高屈曲人工全膝关节表面置换术临床研究

Clinical Study on High Flex Total Knee Arthroplasty

目的：探讨应用高屈曲型假体行人工全膝关节置换术的早期临床效果。方法：2002.12-2006.3月间,对125例（213膝）患者用LPS-FLEX高屈曲型假体行TKA。其中男36例（62膝）,女89例（151膝）,年龄51-85岁,平均68.1岁。骨性关节炎90例（149膝）,类风湿性关节炎35例（64膝）。所有病人均行常规髌骨置换,假体均采用骨水泥固定。结果：术后第一天即开始康复训练,伤口均一期愈合。随访12-52个月,平均34个月。2例因早期屈曲不佳（〈90°）于术后6周在连续硬膜外麻醉下行手法松解后获得满意屈曲度,2例发生感染,其余均疗效优良。随访X线片结合临床均无感染、假体松动、假体周围骨折、骨吸收及脱位发生。HSS评分由术前30-65分,平均48分,提高至术后85-98分,平均91分。结论：LPS-FLEX高屈曲型假体在高屈曲位时仍在胫骨上保持面接触,且胫骨CAM始终在股骨SPINE的基部,从而在获得最大屈曲的同时保持了良好的稳定性。

Objective：To investigate the early clinical effectiveness after High Flex（LPS-FLEX） total knee athroplasty. Methods：From December 2002 to March 2006, 213 knees among 215 atients were performed High Flex total knee arthroplasty. There were 36 males with 62 knees and 89 females with 151 knees,and the average age of the patients was 68. 1 ranging from 51 to 85. The diagnosis of the patients was osteoarthritis in 90 cases （149 knees） , rheumatoid arthritis in 35 cases （64 knees）. Regular patellar replacement was performed and all of the prostheses were fixed by cement. Results：On the first day after operation,rehabilitation was begun,the wound healed in one stage in all the patients and they were followed up from 12 to 52 months with the average of 34 months. The HSS knee score was improved from preoperative 30-65 with average of 48 to postoperative 85-98 with average of 91. Two patients received manipulations under anaesthesia six weeks after operations because of unsatisfactory flexion and the results were fine. There were infections in two patients. No loosening of the prostheses, fracture,obsorbing of bones and dislocations were found in other cases at final follow-up. Conclusion： The prostheses of High Flex extended posterior condylar on the femoral component to facilitate tibiofemoral contact to support high flexion up to 155. At the same time,a modified cam/spine mechanism allowed stability,posterior clearance and protection against subluxation during deep flexion. The result of the initial reports was excellent. Therefore better long term results could be expected.