非置换髌骨的非骨水泥型全膝关节置换术中期疗效

目的 通过回顾性研究一组非置换髌骨的非骨水泥型全膝关节置换术的中期临床疗效,探讨其临床应用的可行性和可靠性.方法 1997年6月-2000年3月,在德国奥格斯堡海森基金会医院第一临床骨科共完成152例152膝非置换髌骨的非骨水泥型全膝关节置换术.男63例,女89例;年龄51～72岁,平均59岁.左膝70例,右膝82例.骨性关节炎146例,创伤性关节炎6例.病程1.0～3.5年.膝关节活动度30～90°平均55°HSS评分(41.5±12.3)分.术中均采用德国Plus公司的后交叉韧带保留型非骨水泥型全膝关节置换假体.结果 术后5例膝前痛,经对症治疗后疼痛缓解.无深部感染发生.145例获随访5～8年,平均6.5年.随访期末HSS评分(87.5±8.2)分,与术前比较差异有统计学意义(P<0.05).膝关节活动度90～110°,平均95°18例患者术后3～6个月X线片示透亮线在胫骨侧,其中15例透亮线宽度<2mm,无临床症状;3例透亮线>2 mm,其中2例因无菌性松动,行胫骨侧假体翻修术,同时更换聚乙烯衬垫,另1例仅有轻度疼痛,随访期间无松动症状,未作特殊处理.结论 中期随访显示股骨侧、胫骨侧骨-假体界面的骨长入,结合效果满意.术后假体早期微动是导致松动的主要原因.保留髌骨的非骨水泥型全膝关节置换术同样可达到满意疗效.

MID-TERM THERAPEUTIC EFFECT ANALYSIS OF CEMENTLESS TOTAL KNEE ARTHROPLASTY WITHOUT PATELLA REPLACEMENT

OBJECTIVE: To explore the flexibility and reliability of cementless total knee arthroplasty (TKA) without patella replacement through a retrospective study of the mid-term therapeutic effect of the treatment of the patients. METHODS: From June 1997 to March 2000, a consecutive series of 152 (152 knees) cementless TKA performed in Hessing-Stiftung was studied. Among them, there were 63 males and 89 females, with 70 left knees and 82 right knees. Their ages ranged from 51 years to 72 years, with an average of 59 years. There were 146 cases of osteoarthritis and 6 cases of traumatic arthritis. The course of the disease lasted for 1.0 years to 3.5 years. The EFK prostheses of German Plus company were used in all the cases. The HSS score before the operation was 41.5 +/- 12.3, and the average range of motion was 55 degrees (ranging from 30 degrees to 90 degrees). RESULTS: Five patients underwent anterior knee pain, and the pain was released after the appropriate treatment. No deep infection happened in all cases. A total of 145 patients (145 knees) were followed up for 5 years to 8 years. The HSS score was 87.5 +/- 8.2 at the end of the follow-up, showing significant difference (P < 0.05). The average range of motion was 95 degrees (ranging from 90 degrees to 110 degrees). Partial radiolucencies occurred at the tibia side in 18 knees 3 to 6 months after the operation. Among them, the width was less than 2 mm in 15 knees without symptom, and more than 2 mm in 3 knees. There were 2 of the 3 knees which were revised at the tibia side because of the aseptic loosing, while 1 patient had only mild pain in the knee during the follow-up, with no sign of loosing. CONCLUSION: The mid-term effect of cementless TKA is satisfactory. The ingrowth of femur and tibial bones is reliable. The early stage migration of the component is the main reason of loosing. Satisfying outcomes can also be achieved without patella replacement during TKA.