全膝关节置换术术中失误及术后早期并发症分析

目的 分析全膝关节置换术（total knee arthroplasty,TKA)术中失误及术后早期并发症的原因。方法 对1993年7月-2000年12月间治疗的423例TKA患者进行回顾性分析。其中男152例，平均年龄64.4岁（53-77岁）；女271例，平均年龄67.2岁（34-87岁）。类风湿性关节炎（RA）142例，骨关节炎（OA）264例，创伤性关节炎13例，化脓性关节炎膝关节强直4例。均采用进口膝关节假体。结果 17例发生了手术中失误或出现术后早期并发症，发生率为4.02%。术中失误包括股骨髁劈裂骨折1例，股骨干穿孔2例，胫骨上端穿孔2例，截骨不当5例，髌骨穿孔1例；术后早期并发症包括术后早期感染1例，深静脉血栓3例，膝关节强直2例。结论 TKA术中失误的原因在于配套器械使用不熟练。对膝关节变形的认识不足，综合外科技术不全面。感染涉及多个环节。合理使用抗凝药物及正确进行术后康复训练对预防深静脉血栓和获得满意的膝关节功能十分重要。

Analysis of intraoperative mistakes and early complications of total knee arthroplasty

Objective To analyze the reasons of intraoperative mistakes and early complications of total knee arthroplasty. Methods From July 1993 to December 2000, 423 patients underwent total knee arthroplasty were reviewed. There were 152 males with an average age of 64.4 years (range 53-77years), and 271 females with an average age of 67.2 years (range 34-87 years) at surgery respectively. The underlying diseases include rheumatoid arthritis in 142 cases, osteoarthritis in 264 cases, post-traumatic arthritis in 13 cases and post-infected ankylosed arthritis in 4 cases; the prostheses of reserved posterior cruciate ligament was used in 317 cases, and posterior stable prostheses in 106 cases. Results Seventeen mistakes or complications were recorded, the incidence was 4.02%. Intraoperative mistakes in the study included femoral condylar fracture in 1 case; femoral shaft perforation in 2 cases; proximal tibia perforation in 2 cases; incorrect osteotomy in 5 cases; patellar perforation in 1 case. Postoperative complications included early infection in 1 case; deep vein thrombosis in 3 cases; and knee stiffness in 2 cases. Conclusion Intraoperative mistakes may be caused by unskilled use of special instruments, underestimation of knee deformities and lack of comprehensive surgical techniques; postoperative infections can be associated with many factors; proper use of anticoagulants and rehabilitation are very important in preventing from deep vein thrombosis and achieving a satisfactory range of motion.