天津医药

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旋转铰链膝关节置换术治疗严重畸形膝关节病变近期效果

肖瑜1,张福江2,马信龙2,任凯晶2   

  1. 1. 天津市天津医院
    2. 天津市天津医院关节外科
  • 收稿日期:2012-08-21 修回日期:2012-11-05 出版日期:2013-06-15 发布日期:2013-06-15
  • 通讯作者: 肖瑜

Short-Term Clinical Outcomes of Primary Rotating Hinge Knee Arthroplasty for Knees with Severe Deformity

XIAO Yu 1,ZHANG Fujiang 2,MA Xinlong 2,REN Kaijing 2   

  1. 1. Tianjin Medical University,Tianjin 300070,China
    2. Department of Joint Surgery, Tianjin Hospital
  • Received:2012-08-21 Revised:2012-11-05 Published:2013-06-15 Online:2013-06-15
  • Contact: XIAO Yu

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摘要： 目的   探讨初次旋转铰链膝关节置换术治疗严重畸形的膝关节病变的适应证和近期疗效。方法  2005年10月至2010年10月，采用Endo-Model旋转铰链假体行初次膝关节置换患者30例30膝，女17例（17膝），男13例（13膝）；年龄53～78岁，平均（65.2±8.3）岁；体重指数25.83～32.47kg/m2，平均（28.21±3.52）kg/m2，身高1.54～1.77cm，平均（1.63±0.15）m。术前膝关节活动范围57.4°±15.6°。比较手术前、后X线片，并采用配对t检验对手术前、后KSS临床及功能评分、膝关节活动范围以及屈曲角度等计量数据进行统计学分析。结果 患者手术时间平均(85.0±14.2)min。无一例发生感染、血栓、神经血管损伤等并发症。所有患者均获得随访，随访时间18～48个月，平均33个月。膝关节活动范围和屈曲角度分别由术前平均57.4°±15.6°和78.9°±20.4°增至术后95.3°±10.2°和103.6°±12.8°；KSS临床和功能评分分别由术前（38.6±12.7）分和(36.3±15.1)分增至术后（87.9±12.5）分和（68.8±18.1）分。髌股关节并发症最常见，有9例（30%）膝前痛患者髌骨轴位片显示髌骨有移位或倾斜。结论 Endo-Model旋转铰链膝关节假体早期效果满意，对治疗膝关节严重畸形病变的一个良好手术选择，但应重视髌股关节并发症的发生。

关键词: 关节成形术, 置换, 膝, 人工关节, 随访研究, 治疗结果, 旋转铰链, Endo-Model

Abstract: Objective   To explore the indication and observe short-term clinical outcome of primary rotating hinge knee arthroplasty for knees with severe deformity. Methods   A retrospective study of the clinical outcomes from Oct 2007 to Oct 2010 was done on 60 knees in 51 patients after receiving the TKA with the Endo-Model rotating hinge prostheses. There were 17 males(21 knees),34 females(39 knees),with the mean age of（65.2±8.3）years(ranged 53-78 years).All patients were evaluated pre and postoperatively using X-ray image, the Knee Society Score(KSS) and ROM and the flexion. Results   The average follow-up time was 33 months. The mean operation time was(85.0±14.2)min。No complications of infection, thrombosis and vascular and nerval injury. The ROM and flexion of knees were improved from average 57.4°±15.6°and 78.9°±20.4°to 95.3°±10.2°and 103.6°±12.8°respectively. The KSS clinical score and function score were improved from average 38.6±12.7 and 36.3±15.1 to 87.9±12.5 and 68.8±18.1 respectively。There were 17 patients having anterior knee pain and we could see their patellars shift or tilt in the axial view of X-ray. Conclusion    The short-term clinical outcomes of Endo-Model rotating hinge TKA are ideal, and it is a good therapy choice for knees with severe deformity. However, the high rate of patellofemoral joint complications should be encountered.

Key words: arthroplasty, replacement, knee, artificial joint, Follow-up studies, treatment outcome, rotating hinge, Endo-Model