初次全膝关节置换术后膝关节僵硬的相关因素分析

Risk factors of stiff knees after primary total knee arthroplasty

[目的]探讨初次全膝关节置换术后膝关节僵硬的发病率和影响因素。[方法]1996年10月～2006年10月回顾性研究1216例初次全膝关节置换术。术后1年45例膝关节屈曲度<90°的患者做为实验组,45例膝关节屈曲度>90°的患者作为对照组。两组根据年龄、性别、体重指数(BMI)和美国麻醉分级(ASA)等进行配对病例对照研究分析影响因素。[结果]两组患者平均年龄、性别比例及术前合并症比较,差异无统计学意义。术前(P=0.001)和术中(P=0.039)膝关节屈曲度与术后膝关节屈曲度比较,差异有统计学意义。术前和术后髌骨低位与术后膝关节僵硬发生呈明显相关性(P=0.001)。[结论]初次全膝关节置换术后膝关节僵硬受多种因素影响,选择合适的患者、术中仔细暴露、重建伸屈膝间隙、减少髌腱和伸膝装置的损伤、选择合适假体、保持良好的下肢力线和术后理疗等因素会明显减少膝关节僵硬的发病率。

[ Objective ] To evaluate the incidence and predictors of stiff knees after primary TKA. [ Method ] A retrospective review was given to the data from 1216 patients undergoing primary total knee arthroplasty between October 1996 and October 2006. Forty-five stiff TKA patients with a 1-year postoperative flexion range of less than 90° was taken as treatment group. Forty- five TKA patients with greater than 90° flexion at 1 year postoperative as control group. The age,sex,body mass index,American Society of Anesthesiologists （ASA） rating, surgeon, implant type, and fixation of the control group were matched to those of the treatment group. A case-control study was conducted to determine predictive factors of stiff TKA. [ Result ] No significant differences were found with regard to the mean age, ratio of sex and preoperative medical comorbidities. Preoperative flexion and intraoperative flexion were predictive of ultimate postoperative flexion （ P = 0.001 and P = 0. 039, respectively）. Preoperative and postoperative relatively decreased patellar heightwere significantly correlated with postoperative stiffness （P = 0.001 ）. [ Conclusion ] Stiffness post-TKA is multifactorial, careful attention to surgical exposure, restoring gap kinematics, minimizing surgical trauma to the patellar ligament/extensor mechanism, appropriate implant selection, and physiotherapy may all serve to reduce the incidence of post-TKA stiffness.