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。     

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     

全膝关节置换翻修术后的异位骨化

全髋置换术和初次全膝置换术后并发异位骨化(HO)的报道较多,尚无全膝关节置换翻修术后HO的研究报道。研究旨在确定全膝关节置换翻修术后HO的发病率、危险因素和临床意义。对1993年至1997年间151例行全膝关节置换翻修术患者中135例(女性72例,男性63例)进行了24～48个月(平均30个月)的随     

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。     

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。     

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。     

二期假体再置换治疗人工全膝关节置换术后深部感染

目的　探讨二期假体再置换术治疗人工全膝关节置换术后深部感染的效果。方法　 3例TKR术后深部感染 ,为急性和亚急性感染 ,平均为 5个月。采取清创、二期假体再置换术并结合抗感染治疗。结果　经治疗后随访 ,3例患者膝部肿、痛消失 ,感染无复发。HSS评分平均为 6 8分 ,膝关节活动平均为 75°。结论　二期假体再置换术是在目前众多全膝关节置换术后深部感染治疗方法中成功率较高 ,有较高临床价值的治疗措施     

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。     

全膝关节置换翻修手术

全膝关节置换翻修手术是一项要求很高的技术。本文从分析初次全膝关节置换术后失败的原因入手,着重介绍了翻修手术的指征、术前评估、手术暴露、骨缺损的分类及相应的修复方法、假体选择等。     

Successful 1-stage exchange total knee arthroplasty for fungal infection

The case of a 75-year-old woman treated by 1-stage exchange arthroplasty for fungal infection of a total knee arthroplasty is reported.     

全膝关节置换治疗膝关节骨关节炎

目的研究全膝关节置换治疗骨关节炎的近中期手术效果,探讨手术方法与术后效果。 方法回顾性分析了皖南医学院弋矶山医院2010年7年至2018年3月临床资料。膝关节骨关节炎手术患者共81例,平均疼痛时间(8±3)年,均采用后稳定型假体,膝关节内外翻、屈曲畸形通过术中骨赘清理、内外侧副韧带和后方关节囊等软组织松解等技术矫正。术后关节囊内注入氨甲环酸抗凝及早期进行康复治疗。术前及术后拍摄下肢全长X片及膝关节正侧位X片记录股胫角度和屈曲畸形角度,统计手术时间、术后引流量。术后随访1、3、6、12、24月复查膝关节正侧位X线,记录膝关节活动度和疼痛情况,并进行膝关节协会评分(KSS)。用SPSS 17.0软件,数据采用配对t检验分析。 结果平均随访时间(22±5)个月,手术时间平均(71±6)min,引流量平均(380±5)ml,膝关节股胫角术后平均为(1.3±1.0)°,术后有4例术后出现膝前痛。无血管及神经损伤等并发症,下肢力线基本恢复正常。无术后感染发生。随访复查膝关节正侧位X线片,未发现假体松动、下沉。随访膝关节活动度、疼痛。膝关节KSS评分有显著改善(临床t＝－66,功能t＝－91.7,P<0.05) 。 结论全膝关节置换术治疗膝关节骨关节炎,术中应用骨赘清理、内外侧,后方关节囊等软组织松解等手术技术,可纠正内外翻畸形,恢复下肢力线、改善膝关节活动度和缓解疼痛,临床效果满意。     

Total knee arthroplasty for the stiff knee

The underlying cause of stiffness must be carefully evaluated when considering total knee arthrolasty for the stiff knee. Any previous skin incision must be recorded as well as the state of the extensor mechanism. The choice of prosthesis constraint should be decided on the state of the soft-tissues often released extensively to gain flexion. A quadriceps release or plasty and a tibial tubercle osteotomy are the current options for exposure, soft-tissue release and bone cuts. Postoperatively, the motion should be started early combined to pain control in order to obtain an average of 65° of flexion at follow-up. The complication rate remains high including recurrent stiffness, delayed wound healing and deep infection.     

Total knee arthroplasty for osteonecrosis

BACKGROUND: A patient with collapse of a femoral condyle caused by osteonecrosis has few treatment options other than total knee arthroplasty. The purpose of this study was to report the clinical and radiographic outcome of total knee arthroplasty for osteonecrosis. METHODS: Between 1987 and 1996, thirty-two total knee arthroplasties were performed with cement in thirty patients with osteonecrosis of the femoral condyle and/or tibial plateau. The study group included twenty-forty women and five men with a mean age of fifty-four years (range, thirty-one to seventy-seven years) at the time of the arthroplasty. Twenty-two patients had atraumatic osteonecrosis associated with corticosteroid use, and eight had spontaneous osteonecrosis. All patients had a complete clinical and radiographic evaluation at a mean of 108 months (range, forty-eight to 144 months) postoperatively. RESULTS: Overall, thirty-one (97%) of the thirty-two knees had a successful clinical outcome. The mean Knee Society score improved from 54 points preoperatively to 95 points at the time of the latest follow-up. No evidence of progressive radiolucency was found around any prosthetic component. CONCLUSIONS: Previous studies have demonstrated less-than-optimal results following total knee arthroplasty in patients with osteonecrosis. The excellent results found in the present study may have been secondary to the use of cemented implants in all cases and ancillary stems when appropriate.     

Total knee arthroplasty

Eighty-six nonhinged total knee arthroplasties performed between 1971 and 1981 have been reviewed. Fifty-one were of the geometric type and 35 of the anametric type. The use of both units resulted in a statistically and clinically significant improvement in preoperative pain and an increase in functional activities. Three of 51 geometric units developed loose components that required revision. None of the 35 anametric units has required revision for loosening. Partial radiolucent lines at the tibial bone-cement interface were noted in 43% of the group. Data analysis of age, weight, and sex demonstrated no statistically significant characteristic of this group when compared with the group without radiolucent lines. However, radiolucent lines were more common in those patients with osteoarthritis than in the group with rheumatoid arthritis. In addition, radiolucent lines were noted in 90% of knees in which a metal-backed tibial tray with a central post was used, compared with 36% of knees without metal-backed tibial components. Relief of pain and correction of instability and deformity can be achieved for most patients following nonhinged total knee arthroplasty.     

Total knee arthroplasty infection: significance of delayed aspiration

The records of 35 patients with total knee arthroplasty infection were reviewed to investigate the significance of delayed aspiration and the success of treatment. In 13 patients, aspiration was performed within 3 months after the onset of symptoms of infection. The median duration of treatment was 243 days, and infection was arrested in all patients. In 22 patients, aspiration was performed >3 months after the onset of symptoms. The duration of treatment was significantly longer in these patients (P<.001). Persistent infection was recorded in 8 patients, and amputation of the involved leg was done in 3 patients. Aspiration within 3 months after the onset of symptoms of infection significantly reduced the duration of treatment and increased the chances of successfully arresting infection.     

Total knee arthroplasty in stiff knees after previous infection

Between July 1986 and August 1996, we performed 32 total knee arthroplasties (TKA) on 32 patients with partially or completely ankylosed knees secondary to infection. Their mean age at surgery was 40 years (20 to 63) and the mean follow-up was ten years (5 to 13). The mean post-operative range of movement was 75.3 degrees (30 to 115) in those with complete and 98.7 degrees (60 to 130) in those with partial ankylosis. The mean Hospital for Special Surgery knee score increased from 57 to 86 points post-operatively. There were complications in four knees (12.5%), which included superficial infection (one), deep infection (one), supracondylar femoral fracture (one) and transient palsy of the common peroneal nerve (one). Although TKA in the ankylosed knee is technically demanding and has a considerable rate of complications, reasonable restoration of function can be obtained by careful selection of patients, meticulous surgical technique, and aggressive rehabilitation.     

重度膝关节外翻畸形的全膝关节置换术

 目的 探讨重度膝关节外翻畸形全膝关节置换术的手术方法及临床效果。方法 对2007年1月至2012年12月采用全膝关节置换治疗的重度膝关节外翻畸形患者22例（23膝）进行回顾性分析。男7例,女15例;年龄41~78岁,平均65岁。股胫角（股骨和胫骨解剖轴线的夹角）22°~50°,平均为34.6°。骨关节炎17例,类风湿关节炎5例。髌骨完全脱位3例3膝,内侧不稳定1例1膝,屈曲挛缩畸形3例4膝。21例22膝采用后稳定型假体,1例1膝采用限制型假体。髌旁内侧入路、常规截骨及单纯外侧软组织松解,术中行髌骨置换5例。以膝关节活动度、X线股胫角及美国特种外科医院（Hospital for Special Surgery,HSS）膝关节评分评价术后疗效。结果 全部病例随访时间1~5年,平均2.5年。膝关节活动度由术前平均43.7°±5.8°（0°~80°）提高至末次随访时110.6°±7.5°（80°~130°）,HSS膝关节评分由术前平均（19.6±4.7）分（6~34分）提高至末次随访时（89.7±3.6）分（84~96分）,手术前后的差异有统计学意义。外翻畸形基本得到矫正,末次随访时股胫角平均为8.6°±0.8°（0°~12°）,较术前34.6°±2.4°（22°~50°）明显改善,手术前后的差异有统计学意义。术后2例2膝有膝关节内侧不稳症状,给予膝关节支具保护;1例1膝术前严重髌骨脱位患者术后存在半脱位,未予特殊处理;2例2膝术后出现腓总神经麻痹,未予特殊处理。随访期间未发生感染、松动及深静脉血栓形成等并发症。结论 对重度膝关节外翻畸形患者可采用常规截骨、单纯外侧软组织松解及后稳定型假体植入,能较好地矫正外翻畸形,近期疗效满意。