术前活动度对人工全膝关节置换术后功能影响的观察

Influence of preoperative range of motion on the early clinical outcome of total knee arthroplasty

目的回顾性分析患者手术前的活动度对人工全膝关节置换(TKA)术后功能的影响。方法随访2000年1月—2003年12月在我科行TKA的患者65例(97膝),年龄64．8±9．9岁(35～85岁)。其中骨性关节炎55例(81膝),类风湿关节炎10例(16膝)。单膝置换33例,双膝同时置换32例。所有患者按术前膝关节活动度数(ROM)分成两组,≤90°(5°～90°)49膝,>90°(95°～140°)48膝。对两组患者进行疗效(最大屈膝度、活动度、KSS评分及功能评分)对比。所有患者均采用Scorpio后稳定型骨水泥固定的假体,均为初期置换,全部手术由同一组医师完成。术后3 d在同一康复师指导下行患肢CPM及主动功能锻炼至出院。结果平均随访时间29个月(10～44个月)。所有膝关节的活动度从术前的平均84．2°(5°～140°)提高到术后的平均101．6°(40°～140°) (P=0．000);而最大屈膝度数术前的平均103．5°(25°～140°)与术后的平均101．6°(40°～140°)无显著差异(P=0．439);KSS膝关节评分从术前平均19．5分(-24～62分)提高到术后平均78．8分(50～95分)(P=0．000)。所有患者的总满意度为93．8％(61／65)。两个分组比较,ROM≤90°的膝关节ROM及最大屈膝度术后均较术前有提高,而ROM>90°的膝关节平均最大屈膝度术后反而下降。没有翻修及深部感染。结论(1)在影响TKA术后膝关节功能的多种因素中,手术技术是关键因素。(2)在其他因素相同的情况下,术前膝关节的活动度对TKA术后的功能也有很大的影响,术前活动度大的膝关节比那些术前活动度小的膝关节术后能获得更好的功能。

Objective To retrospectively analyze the influence of preoperative range of motion （ROM） and maximal flexion degree on the early clinical outcome of total knee arthroplasty （TKA）. Methods From January 2000 to December 2003, 97 knees of 65 patients that were underwent total knee arthroplasty with Scorpio posterior-stabilized knee prosthesis were reviewed. There were 55 osteoarthritis patients （81 knees） , and 10 rheumatoid arthritis （ 16 knees）. Thirty-three patients were underwent unilateral TKA, 32 patients were underwent bilateral TKA. According to the preoperative ROM of knee, these patients were divided into two groups, one≤90° （ range, 5°-90°） and the other 〉 90° （ range, 95°-140° ）. Finally the clinical outcomes of two groups （include ROM, maximal flexion degree, KSS score and function score）were evaluated. Three days later after operation, continuous passive motion （CPM） and active functional exercise of the knee were begun, and the wound healed well in all patients. All these operations were primary total knee arthroplasty. Results The patients were followed up for average 2 years 5 months （ range, 10 months to 3 years 8 months）. The average ROM of knee was improved to 101.6°（ range, 40°-140°） after operation from 84. 2° （ range, 5°-140° ） before operation （ P = 0. 000 ） ; the average maximal flexion degree was decreased from 103.5° （ range, 25°-140°） before operation to 101.6° （ range, 40°-140°） after operation （P = 0. 439） ; KSS of knee joint was improved to 78. 8 points after operation （ range, 50-95 points） from 19.5 points （ -24-62 points） before operation （P =0. 000）. There was statistically difference between the c｜inica｜ outcomes （ROM, maximal flexion degree, KSS score and function score） in the two groups before and after operation. Those knees with good preoperative ROM tend to lose flexion, while those with poor preoperative ROM gain flexion after TKA. No revision and deep infection happened. Conclusions TKA is a complex operation, the clinical outcome of TKA is mainly determined by the good operation skill,abundant clinical experience and the familiarity with the prosthesis of the surgeon. At the same conditions such as same surgeon, same prosthesis and same physical therapy, preoperative range of motion of knee influence on the early clinical outcome of total knee arthroplasty, knees that have good preoperative ROM have better clinical outcomes postoperatively than those with poor preoperative ROM.