严重屈膝畸形的人工膝关节表面置换术

Total knee replacement of severe flexion contracture deformities greater than 60 degree

为探讨重度屈膝畸形（屈曲角度≥６０度）如何进行人工全膝关节表面置换术（ＴＫＲ），作者于１９８７年４月～１９９４年５月对２３例患者、３７个膝关节行ＴＫＲ，均获得了较好的临床治疗效果。术后患者疼痛明显减轻，屈曲角度由术前的平均７７．９７度降至术后的平均６．７度，其中６２．１％膝关节屈曲角度＜５度，关节屈伸活动度也由术前的平均２５．６度增至术后的平均８３．６度。膝评分优良者占７３．８３％，膝功能评分优良者占１３％。作者认为，重度屈膝畸形并非ＴＫＲ的绝对禁忌证，关键在于术中对后关节囊、侧副韧带等挛缩组织的彻底松解和平衡，必要时应切除后交叉韧带并适当多切除股骨髁及胫骨平台骨质。

The technique of total knee arthroplasty for the patients with severe flexion contractures of more than 60° is not clear.Recently,We have performed 37 total knee arthroplasties in 23 patients with flexion contracture of more than 60° (average 77 97°).Among them,14 knees (37 9%) with flexion contracture of more than 90°, and 7 knees (18 0%) with 90° flexion fusion deformities.Significant improvements occurred after averaged 4 3 year follow up.Complications occurred in four patients:three had transient peroneal nerve palsy,and one had temporary circulatory disturbance of the lower extremity.They recovered after conservative therapy.We consider that severe flexion contracture of more than 60° is not a contraindication of TKR.Staged bone resection and thoroughly soft tissue release of the posterior capsule and collateral ligament balance were the critical procedure.If necessary,additional distal femoral condyle resection with posterior cruciate ligment sacrifice can be considered.