全膝关节置换后关节后方复合松解的可行性评价

Feasibility of posterior composite release of the knee joint after total knee arthroplasty

背景:临床对于膝骨关节炎患者可以实施全膝关节置换治疗,为提高修复效果,促进功能恢复,要采取有效措施改善置换过程中的关节间隙以及置换后的关节活动度。目的:探讨全膝关节置换后行关节后方复合松解的有效性及可行性。方法:从两家三甲医院2009年12月至2013年12月收治的行单侧全膝关节置换的膝骨关节炎患者中选择118例进行研究,随机分为对照组和观察组,每组59例。在患者全膝关节置换过程中完成截骨之后,对照组行常规后髁增生骨清理,观察组行关节后方复合松解。观察两组患者置换后伸、屈膝间隙情况和主动屈膝90°和120°所需时间,记录3个月随访时的膝关节功能美国纽约特种外科医院评分以及最大屈膝角度,并进行比较。结果与结论:经统计和比较,两组患者在屈膝间隙方面差异无显著性意义(P>0.05);但在伸膝间隙、主动屈膝90°、120°所需时间以及最大屈膝角度方面,两组差异均有显著性意义,观察组优于对照组(P均<0.05)。比较置换后3个月两组患者的膝关节功能美国纽约特种外科医院评分,可得观察组的各项指标得分以及总分均显著高于对照组,差异均有显著性意义(P均<0.05)。表明全膝关节置换后行关节后方复合松解具有一定的有效性和可行性,可以有效改善置换过程中伸膝间隙以及置换后膝关节活动度,但对置换过程中屈膝间隙方面无明显影响。

BACKGROUND：Knee osteoarthritis can be treated by total knee arthroplasty. To improve therapeutic effect and promote postoperative recovery, we should take effective measures to improve the joint space and postoperative range of motion. OBJECTIVE：To explore the effectiveness and feasibility of posterior composite release of the knee joint after total knee arthroplasty. METHODS：118 knee osteoarthritis patients undergoing unilateral total knee arthroplasty in two hospitals from December 2009 to December 2013 were selected, and were randomly divided into control group （59 cases） and observation group （59 cases）. After osteotomy during operation, the control group underwent bone removal of conventional condylar hyperplasia. Observation group underwent posterior composite release of the knee joint. Postoperative extension, flexion gap and the time required for postoperative active flexion 90°; and 120°; were observed in the two groups. Hospital for Special Surgery Knee Score and maximum flexion angle were recorded in 3 months of fol ow up, and compared between the two groups. RESULTS AND CONCLUSION：Through the statistics and comparison, no significant difference in flexion gap was found between the two groups （P〉0.05）. However, significant differences in extension gap, the time for active flexion 90° and 120°and the maximum flexion angle were detectable between the two groups, and above indexes were better in the observation group than in the control group （P〈0.05）. Hospital for Special Surgery Knee Score of each index and total score were significantly higher in the observation group than in the control group （P〈0.05）. These results suggest that rear joint composite release after total knee arthroplasty has certain validity and feasibility, can effectively improve knee extensor gap and the postoperative range of motion during replacement, but does not impact flexion gap during replacement.