高度屈曲畸形膝的全膝关节置换策略

目的 探讨膝关节高度屈曲畸形的临床特点和矫形手术的技巧.方法 2002年10月至2007年6月,对8例膝关节屈曲畸形>60°的患者行全膝关节置换术,所有患者均使用旋转铰链式假体(Plus RT-solution).男3例,女5例;年龄42～73岁,平均63.3岁.术前诊断:骨性关节炎4例,创伤后畸形愈合1例,结核1例,类风湿关节炎1例,强直性脊柱炎膝关节强直1例.创伤后畸形愈合的病例采用原膝关节内侧入路,其余患者均采用正中切口髌骨内侧入路,所有病例均未行髌骨置换.疗效评估主要采用影像学观察和膝关节HSS评分(Hospital for Special Surgery knee score).术前屈曲畸形平均96.5°(70°～105°),HSS评分平均10分(3～15分),无关节活动度.结果 术后平均随访39.9个月(9～80个月).影像学显示无假体松动,髌骨轨迹良好.术后平均伸直阻滞8°(5°～15°),HSS评分平均85分(74～93分),膝关节平均活动度90°(80°～110°).1例患者有髌股关节症状,无感染、松动等相关并发症.结论 对于膝关节高度屈曲畸形的患者,行充分的软组织松解,合适的截骨,并结合使用旋转铰链式假体,可以取得良好的手术效果.

Strategy of total knee arthroplasty in the patients with severe flexion contracture

Objective To investigate the clinical characteristics of severe flexion cnntracture and discuss the techniques in correction of severe flexion contractures in total knee arthroplasty. Methods The present study included 8 patients (3 males, 5 females) with knee contractures greater than 60° who underwent total knee arthroplasty. Of these 8 patients, four were osteoarthritis, one was femoral malunion after trauma, one was tuberculosis of the knee, one was rheumatoid arthritis and one was ankylosing spondylitis. The average age of the patients was 63.3 years (range, 42-73 years). Anterior midline incision and medial parapatellar retinacular approach were used in all but one patient, in whom the original incision was used due to femoral malunion after trauma. Rotating hinged prostheses were applied for all patients. The patella was not replaced in all patients. Radiological imaging and HSS score (Hospital for Special Surgery knee score) were used to evaluate the surgical outcomes. Results The average follow-up period was 39.9 months (range, 9-80 months). The radiology indicated that there were no prostheses loosing, the patellofemoral tracking were normal. Before surgery, the average flexion contracture was 96.5° (range, 70°-105°), and the average HSS scores was 10 (range, 3-15), no motion of joint was observed. After surgery, the average residual flexion contractures was 8° (range, 5°-15°), the average HSS scores increased to 85 (range, 74-93), and the average motion of joint improved to 90° (range, 80°-110°). At follow-up, one patient had patellofemoral joint symptom after surgery. No infection and loosing were occurred. Conclusion After sufficient release of the contracted soft tissues, appropriate management of the femoral bone resection combined with the usage of rotating hinged prostheses, satisfactory outcome could be obtained in patients with severe flexion contractures who underwent total knee arthroplasty.