标准型股骨髁、胫骨托与高切迹胫骨聚乙烯垫组合TKA治疗严重膝关节骨性关节炎并膝内、外翻畸形

目的探讨采用标准型股骨髁、胫骨托与高切迹胫骨聚乙烯垫组合全膝关节置换术（TKA）治疗严重膝关节骨性关节炎并膝内、外翻畸形的临床疗效。方法采用标准型股骨髁、胫骨托与高切迹胫骨聚乙烯垫组合TKA治疗20例（25膝）严重膝关节骨性关节炎并膝内、外翻畸形,其中2例保留后交叉韧带,18例不保留后交叉韧带。结果本组20例术后获得平均12（5~60）个月随访。术前膝关节活动范围15°~85°,术后0°~130°。膝内、外翻畸形得到矫正。术前KSS评分（11.50±1.61）分,术后（91.35±1.23）分。结论采用标准型股骨髁、胫骨托与高切迹胫骨聚乙烯垫组合TKA治疗严重膝关节骨性关节炎并膝内、外翻畸形术中通过软组织平衡技术的应用,操作方便,假体稳定性及关节活动度好。早期临床疗效满意,远期疗效有待进一步随访观察。     

不同股骨髁间截骨膝关节假体在膝关节置换术中的应用

[目的]探讨不同股骨髁间截骨膝关节假体在膝关节置换术中的应用。[方法]自2005年5月²010年10月本科行TKA术的患者107例(122膝)。使用深盘型后稳定假体62例(72膝),使用桩柱型后稳定假体45例(50膝)。对比两组术前、术后KSS评分、功能评分、测量膝关节ROM。[结果]两组术后与术前的KSS评分、功能评分、膝关节ROM比较,差异均有统计学意义(P<0.05)。两组术后KSS评分、功能评分、膝关节ROM比较,差异均无统计学意义(P>0.05)。深盘型后稳定假体组有1例,术后出现膝关节假体周围感染,经过一期骨水泥旷置,3个月行二期翻修;桩柱型膝关节假体组有1例术中发生股骨外髁骨折,术中及时发现给予螺钉内固定,1例术后7个月股骨假体周围骨折,给予钢板内固定术,患者均痊愈出院。两组术后随访X线片观察膝关节假体位置、力线、固定性能等均显示良好,无松动、透亮线等异常表现。[结论]两种不同术式股骨髁间截骨膝关节假体行TKA临床疗效满意,术后膝关节功能良好。     

TC-Dynamic膝关节假体在膝关节置换中的应用

[目的]探讨TC-Dynamic膝关节假体在膝关节置换中的应用.[方法]自2005年10月～ 20l0年12 月,采用TC-Dynamic膝关节假体行TKA共40例(50膝)与Depuy P.F.C.Sigma膝关节假体行TKA 40例(45膝)进行临床对比研究.对比两组术前、术后KSS评分、功能评分、Feller评分、测量膝关节ROM、术后膝前疼痛及髌骨弹响.[结果]两组术后与术前的KSS评分、功能评分、Feller评分及膝关节ROM比较,差异均有统计学意义(P＜0.05).两组术后KSS评分、功能评分、Feller评分、膝关节ROM及比较,差异均无统计学意义(P＞0.05).两组手术用时TC-Dynamic膝关节假体较Depuy P.F.C.Sigma膝关节假体组平均少10 min.TC-Dynamic膝关节假体组膝前疼痛1例(1膝),髌骨弹响1例(1膝),Depuy P.F.C.Sigma膝关节假体组膝前疼痛2例(2膝),髌骨弹向3例(3膝).两组术后随访X线片观察膝关节假体位置、力线、固定性能等均显示良好,无松动、透亮线等异常表现.[结论]使用TC-Dynamic膝关节假体行TKA临床疗效满意,术后膝关节功能良好.     

间隙平衡技术在全膝关节置换术中应用的中期随访研究

[目的]分析间隙平衡技术在全膝关节置换(total knee arthroplasty,TKA)术中应用的临床效果及注意事项.[方法]回顾分析2004年3月～ 2006年3月应用间隙平衡(gap balancing,GB)技术的TKA患者45例(49膝),男16例,女29例,手术时年龄52 ～ 79岁,平均62.4岁.另取同期采用测量截骨(measured resection,MR)技术的TKA患者70例(76膝)设为对照组.比较分析两组患者的手术情况、影像学、膝关节功能恢复情况.[结果] 115例患者均获随访,时间6～8年,平均6.8年.GB组单膝手术时间、胫骨截骨量、股骨截骨量均明显低于MR组,术中股骨假体相对外上髁解剖轴内旋角度GB组大于MR组(P＜0.05).TKA术后两组患者髌骨外倾角度存在显著性差异(P＜0.05),GB组明显大于MR组.术后膝关节KSS、VAS评分及并发症发生率两组比较均无显著性差异(P＞0.05).[结论] TKA术中应用GB技术手术时间短,截骨量少,股骨假体相对外上髁解剖轴内旋和髌骨倾斜角度较大,中期随访临床效果和MR技术无明显差异,GB技术应避免内侧软组织过度松解,预防术后屈曲失稳及髌股关节并发症.     

股骨髁前后径与内外径比值对膝关节置换的影响

[目的]测量股骨髁的前后径、内外径,分析两者的比值对全膝关节置换的影响。[方法]选取2015年10月～2017年12月行全膝关节置换的170例患者,手术前利用X线片在膝关节上对股骨髁的前后径、内外径进行测量,算出两者比值,对比假体数据,将比值>0.9的60例患者分为两组,对照组:采取髓内长定位杆截骨;研究组:采取髓内短定位杆截骨,均为30例,对两组临床效果进行比较。[结果]两组患者术后均未出现感染、假体周围骨折及假体松动;两组患者术后KSS评分、伸直角度和伸膝障碍所占比例差异均无统计学意义(P>0.05);两组膝关节屈曲角度、股骨假体屈曲角度和股骨前端切迹差异均有统计学意义(P<0.05)。[结论]针对股骨髁前后径、内外径比值较大者,采取髓内短定位杆截骨能够维持伸屈稳定,降低截骨切迹和假体周边骨折发生概率,临床应用效果良好。     

CT扫描在全膝关节置换术中髌股关节轨迹不良股骨旋转力线的研究

[目的]探讨CT扫描技术检测全膝关节置换术(TKA)中对髌股关节轨迹不良股骨旋转截骨角度确定的作用。[方法]将72例(74膝)TKA中髌股关节轨迹不良患者随机分为两组:(1)CT扫描组35例(36膝):术前CT扫描确定股骨后髁角,术中采用CT确定的股骨后髁角进行股骨外旋截骨,其余TKA手术操作相同;(2)对照组37例(38膝):术中采用与后髁轴线呈固定外旋3°进行股骨外旋截骨,两组术后均行CT扫描分析股骨假体旋转不良角度并对其绝对值进行比较。[结果]术后随访时间24¹20个月,平均53.6个月。CT扫描组KSS功能评分从术前的平均35分提高到术后平均81分;对照组KSS功能评分从术前的平均34分提高到术后平均83分,两组比较均无显著性差异(P>0.05)。CT扫描组:TKA术后股骨假体旋转不良角度为1.4°±0.06°,对照组为2.5°±0.14°,两组比较差异有统计学意义(t=4.18,P<0.01)。CT扫描组股骨假体旋转不良率为12.5%,经验组为24.6%,两组比较差异有统计学意义(x2=16.58,P<0.01)。[结论]术前CT扫描确定股骨假体旋转参考轴,可用于指导全膝关节置换术中股骨旋转截骨角度,有效提高TKA手术股骨假体旋转力线的准确性。     

深盘型假体对全膝关节置换初期疗效的影响

目的探讨深盘型假体对全膝关节置换初期疗效的影响。方法 2006年6月~2012年1月,本组应用深盘型垫片假体行TKA的76例（97膝）患者进行随访,随访时间2~6年,平均4.2年,其中女65例,男11例;年龄55~78岁,平均65.8岁;选择男女共76名志愿者,年龄在18~42岁之间,平均30.5岁,随机左右膝。对比TKA组术前、术后KSS评分、功能评分、膝关节ROM、股骨后髁偏心距;对比TKA组与志愿者组膝关节从伸直位到最大屈曲位时股骨相对于胫骨前后移动的距离。结果 TKA组手术前后膝关节KSS评分、功能评分及膝关节ROM比较,差异均有统计学意义（P〈0.05）,手术前后股骨后髁偏心距差异无统计学意义（P〉0.05）。TKA组膝关节从伸直位到最大屈曲位时股骨相对于胫骨向后移动距离之差（6.24±2.45）mm。志愿者组膝关节伸直至最大屈曲位时股骨相对于胫骨向后移动距离之差（10.87±1.49）mm,两者差异有统计学意义（P〈0.05）。1例术后出现伤口浅表感染,经处理后痊愈。1例术后出现膝关节假体周围感染,经二期翻修痊愈出院。术后随访X线片观察膝关节假体位置、力线、固定性能等均显示良好,无松动、透亮线等异常表现。结论使用深盘型膝关节假体行TKA术,初期临床疗效满意;TKA组术后膝关节伸直至最大屈曲位时股骨相对于胫骨后移距离较志愿者组短。     

人工全膝关节置换后股骨假体角度的CT影像学评估：股骨外上髁线参照与间隙平衡技术的对比研究

[目的]虽然人工全膝关节置换术中假体旋转定位的重要性已得到公认,但术中以哪条轴线为参照能够更加精确的保证股骨假体的旋转定位,目前尚存争议.研究表明股骨外上髁线(TEA)与膝关节屈曲轴线平行,但这一轴线术中难以精确确定.本文采用间隙平衡技术(BG),对比TEA技术在股骨假体实际旋转角度测量的差异 [方法]30例人工全膝关节置换分为2组(每组15膝),分别采用.TEA和BG技术,术后行CT扫描测量股骨假体旋转角度并行膝关节学会评分(KSS).[结果]BG组中股骨假体平均外旋角度为2.7°±1.1°,TEA组为5.6°±1.6°(P=0.001).术后KSS功能评分改善BG组高于TEA组(P=0.002).但两组的KSS膝评分无显著性差异(P=0.39).[结论]研究表明,与BG技术相比,术中应用TEA参照确定股骨假体的旋转定位可导致股骨假体的过度外旋,其术后KSS功能评分亦较差.     

旋转平台假体在全膝关节置换术中的应用及早期疗效观察

[目的]观察旋转平台人工膝关节置换术的临床疗效.[方法]对79例患者93膝行TKA,采用正中切口髌旁内侧入路,安装假体,膝关节均未进行髌骨置换.术后复查X线片观察假体固定情况,采用美国膝关节学会评分(KSS评分)评定膝评分及膝功能评分,观察并发症发生情况.[结果]本组平均随访时间(33.61±7.34)个月(24～48个月).末次随访时,关节总活动度明显增加,由术前68.76°增加至术后107.53°(P相似文献   

髌骨合理设计在全膝关节置换中的临床效果

目的探讨髌骨合理设计后重塑在全膝关节置换(TKA)中的临床效果。方法根据股骨假体滑动轨迹及所需置换髌骨的形态,对56例TKA患者(72膝)术中进行髌骨合理设计并重塑,观察患者术后的关节活动度及疼痛情况,用KSS膝关节评分系统评定治疗效果。结果 56例均获得随访,时间6~18个月。仅1例患者膝关节活动度70°,活动较差,但疼痛明显减轻;其余患者屈曲活动度在0°~110°。KSS评分:优69膝,良2膝,中1膝,优良率达到98.6%。结论术中根据股骨假体滑动轨迹对髌骨合理设计并重塑,可以使未进行髌骨置换的TKA患者取得满意的治疗效果。     

初次人工全膝关节表面置换术治疗膝关节骨关节病108例的疗效观察

[目的]探讨初次人工全膝关节表面置换术(total knee arthroplasty,TKA)治疗膝关节病的临床疗效。[方法]对108例130个膝关节行TKA,男50例(60膝),女58例(70膝);年龄47～87岁,平均71.5岁,术前诊断骨性关节炎62例(70膝),类风湿性关节炎37例(51膝),创伤性关节炎4例,滑膜软骨瘤病2例,色素沉着绒毛结节性滑膜炎2例,陈旧关节结核1例,采用后方稳定假体80例(92膝),后交叉韧带保留假体28例(38膝)。[结果]108例患者均获随访,时间24～84个月,平均50.3个月。患者术后在疼痛、功能、活动度方面改善明显,采用HSS评分系统进行评分,由术前平均48.4分提高到89.3分。术后130个膝关节平均活动度为102°,126个膝关节术后力线正常,3例残留6°～8°内翻,1例后遗15°外翻畸形,手术优良率90.5%。[结论]TKA对治疗严重膝关节病效果满意,术中正确的选择切口,注意假体软组织平衡,精确截骨,注重术中髌骨轨迹的纠正是手术成功的关键。     

关节内置管局部浸润镇痛在全膝关节置换术的应用

[目的]观察使用关节内置管局部浸润镇痛对全膝关节置换术后镇痛的早期临床疗效.[方法]收集从2008年12月～2009年4月在本院行全膝关节置换术后采用置管镇痛者11例(12膝).其中男3例,女8例,单侧手术者10例,同期双侧手术者1例.术前诊断:退变性骨关节炎8例,类风湿性关节炎2例,创伤后关节炎1例.所有患者围手术期镇痛方案均统一,术中关节周围注射"鸡尾酒"镇痛药液,并关节内置管术后1 d单次追加推注镇痛药液.记录患者术后1～3 d疼痛VAS评分、总体满意度、膝关节活动度、主动直腿抬高时间及伤口并发症等.[结果]所有患者均未使用胃肠外阿片类药物,术后1～3 d休息痛和运动痛VAS评分均获得显著改善,主动直腿抬高时间平均为2.6 d,手术后第2 d和第3 d的膝关节平均主动活动度各为41°和55°,患者总体满意度高,无明显并发症.[结论]全膝关节置换术后经关节内置管多模式局部浸润镇痛,能显著延长术后镇痛时间,降低手术24 h以后的休息痛、运动痛以及VAS评分,促进关节早日锻炼,提高患者满意度,且简单、实用、安全、有效.     

Total joint arthroplasty in orthotopic liver transplant recipients

Eight total hip and two total knee arthroplasties were performed from 1986 to 1991 in eight patients who had orthotopic liver transplantation. The indications for joint arthroplasty were avascular necrosis of the femoral head in five hips, pathologic femoral neck fracture caused by osteopenia in three hips, avascular necrosis of femoral and tibial condyles in one knee, and posttraumatic arthritis in one knee. Six patients (75%) had significant osteopenia. The mean interval between liver transplantation surgery and hip or knee joint arthroplasty was 2 years (8–48 months). The patients who had hip arthroplasty were followed for a mean of 4.85 years (2–8 years), and those who had a knee arthroplasty after a hip arthroplasty, for a mean of 3.5 years (2–5 years) after the knee arthroplasty. In the patients who had hip arthroplasty, the mean Harris hip score was improved from 34 to 82 points. In the two patients who had a knee arthroplasty, the mean score was improved to 100 points both for pain and function of the knee and for overall function from mean preoperative knee scores of 49 and 25 points, respectively. Radiographs did not reveal any loosening of the components. None of the patients required reoperation, and there were no serious postoperative complications.     

全膝关节置换术两种股骨假体定位的比较

[目的]探讨应用陀螺仪股骨髓外定位截骨行全膝关节置换的可行性及临床疗效.[方法]回顾性分析2019年3月-2020年1月行初次全膝关节置换的53例患者(61膝)的临床资料,其中27例使用陀螺仪髓外定位股骨侧截骨行全膝关节置换术(髓外组),34例行传统髓内导向杆定位股骨侧截骨全膝关节置换术(髓内组),比较两组临床疗效.[...     

人工膝关节置换术治疗重症膝关节疾病92例临床分析

目的探讨人工膝关节置换术(TKA)治疗重症膝关节疾病的临床疗效。方法1999年6月~2006年1月,对92例重症膝关节疾病(106膝)使用后稳定型TKA。其中10例(11膝)为类风湿性关节炎,2例(2膝)为创伤性关节炎,80例(93膝)为严重骨性关节炎,5例(5膝)合并外翻畸形,40例(50膝)并内翻畸形。所有患者进行10个月~6年(平均30个月)的随访,并应用HSS膝关节评分系统进行分析。结果手术优良率为94.2%,患者术后在疼痛、功能及关节活动度等方面都有明显改善,各种并发症的发生率低。结论TKA是治疗重症膝关节疾病的有效方法。     

The clinical consequences of flexion gap asymmetry in total knee arthroplasty

This study was carried out to compare femoral component rotation of 18 knees from 18 patients who suffered from lateral flexion instability after total knee arthroplasty (Western Ontario and McMaster University Osteoarthritis [WOMAC], 6.4 points; International Knee Society [IKS] score, 119 points) with 10 asymptomatic controls (WOMAC, 0.1 points; IKS score, 182 points) after total knee arthroplasty. The symptomatic patients showed increased lateral joint laxity as determined by fluoroscopic stress radiography. Femoral component rotation was determined by computed tomography scans. The femoral component rotation was more internally rotated in symptomatic patients (5.5 degrees ) than in controls (1.0 degrees ) (P = .04). Varus laxity in flexion was higher in symptomatic patients (11.0 degrees ) than in controls (7.0 degrees ) (P < .001). Increased lateral flexion laxity is associated with increased internal femoral component rotation and a less favorable clinical outcome.     

Comparison of two total knee prostheses on the incidence of patella clunk syndrome

The patella clunk syndrome is not an uncommon complication, particularly after posterior-stabilized (PS) total knee arthroplasty. The present study was a consecutive unselected series comparing the incidence of the patella clunk syndrome amongst two comparable groups of elderly patients with knee arthritis implanted with the Insall-Burstein (IB II) total knee system and the newer NexGen Legacy total knee prosthesis. While 7.5% of patients in the PS IB II group developed patella clunk syndrome, none occurred in the NexGen group (P=0.05). We believe the difference is due mainly to a change in the design of the prosthesis, especially the more posterior intercondylar box and femoral cam of the NexGen femoral component.     

Total Knee Arthroplasty After Failed Distal Femoral Varus Osteotomy Using Selectively Stemmed Posterior Stabilized Components

The purpose of this study was to evaluate the outcomes of patients treated with total knee arthroplasty (TKA) for progression of arthritis after distal femoral varus osteotomy. Twenty-two consecutive distal femoral varus osteotomies converted to TKA were reviewed at a mean follow-up of 5 years (range, 2-14 years). Stemmed femoral or tibial components were used in 5 knees with poor bone quality, while the remaining 17 knees were treated with unstemmed components. The mean Knee Society knee and function scores in surviving knees were 91 points (range, 67-100 points) and 64 points (range, 50-70 points) respectively at final follow-up. Two patients underwent revision arthroplasty for polyethylene wear and component loosening at 8 and 11 years after the index arthroplasty, respectively. Standard components provide satisfactory stability in TKA after distal femoral varus osteotomy after appropriate ligamentous balancing, without the need for stemmed or highly constrained components in the majority of patients.     

人工全髋关节置换中合并股骨近端畸形的股骨侧重建

目的探讨人工全髋关节置换中合并股骨近端畸形的股骨侧重建方法及疗效。方法 2004年3月-2009年6月,对25例26髋合并股骨近端畸形的髋关节疾病患者行人工全髋关节置换术,同时根据不同畸形部位重建股骨侧。其中男10例10髋,女15例16髋;年龄42～82岁,平均64岁。关节置换原因:原发性骨关节炎2髋,先天性髋关节脱位8髋,创伤性关节炎14髋,结核性关节炎2髋。病程10个月～25年,平均10.6年。术前Harris评分为(44.2±5.1)分,美国西部Ontario与McMaster大学骨关节炎指数(WOMAC)评分为(45.0±2.7)分。股骨近端畸形按照Berry分类系统,根据畸形原发病分类:先天性髋关节发育不良8髋,骨折畸形愈合7髋,陈旧性结核2髋,股骨头骨骺滑脱2髋,既往有粗隆下截骨手术史1髋,髋臼加盖术1髋,内固定术5髋;根据畸形部位分类:大粗隆5髋,股骨颈10髋,干骺端10髋,股骨干1髋。结果患者术后切口均Ⅰ期愈合;1周内3例发生下肢深静脉血栓形成,行制动及抗凝治疗后治愈;术后6周1例发生大转子滑囊炎,口服止痛药物缓解。25例均获随访,随访时间1年6个月～6年,平均3年3个月。末次随访Harris评分为(88.4±3.6)分,WOMAC评分改善至(82.0±5.2)分,与术前比较差异均有统计学意义(P<0.05)。X线片示1例术后8个月出现无菌性松动,行翻修术;其余患者假体无松动。结论对于伴有股骨近端畸形的患者,需要精确分类,有针对性地选择假体并设计个性化手术方案,才能获得良好的股骨侧重建,取得满意疗效。     

Conversion of failed modern unicompartmental arthroplasty to total knee arthroplasty

Between January 1983 and January 1991, 29 patients (31 knees) with a failed Robert Brigham metal-backed knee arthroplasty (Johnson & Johnson, Raynham, MA) underwent revision to a total knee arthroplasty (TKA). Twenty-five patients had osteoarthritis, three avascular necrosis, and one rheumatoid arthritis. The average patient age was 72.3 years (range, 49–88 years), and the average weight was 179 lb. (range, 112–242 lb.). The interval between the primary and secondary index procedures averaged 62 months (range, 7–106 months), and mean postrevision follow-up period was 45 months (range, 24–104 months). The primary mechanism of failure of the UKA was tibial polyethylene wear in 21 knees and opposite compartment progression of arthritis in 10 knees. Sixteen knees had particulate synovitis with dense metallic staining of the synovium. At revision, the posterior cruciate ligament was spared in 30 knees and substituted in 1 knee. Restoration of bony deficiency at revision required cancellous bone—graft for contained defects in seven knees, tibial wedges in four knees, and femoral wedges in two knees. No defects received structural allografts. The data suggest that failed, modern unicompartmental knee arthroplasty can successfully be converted to TKA. In most cases, the posterior cruciate ligament can be spared and bone defects corrected with simple wedges or cancellous grafts. Moreover, the results of revision of failed unicompartmental knee arthroplasty are superior to those of failed TKA and failed high tibial osteotomy and comparable to the authors' results of primary TKA with similar-length follow-up periods. Although these results are encouraging, longer-term follow-up evaluation is required to determine survivorship of these revision arthroplasties.