可旋转铰链式膝关节置换的初步报告

目的：探讨可旋转铰链式膝关节假体的应用。方法：自1997年6月～2002年5月，采用可旋转铰链式膝关节对12例16膝进行了置换，所有病例均进行了随访，随访时间6个月～5年，平均随访时间2．4年。采用HSS(Hospital for Special Surgery)评分标准对手术疗效进行评价。结果：总优良率93．75％。结论：可旋转铰链式膝关节疗效肯定，远期疗效需进一步随访。     

可旋转铰链式膝关节在骨肿瘤保肢术中的应用

[目的]探讨膝关节肿瘤的保肢治疗以及可旋转铰链式膝关节在保肢手术中的适应证及手术方法.[方法]自1997年10月～2004年10月作者采用可旋转铰链式膝关节置换膝关节肿瘤病人11例11膝.所有病例均进行了随访,随访时间最长7 a,最短6个月,采用HSS（hospital for special surgery）评分标准对手术疗效进行评价.[结果]所有患者术后评分均为优.11例假体无1例松动,4例恶性骨肿瘤2例软骨肉瘤随访已过3 a,现生存良好.1例股骨骨肉瘤于术后1 a出现股骨近端部位跳跃转移,后截肢.1例骨肉瘤于1 a 8个月出现肺转移,1例骨巨细胞瘤于术后1 a出现肺部转移,现仍存活,关节功能良好.[结论]可旋转铰链式膝关节置换膝关节肿瘤病人是一种有效的保肢方法,但选择适应证应慎重.     

旋转铰链式膝关节假体重建膝部骨肿瘤切除后骨缺损

[目的]评估量体定制旋转铰链式膝关节假体重建膝部骨肿瘤切除后膝关节功能的临床疗效。[方法]自2000年3月~2008年5月对膝部骨肿瘤36例实施肿瘤切除,应用定制人工关节重建膝关节功能,男29例,女7例,年龄12~33岁,其中骨肉瘤21例,骨巨细胞瘤12例,转移性肿瘤3例,21例骨肉瘤患者术前均行新辅助化疗,所有病例均采用骨水泥型旋转铰链式膝关节假体,利用国际骨与软组织肿瘤协会(MSTS)93功能重建评分系统对患者进行术后肢体功能评定。[结果]4例患者失访,其余32例患者均获得随访,随访资料完整,随访时间1.5~6年(平均2年8个月)。按MSTS93评分标准,患肢功能评分11~28分,平均(22.28±4.33)分,其中优20例,良8例,中2例,差2例。[结论]定制旋转铰链式膝关节假体重建膝部骨肿瘤切除后骨缺损不仅可保留患肢,而且最大程度地恢复患肢功能。恶性骨肿瘤有效的化疗为保肢术提供了可靠保障。     

铰链式全膝关节置换术后假体周围骨折

假体周围骨折是人工关节置换术术后并发症之一,其发生与假体类型及患者自身因素密切相关,并且治疗方法相对复杂,本文针对铰链式全膝关节置换术后假体周围骨折的产生机理及其治疗手段进行回顾性的文献复习,以期对此类骨折的认识及治疗策略的选择有所帮助。     

旋转铰链型膝关节置换治疗膝关节骨关节炎

目的 探讨旋转铰链型膝关节置换治疗膝关节骨关节炎的疗效。方法 采用旋转铰链型膝关节置换治疗30例膝关节骨关节炎患者。记录手术情况及并发症发生情况,比较手术前后膝关节活动度、疼痛VAS评分、HSS评分。结果 手术时间80～96(85.2±6.4) min,术中出血量50～90 (74.5±6.5) ml,术后引流量60～300(150.4±30.6) ml。患者均获得随访,时间14～30个月。术后6个月膝前区疼痛4例,末次随访时疼痛症状消失,患膝关节负重良好。末次随访时,膝关节X线片显示关节假体位置良好、假体骨骼界面稳固、无松动。疼痛VAS评分、HSS评分及膝关节活动度:末次随访及术后1周均较术前明显改善(P <0.05),末次随访均较术后1周明显改善(P <0.05)。结论 旋转铰链型膝关节置换治疗膝关节骨关节炎效果良好,可以缓解疼痛,恢复患者膝关节活动度。     

旋转铰链式膝关节假体临床使用的初步体会

目的观察采用旋转铰链式膝关节假体行人工全膝关节置换术的临床疗效和并探讨其运用经验。方法对我科近三年来采用旋转铰链式膝关节假体治疗严重膝关节病变12例病人(12个膝)进行回顾性分析。结果术后膝关节功能较术前改善明显,关节功能评分从术前平均48分提高到术后平均86分,优为8例、良为4例,没有近期并发症发生,病人主观满意度百分之百。结论旋转铰链式膝关节假体对治疗严重的膝关节病患疗效满意。     

旋转铰链膝关节假体在治疗复杂膝关节疾病中的临床应用

目的：探讨旋转铰链型膝关节假体治疗复杂膝关节疾病的近期疗效。方法对2011年1月至2013年4月应用旋转铰链型膝关节假体置换治疗严重膝关节畸形及翻修手术8例患者的临床资料进行分析,比较手术前后膝关节活动度及HSS评分,明确其疗效。其中骨关节炎3例,创伤性关节炎2例（为叉韧带及内侧副韧带断裂）,强直性脊柱炎双膝关节病变1例,膝关节翻修2例。术前膝关节活动度80°～100°,平均90°;HSS评分11～40.5分,平均25.5分。结果术后全部获得随访,随访3～28个月,平均12个月,畸形矫正,疼痛消失,无1例发生并发症;所有患者行走步态恢复,膝关节屈曲达110°～140°,平均127.5°,无伸展滞缺,较术前平均增加37.5°。 HSS评分88～95分,平均91.25分,较术前平均提高65.75分,优良率100％。结论旋转铰链型膝关节假体对复杂膝关节病变及翻修术近期效果良好,远期效果有待进一步观察。     

旋转铰链膝关节置换术治疗严重膝关节畸形近期疗效观察

[目的]探讨旋转铰链膝关节置换术治疗严重膝关节畸形的近期疗效。[方法]对2012年1月~2015年4月应用旋转铰链型膝关节假体置换治疗严重膝关节畸形患者的临床资料进行分析,其中男17例,女13例,平均年龄60.5岁(51~70岁),原发疾病分别为骨性关节炎合并严重的膝内翻、膝外翻畸形20例,类风湿性关节炎10例,比较手术前后膝关节活动度及HSS(hospital for special surgery)评分,明确其疗效。[结果]手术时间平均(62.00±10.20)min。无1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9~27个月,平均14个月,所有病例患膝疼痛明显缓解,内外翻和屈曲畸形均纠正,关节活动范围由术前的89.0°(60°~110°)改善为术后的117°(100°~130°)。HSS评分从术前的42.5分(21~62分)增加到术后的平均90分(80~98分)。[结论]旋转铰链型膝关节置换对严重膝关节畸形患者近期效果良好,可以很好的解除膝关节疼痛,矫正畸形,改善关节功能及提高生活质量,但远期效果有待进一步观察。     

可旋转衬垫人工膝关节的临床应用

目的：探讨可旋转衬垫人工膝关节的特点和手术要点，观察手术后的临床效果。方法：自l996年10月-2002年6月对69例78膝施行可旋转衬垫人工膝关节置换术。手术要点：对有膝内、外翻者，充分松解和平衡内、外侧软组织张力；保留内外侧副韧带和后交叉韧带的完整；保证屈曲和伸直间隙相等；重视试模复位和股、胚甘假体安装的正确对线、对位。髌骨半脱位者充分松解髌骨外侧支持带。78膝中65膝获得随访，平均随访2．7年。获得随访的病例中，骨关节病60膝，术前HSS评分平均62．0分，类风湿性关节炎5膝，术前HSS评分平均54．0分。结果：63个膝效果优良(96．9％)，术后HSS评分：骨关节病者平均92．0分，类风湿性关节炎者平均89．0分。2膝效果较差，HSS评分为63．0分和67．0分。结论：可旋转衬垫人工膝关节最接近膝关节生理状态，活动中股骨假体与可旋转衬垫间匹配良好、应力分布均匀，聚乙烯衬垫的磨损减小。采取正确的手术技术，可获得满意的近期临床效果，中远期效果有待进一步随访观察。     

Total knee arthroplasty with rotating-hinge Endo-Model prosthesis: clinical results in complex primary and revision surgery

Introduction

Rotating-hinge knee implants are highly constrained devices able to provide the stability needed for arthroplasty in case of severe bone loss and complex instability. Notable doubts still exist in using rotating-hinge devices, mainly due to risk of mechanical failure and risk of infection.

Materials and methods

We retrospectively evaluated the functional and clinical outcomes in a series of patients treated with the rotating-hinge Endo-Model prosthesis either for primary or revision total knee arthroplasty. Between 1997 and 2009 we implanted 123 Endo-Model prosthesis (118 patients) at our institution. At the time of this study we could evaluate 45 prosthesis (25 primary and 20 revision TKAs) from the clinical and radiological site, with average follow-up of 42.2 months.

Results

During the follow-up period, three patients reported complications, which in two cases finally led to revision with explantation. Mean survival of the implants attested at 93.3 %. The average post-operative clinical Knee Society score in the evaluated series was 94.2, the functional one 78.7. The average range of motion was 0°–108°. No signs of joint instability or misalignment were noted. Pain was present in a minority of patients, but always at a mild/occasional extent. No evidences of loosening or implant failure have been reported. No substantial divergences in the outcomes have been found across different patient categories after stratification in agreement with the Knee Society.

Conclusions

Coherent with previously published works, we confirm the Endo-Model prosthesis to provide excellent pain relief, restoration of walking capacity and intrinsic knee stability both in complex primary and in revision knee arthroplasty, with good or excellent results in the majority of patients and acceptable complication rate.     

AGC DA prosthesis in severe deformity and revision knee arthroplasty]

The AGC DA replacement has been used in our department for latest 3 years. 28 arthroplasties were performed on 26 patients. There were 20 women and 6 men of age from 29 to 74 (average 58,7). Bilateral knee replacements were performed on one man and one woman. 18 patients from this group were diagnosed as RA, 7 OA, and 1 LED. Primary knee replacement were done on 15 knees and secondary on 13 using AGC DA type. 26 patients were examined after half a year follow up according to Clinical Rating System of The Knee Society: 21 patients had good (75%), 6 satisfactory (21.4%) and 1 poor (3.6%) results. The results after secondary replacements were generally worse then primary ones. That was mainly due to limited ROM and walking ability. There were no early complications in wound healing although 11 patients had prolonged steroids therapy and 7 of them had also methotrexate combined with steroids given as a basic pharmacological treatment of systemic disease. There were two other complications. One patient with loosening of tibial part because of primary tibial component malpositioning. Reoperation and correcting position with longer stem was performed after 8 months. Second patient with extensor mechanism insufficiency caused luxation of prosthesis in flexion. Extensive exercises of extensor muscles solved the problem.     

重度外伤性鞍鼻畸形的个性化硅胶假体填充治疗

目的:探讨个性化硅胶假体在重度外伤性鞍鼻畸形治疗中的应用。方法:根据每位患者受伤程度,以整块硅橡胶为材料,雕刻适合每一位患者的鼻部填充假体,术中于鼻骨表面分离假体置入腔隙,置入假体。结果:6例患者进行个性化硅胶假体填充治疗后,均取得良好效果,术后随访3个月~2年,无并发症发生。结论:个性化硅胶假体填充生物相容性好、适合雕刻、材料充足、经济实用,仍然是目前治疗重度鞍鼻畸形的理想方法之一。     

重度膝关节外翻畸形的全膝关节置换术

 目的 探讨重度膝关节外翻畸形全膝关节置换术的手术方法及临床效果。方法 对2007年1月至2012年12月采用全膝关节置换治疗的重度膝关节外翻畸形患者22例（23膝）进行回顾性分析。男7例,女15例;年龄41~78岁,平均65岁。股胫角（股骨和胫骨解剖轴线的夹角）22°~50°,平均为34.6°。骨关节炎17例,类风湿关节炎5例。髌骨完全脱位3例3膝,内侧不稳定1例1膝,屈曲挛缩畸形3例4膝。21例22膝采用后稳定型假体,1例1膝采用限制型假体。髌旁内侧入路、常规截骨及单纯外侧软组织松解,术中行髌骨置换5例。以膝关节活动度、X线股胫角及美国特种外科医院（Hospital for Special Surgery,HSS）膝关节评分评价术后疗效。结果 全部病例随访时间1~5年,平均2.5年。膝关节活动度由术前平均43.7°±5.8°（0°~80°）提高至末次随访时110.6°±7.5°（80°~130°）,HSS膝关节评分由术前平均（19.6±4.7）分（6~34分）提高至末次随访时（89.7±3.6）分（84~96分）,手术前后的差异有统计学意义。外翻畸形基本得到矫正,末次随访时股胫角平均为8.6°±0.8°（0°~12°）,较术前34.6°±2.4°（22°~50°）明显改善,手术前后的差异有统计学意义。术后2例2膝有膝关节内侧不稳症状,给予膝关节支具保护;1例1膝术前严重髌骨脱位患者术后存在半脱位,未予特殊处理;2例2膝术后出现腓总神经麻痹,未予特殊处理。随访期间未发生感染、松动及深静脉血栓形成等并发症。结论 对重度膝关节外翻畸形患者可采用常规截骨、单纯外侧软组织松解及后稳定型假体植入,能较好地矫正外翻畸形,近期疗效满意。     

Kinematic rotating-hinge total knee arthroplasty

The first fifty kinematic rotating-hinge total knee arthroplasties that were done at the Mayo Clinic were reviewed. The indication for use of this prosthesis was either ligamentous instability or loss of bone, or both. At a mean length of follow-up of fifty months (range, twenty-nine to seventy-nine months), the clinical results of thirty-eight knees in thirty-six patients were evaluated. Fifteen of the thirty-eight knees had had a primary arthroplasty and twenty-three had had a revision arthroplasty using the kinematic rotating-hinge prosthesis. Using the knee-rating score of The Hospital for Special Surgery, there were fourteen excellent, twelve good, five fair, and five poor results. For two knees there was inadequate information to calculate a knee-rating score. Lucent lines that were more than one millimeter in width were seen with 25 per cent of the femoral and 50 per cent of the tibial components. Progression of lucent lines was observed in thirteen knees, and five knees showed probable radiographic loosening. The high incidence of complications was distressing, with a 16 per cent rate of sepsis, a 22 per cent rate of patellar instability, and a 6 per cent rate of breakage of the implant. In our opinion, this implant should be used only in knees in which there is functional absence of a collateral ligament that cannot be managed by soft-tissue reconstruction.     

严重畸形膝骨关节病的人工膝关节置换术

目的探讨严重畸形的膝骨关节病在行关节置换手术治疗过程中需要注意的问题，以及具体的手术操作注意事项。方法总结分析了本组采用全膝关节置换治疗严重畸形的膝骨关节病共57例，随访33例52膝的临床资料。结果随访病例应用美国HSS评分系统，满分100分。85分以上为优；70～84分为良；60～69分为尚可；60以下为差。随访的全部病例中14例21膝为优，16例26膝为良，3例5膝为尚可，优良率90．38％，满意率96．15％。结论全膝关节置换术治疗严重畸形的膝关节病变时存在一定的难度，但是通过正确的截骨及软组织平衡也可以达到满意的效果。     

Total knee arthroplasty using navigation system for severe osteoarthritis with extra-articular deformity

Purpose

The purpose of this study was to evaluate the use of total knee arthroplasty (TKA) using a computer-assisted navigation system for treating osteoarthritis with extra-articular deformity.

Methods

Between January 2006 and January 2009, computer-assisted navigation TKAs were performed on eight knees in eight patients, who had severe osteoarthritis with an ipsilateral extra-articular deformity. All patients were followed up for a minimum of 24 months. The involved knees were evaluated by function scores, Knee Society knee scores, and analyzing knee flexion before the operation and at the latest follow-up.

Results

Postoperatively, the function scores, Knee Society knee scores, and knee flexion all improved significantly. The ideal mechanical axis of the lower extremity was obtained in all cases.

Conclusion

TKA using a computer-assisted navigation system might provide an efficient treatment for patients with osteoarthritis in combination with an extra-articular deformity.     

Custom rotating-hinge total knee replacement in patients with spina bifida and severe neuromuscular dysfunction

Spina bifida (SB) is a congenital disorder which may result in a number of musculoskeletal problems. Total knee replacement (TKR) in this patient group is technically demanding due to bone deformity, soft tissue contracture, muscle tone abnormality and ligament insufficiency. This is a retrospective review of three patients with SB and disabling knee arthritis who were managed with a custom rotating-hinge (RHK) total knee system. All patients reported an improvement in knee pain and stability at mean follow-up 47?months (43-53). Mean Oxford Knee score improved from 21 preoperatively to 32 at final follow-up. One patient required revision of tibial and patella components at 37?months for lateral patella instability and excessive wear. Custom RHK for patients with SB, severe neuromuscular dysfunction and bone deformity relieves pain, restores stability and improves early knee function; however there is a significant risk of extensor mechanism complications and functional outcome is worse than primary TKR in the general population.     

全膝关节表面置换治疗严重膝关节畸形

目的探讨人工全膝关节表面置换术(TKA)治疗严重膝关节畸形临床疗效。方法应用全膝关节表面置换治疗严重膝关节畸形36例(48膝)。使用HSS评分标准评估分析术前、术后膝关节功能及术后疼痛、膝关节活动度的改善情况。43膝采用后稳定型人工全膝关节假体,5膝采用CCK型人工全膝关节假体。结果术后早期均无感染等并发症发生。术后X线片示假体位置良好,下肢力线良好。患者均获得随访,时间6～18个月。HSS评分术前为(41±5.3)分,术后6个月为(87.7±6.5)分。手术优良率为83.3%。患者疼痛、功能方面及活动度均有明显改善。结论全膝关节置换术对严重膝关节畸形的治疗效果满意。但应严格掌握手术适应证。