关节角、股骨假体冠状角、股骨假体矢状角、胫骨假体冠状角、股骨假体矢状角5个指标进行比较,以偏离中线2°或3°确定为力线不良。结果与结论：共纳入19篇随机对照试验文献,共2654例（3392膝）。Meta分析结果显示,计算机辅助导航全膝关节置换后机械轴恢复精确率明显优于传统全膝关节置换,其中偏倚3°时,P〈0.00001;偏倚2°时, P=0.0008。计算机辅助导航全膝关节置换后股骨假体冠状角恢复精确率（3°）明显优于传统全膝关节置换（P=0.002）;偏倚2°时两种方案差异无显著性意义（P=0.290）。计算机辅助导航全膝关节置换后股骨假体矢状角恢复精确率（3°）明显优于传统全膝关节置换（P=0.040）;偏倚2°时两种方案差异无显著性意义（P=0.950）。计算机辅助导航全膝关节置换后胫骨假体冠状角恢复精确率明显优于传统全膝关节置换,偏倚3°时,P=0.0007;偏倚2°时,P=0.002。计算机辅助导航全膝关节置换后股骨假体矢状角恢复精确率（3°）明显优于传统全膝关节置换（P=0.030）;偏倚2°时两种方案差异无显著性意义（P=0.260）。提示计算机辅助导航全膝关节置换后肢体力线、股骨/胫骨假体力线偏倚3°以内的精确率均优于传统全膝关节置换,但股骨假体冠状角、股骨假体矢状角、股骨假体     

同时双侧全膝表面置换与单侧全膝关节置换围手术期康复的比较

背景：目前对于双膝严重骨性关节炎行两组同时双侧全膝表面置换的围手术期康复的相关研究尚不多见。目的：比较双膝骨性关节炎两组同时双侧全膝表面置换术与单侧全膝关节置换围手术期康复训练的效果。方法：两组医生对59例（118膝）患者双膝骨性关节炎同台同时全膝表面置换,与同期80例单膝骨性关节炎行单侧全膝关节置换患者（对照组）进行疗效比较。两组患者置换前均进行康复教育及预备康复,置换后康复方法标准一致。结果与结论：同时双侧全膝表面置换组置换前通过压腿平均减小屈曲畸形角度11.2°（5°～22°）。置换后3～6周,股四头肌、腘绳肌肌力5级,较置换前平均增加0.8级;平均ROM≥95°（110±15）°;无痛行走500m以上;独自无痛上下10级楼梯,无肿胀;出院时HSS评分较置换前增加。置换后3个月没有发现松动表现及不良反应,其康复疗效与对照组对比差异无显著性意义。表明,在围手术期对双膝骨性关节炎两组医生行同时双侧全膝表面置换,通过系统而量化的康复,有利于减少置换中截骨量和置换后并发症,促进患者膝关节功能恢复,与单侧全膝关节置换相比康复结果无明显差异。     

同时双侧全膝表面置换与单侧全膝关节置换围手术期康复的比较

背景:目前对于双膝严重骨性关节炎行两组同时双侧全膝表面置换的围手术期康复的相关研究尚不多见。目的:比较双膝骨性关节炎两组同时双侧全膝表面置换术与单侧全膝关节置换围手术期康复训练的效果。方法:两组医生对59例(118膝)患者双膝骨性关节炎同台同时全膝表面置换,与同期80例单膝骨性关节炎行单侧全膝关节置换患者(对照组)进行疗效比较。两组患者置换前均进行康复教育及预备康复,置换后康复方法标准一致。结果与结论:同时双侧全膝表面置换组置换前通过压腿平均减小屈曲畸形角度11.2°(5°～22°)。置换后3～6周,股四头肌、腘绳肌肌力5级,较置换前平均增加0.8级;平均ROM≥95°(110±15)°;无痛行走500m以上;独自无痛上下10级楼梯,无肿胀;出院时HSS评分较置换前增加。置换后3个月没有发现松动表现及不良反应,其康复疗效与对照组对比差异无显著性意义。表明,在围手术期对双膝骨性关节炎两组医生行同时双侧全膝表面置换,通过系统而量化的康复,有利于减少置换中截骨量和置换后并发症,促进患者膝关节功能恢复,与单侧全膝关节置换相比康复结果无明显差异。     

老年患者人工骨水泥型与非骨水泥型全髋关节置换后假体稳定性及髋关节功能比较

选择1999-01/2002-01重庆医科大学第二附属医院骨科行初次全髋置换获得完整随访资料40例老年髋部疾患患者。骨水泥组16例,非骨水泥组24例。置换后下地时间骨水泥组明显短于非骨水泥组（P〈0.05）。骨水泥组1例患者发生骨水泥外漏,对关节功能无影响;非骨水泥组1例发生股骨近端线形骨折,以钢丝环扎固定并最终愈合,1例出现与牵拉有关的坐骨神经损伤,保守治疗2个月后恢复,1例髋关节发生脱位,予手法闭合复位成功。2例骨水泥柄在骨-水泥界面和1例非骨水泥柄在骨-假体界面出现小于2mm的透亮线,1例非骨水泥柄在Gruen7区出现局灶性骨溶解,每组各有两个臼杯在Delee1区出现局灶性骨溶解,两组假体周围透亮线的发生率差异无显著性（P=0.08）。所有X射线片显示假体无移位、松动及下沉。     

Gait in the early days after total knee and hip arthroplasty: a comparison

Purpose. To evaluate whether gait after Total Knee Arthroplasty (TKA) is different from gait after Total Hip Arthroplasty (THA) in the early days following surgical intervention.

Method. The gait was studied in water, thus exploiting its buoyancy force. Twenty consecutive patients underwent TKA and twenty consecutive patients underwent THA. The mean age was 70.2 years (SD 6.9). Twenty age-matched volunteers were the control group.

Results. At the beginning TKA and THA patients had the same speed and the same step length. At day 15 there was a speed difference in favour of THA patients (t = - 2.245, df 38, p = 0.031). Likewise, the step length was longer in THA patients (t = -2.293 df 38, p = 0.027). In contrast to TKA patients, THA patients were unbalanced, having a longer stance phase on the non-operated leg and a longer swing on the contralateral one.

Conclusions. Gait strategies were completely different after TKA and THA interventions. TKA patients were balanced over their feet and they appeared more cautious and more concerned about gait quality than moving quickly. By contrast, THA patients were unbalanced, having a longer stance phase on the non-operated leg and a longer swing on the contralateral one. However, their speed gain was higher.