人工膝关节置换治疗重症膝关节病118例

选择2000-06/2007-01贵州省人民医院骨科收治的行人工全膝关节置换患者118例(138膝),男45例,女73例;年龄52～81(61±8)岁;类风湿性关节炎28例(34膝),创伤性关节炎6例(6膝),严重骨性关节炎84例(98膝),其中合并外翻畸形14例(18膝),合并内翻畸形25例(28膝).所选假体类型Link Gemini假体38膝,Zimmer Nexgen 68膝,Depuy pfc sigma旋转平台32膝.全部患者均获得随访,随访时间10个月～6 年(平均28个月).置换前膝关节HSS评分(34.00±7.65)分,末次随访时 (81.00±6.89)分,其中优87膝(63%),良43膝(31%),可8膝(6%),优良率94%.118例患者中发生感染4例,3例单膝置换后下肢发生深静脉血栓形成,经抗凝及对症处理痊愈.3例(4膝)置换后2个月发生膝关节疼痛,检查膝关节无红肿,无压痛,活动度基本正常,摄X射线平片示假体位置良好,行股神经封闭后症状缓解.提示全膝关节置换是治疗重症膝关节疾病的有效方法.

Total knee arthroplasty for treatment of severe knee joint diseases in 118 cases

A total of 118 patients (138 knees) who received total knee arthroplasty at the Department of Orthopedics, Guizhou Province People's Hospital between June 2000 and January 2007 were included in this study. These patients comprised 45 males and 73 females and were averaged (61±8) years old (range, 52-81 years). Of them, 28 (34 knees) suffered from rheumatoid arthritis, 6 (6 knees) from traumatic arthritis, 84 (98 knees) from severe osteoarthritis, 14 (18 knees) complicated by extraversion, and 25 (28 knees) complicated by inversion. Link Gemini knee prosthesis was used in 38 knees, Zimmer Nexgen knee prosthesis in 68 knees, and Depuy pfc sigma rotation platform knee system in 32 knees. All patients were followed up for an average of 28 months (range, 10 months-6 years). Prior to replacement, the mean knee score, according to the Hospital for Special Surgery (HSS) rating scale, was (34.00±7.65) points, and at the latest follow-up examination, it was (81.00±6.89) points. HSS score was excellent in 87 knees (63%), good in 43 knees (31%), and fair in 8 knees (6%). The excellent and good rate was 94%. Of 118 patients, 4 presented with infection and 3 showed deep venous thrombosis in lower limb following unilateral total knee arthroplasty and healed after anticoagulation and symptomatic therapy. There were 3 patients presenting with knee joint pains 2 months following knee joint arthroplasty. No knee joint red swelling and tenderness were found. Range-of-motion was basically normal. X-ray photograph indicated good position of prosthesis. Pains were relieved after femoral nerve block. All these findings suggest that total knee replacement is an effective method of treating severe knee joint diseases. INTRODUCTIONTotal knee arthroplasty (TKA), as an important part of artificial joint replacement for treatment of severe knee joint diseases, initiated from the first knee joint prosthesis developed by Cunstno in 1960s and was put in use. But following TKA, large-scale severe complications appear due to condition limitations, which results in failed surgery. With development of molecular biology and materials, as well as further research of installing technique and knee joint biomechanics, TKA has been shown to be gradually perfect theoretically. A novel prosthesis better corresponds to the physiological standards of human body in terms of structure design, material strength, and shape. These improvements greatly enhance prosthesis survival rate and markedly decreases complication incidence following TKA. TKA has been shown to be an efficient method of treating severe knee joint diseases. It can effectively relieve joint pains and improve joint functions, and is mostly used in elderly populations (over 60 years old) who complicated by other diseases, such as diabetes mellitus, hypertension, heart disease, phlebitis of lower extremities. In addition to above-mentioned, poor body resistance enhances surgery risk and difficulties, and complications would be correspondingly increased following TKA. The present study retrospectively analyzed a total of 118 patients with severe knee joint diseases who underwent TKA at the Department of Orthopedics, Guizhou Province People's Hospital between June 2000 and January 2007.