人工全膝关节置换术治疗严重畸形膝关节临床研究

目的：探讨人工全膝关节置换术（total knee arthroplasty， TKA）治疗严重畸形膝关节的手术方法和临床疗效。方法对人工全膝关节置换术916例（1031膝），严重畸形膝关节置换术80例，其中56例（70膝）成功随访。严重内翻畸形19例（23膝）、严重外翻畸形21例（27膝）、严重屈曲畸形16例（20膝）。术后平均随访时间60个月（6个月～10年）。对膝关节屈伸活动度、HSS、KSS膝关节评分系统对手术前后进行回顾性研究。结果膝关节屈伸活动度由术前平均80°（伸直0°～屈曲120°）提高到术后115°（伸直0°～屈曲130°），膝关节评分系统 HSS、KSS术前及随访时比较差异有统计学意义（P＜0．05），KSS评分：临床评分由术前平均33分（10～68分）提高到术后平均81分（70～100分），HSS临床评分由术前平均43分（27～68分）提高到术后平均86分（72～100分）。膝内外翻、屈曲挛缩畸形得到较好矫正。结论严重畸形膝关节通过关节置换术同样能恢复正常的关节功能，提高了患者生活质量，获得满意的临床疗效。

Total knee arthroplasty for treatment of severely deformed knee

Objective To investigate the methods and clinical results of total knee arthroplasty （ TKA） in patients with severe knee deformity.Methods From February 1999 to December 2012,916 patients （1031 knees） underwent TKA in this hospital ,inclu-ding 80 patients with severe knee deformity ,of which,56 patients （70 knees） were followed up,among them,19 patients （23 knees） with varus knee deformity,21 patients （27 knees）,patients with severe flexion deformity were 16 patients （20 knees） knee flexion de-formity.The mean follow-up period was 60 months（ranging from 6 months to 10 years）.To evaluate the outcomes of TKA at the time of pre-operation and follow-up respectively,range of motion（ROM）,the HSS score and the KSS score were used.Results The average ROM improved from 80°（0°-120°） preoperatively to 115°（0°-130°） postoperatively.The HSS score and the KSS score were signifi-cantly improved compared with pre-operation（P〈0.05）.KSS improved from 33 points （10-68 points） preoperatively to 81 points （70-100 points）,HSS improved from 43 points （27-68 points） preoperatively to 86 points （72-100 points）.Varus knee deformity,val-gus knee defoimity and flexion deformity were corrected .Conclusions TKA improves the function of knee effectively and the quality of patients＇life.The effect of TKA is satisfactory .