全膝关节置换术后异位骨化的形成及对临床效果的影响

Heterotopic ossification after total knee arthroplasty and effect on outcomes

目的探讨全膝关节置换术后异位骨化的产生、转归、相关因素及其对临床效果的影响。方法对248例(264膝)接受全膝关节置换术的患者进行3个月～2年的随访,119膝采用了保留后十字韧带型假体,145膝采用不保留后十字韧带的后稳定型假体。142例(150膝)患者术后两周内连续服用消炎痛,106例(114膝)患者未服用任何非甾体类抗炎药。术前X线片测量关节间隙骨赘的大小并分为1～3度。术后3、6、12、24个月拍摄X线片,根据异位骨化形成情况分级:0级,无异位骨形成;Ⅰ级,骨化物<2cm;Ⅱ级,骨化物>2cm;Ⅲ级,骨化物>5cm。手术前后测量关节活动度,按照美国膝关节协会评分标准(KSS)评价膝关节功能。结果共有27膝(10.23%)膝关节发生了异位骨化,Ⅰ级13膝,Ⅱ级8膝,Ⅲ级6膝。Ⅲ级异位骨化患者术后12个月KSS评分(83.1±1.5)分,对照组(0级)(94.3±3.1)分,差异有统计学意义(P<0.01);Ⅲ级异位骨化患者术后12个月关节活动度88.2°±4.1°,对照组(0级)101.5°±4.8°,两者比较差异有统计学意义(P<0.01)。术前关节2度、3度增生患者异位骨化的发生率高于1度增生患者(P=0.014,P=0.007)。术后服用消炎痛患者异位骨化发生率低于未服用者(P<0.01)。使用保留后十字韧带型假体患者与使用后稳定型假体患者的异位骨化的发生率比较,差异无统计学意义(P>0.05)。结论全膝关节置换术后Ⅲ级异位骨化可引起临床症状和关节活动度受限。术前严重的增生会增加异位骨化的发生率。术后服用非甾体类抗炎药可降低异位骨化的发生率。异位骨化的发生与所用假体没有关系。

Objective To study the formation of heterotopic ossification （HO） after total knee arthroplasty （TKA） and effect on postoperative outcomes. Methods There were 248 patients （264 knees） who accepted total knee arthroplasty for follow-up （from 3 months to 2 years）. 119 were posterior cruciate ligament （PCL） retaining implants, 145 were PCL sacrificing. 150 patients had taken NSAIDS within the first 2 postoperative weeks. Measured the extent of osteophyte and classified to 3 level in the preoperative X-ray. 3, 6, 12 and 24 months after operation, observed HO in X-ray, and grade to 3 types： typeⅠ 〈 2 cm, type Ⅱ 〉2 cm, type Ⅲ 〉5 cm. Track record of average range of motion and KSS score. Results A total of 27 knees （10.23%） showed HO after TKA, which included type Ⅰ 13 knees, type Ⅱ 8 knees, type Ⅲ 6 knees. Average KSS score of typeⅢ was 83.1±1.5. It was lower than normal group （P〈 0.01）. Average range of motion of typeⅢ was 88.2°＋4.1°, lower than normal group （P〈 0.01 ）. The incidence of HO in 2 and 3 level ostephyte hyperplasia higher than level 1 （P=0.014, P=0.007）. The incidence in the patients taken NSAIDS was lower than patients taken none （P〈 0.01 ）. There was no significant difference between PCL retaining implants and PCL sacrificing implants （P 〉0.05）. Conclusion TypeⅢ HO after TKA impact clinic outcome. Ostephte increases the probability of HO, and NSAIDS decrease the probability. The incidence of HO have no relation with implants.