全膝置换术治疗膝关节创伤性关节炎

Treatment of Traumatic Arthritis by Total Knee Arthroplasty

目的探讨全膝置换术(TKA)在膝关节创伤性关节炎治疗中的特点。方法对8例膝关节严重创伤后形成的骨性关节炎施行了TKA手术,术中采用植骨、加装金属垫片的方法修复塌陷的胫骨平台,对内、外翻不稳的膝关节选择了CCK假体代偿由侧副韧带损伤引起的不完全功能缺失,严重者甚至使用旋转型铰链膝,其他还有通过后方的软组织松解等技术来增加关节活动度。结果采用HSS膝关节评分系统,8例由术前的平均42分上升至术后的平均88分(P<0.05),关节活动度由术前的平均76°升至术后的平均106°(P<0.05)。所有患者随访至少1年以上,平均2.1年,随访结束时膝关节评分平均82分(P<0.05),关节活动度平均93°(P<0.05)。结论根据膝关节创伤性关节炎的损伤特点因人而异地选择合适的TKA手术方案可以获得满意的结果,术中注意防止因骨折畸形愈合所导致的技术上的失误。

Objective To explore the surgical technique of total knee arthroplasty for the knee with traumatic arthritis.Methods Total knee arthroplasties were performed on 8 cases of traumatic arthritis.The bone defects of tibial plateau were repaired by bone grafting and metal augmentation.The functional defects of damaged collateral ligaments were compensated with special prosthesis like CCK,even with rotating hinge knee on the condition of ruptured ligaments.Results The averaged knee scores were improved from preoperative 42 points to postoperative 88 points according to HSS knee score system (P<0.05).The mean arc of motion was increased from 76° to 106° (P<0.05).All cases were followed up for an average of 2.1 years.The mean score of knee joint was 82 points(P<0.05)and ROM was 93° (P<0.05).No obvious complication was occurred.Conclusion The satisfactory results can be obtained to the patients with traumatic arthritis by total knee arthroplasty on the condition that the operation plan is made individually.Attention should be paid to the deformity after the union of bone fracture which can lead to technical error.