旋转平台高屈曲型人工全膝关节置换术的临床应用

Clinical application of rotating platform high flexion total knee replacements

目的探讨旋转平台高屈曲型人工全膝关节置换术（total knee replacements，TKR）的特点及临床效果。方法对61例患者（78膝）行旋转平台高屈曲型（Sigma RP-F）人工TKR，其中17例为双侧膝关节置换。男13例15膝，女48例63膝；年龄45～79岁，平均64．3岁。术前诊断：膝骨关节炎56例，类风湿关节炎5例。采用正中切口髌旁内侧入路，所有膝关节都未进行髌骨置换，但对髌骨进行去神经化和修复术。结果本组随访3～16个月，平均10．5个月。影像学显示无松动，无髌骨翘起、半脱位或脱位。临床评定采用美国膝关节学会（KSS）评分，术前平均膝评分48分（33～72分），膝功能评分41分（28～63分），术后随访膝评分97分（88～100分），膝功能评分96分（84～99分），膝关节活动度平均为130°（110°～150°），未发现假体旋出、不稳定或感染的患者。结论旋转平台高屈曲人工全膝关节可提供足够的关节接触面积、全程的髌骨轨迹、足够的胫骨关节轴向旋转自由度，使膝关节可安全达到高屈曲的目的，近期随访疗效满意，但是否达到实验室分析的减少磨损、增加假体使用寿命的目的仍需进一步随访。

Objective To discuss the characteristics and clinical results of rotating platform high flexion （RDHF） total knee replacement TKR. Methods A total of 61 patients （78 knees） including 13 males （ 15 knees） and 48 females （63 knees） at age range of 45-79 years （ mean 64.3 years） were treated with Sigma （RP-HF） rotating platform high flexion total knee replacement. Osteoarthritis was found in 56 patients and rheumatoid arthritis in 5. By medial parapatella approach, denervation and facet repair of the patella were done, without replacing them. Results All 78 knees were followed up for 3-16 months （mean 10.5 months）. The X-ray film demonstrated no prosthesis loosening, patella dislocation or subluxation. According to the knee society scoring system, the preoperative score was 48 points （33-72 points） and the knee functional score was 41 points （28-63 points） on average. After surgery, the knee score was 97 points （88-100 points）, the functional score 96 points （84-99 points）, and the range of motion （ROM） 130°（ 110°- 150°） on average. No spin-out or infection were detected. Conclusions The Sigma RP-HF knee system provides sufficient contact area, full range of patella locus and sufficient axial rotation, which helps reach a stable and durable high flexion performance. Our short-term clinical follow up result is good but the advantages of low wear and longevity of the Sigma RP-HF prosthesis still need further study.