铰链式膝关节置换治疗老年股骨髁间粉碎性骨折合并膝关节疾病13例

Hinged knee replacement for 13 cases of senile comminuted fracture of the femoral condyle combined with knee joint diseases

回顾性分析2005-05/2007-05陕西省人民医院骨科收治的股骨髁间粉碎性骨折合并膝关节疾病患者13例,男4例,女9例;年龄65～75岁,平均70.5岁;左膝5例,右膝8例。受伤原因除1例由于高处坠落致伤外其余均为摔倒跌伤,并全部为新鲜骨折。其中合并骨性关节炎8例,类风湿性关节炎5例,合并糖尿病2例,7例中合并有不同程度老年心脑血管疾病,9例中存在不同程度的骨质疏松,其中1例有严重的骨质疏松。全部患者均行铰链式膝关节置换,记录置换时间,置换过程中出血量,置换后住院天数,HSS评分及围置换期并发症,置换后摄标准膝关节正侧位X射线平片观察假体位置。13例患者均获得随访,平均14.3个月。置换时间100～150min,平均107min。置换后1例患者出现下肢静脉血栓,给予溶栓,安置下肢滤器等治疗,2例出现不同程度的肺部感染给以抗感染雾化等治疗。术后及随访X射线显示假体位置良好、力线正确、无假体松动迹象。置换后内外翻和屈曲挛缩畸形均消失,膝关节保持外翻6°,关节屈曲活动范围达0°～120°。置换前13例患者膝关节评分平均为40分（21～57分）,末次随访时HSS评分平均83.5分（68～90分）,优8例,良4例,优良率92.3%。提示对于老年股骨髁间粉碎性骨折合并有膝关节疾病患者铰链式膝关节置换是一种较好的术式,能有效改善功能,显著提高患者的生活质量。

From May 2005 to May 2007, 13 cases of comminuted fracture of femoral condyle combined with knee joint diseases were admitted to Department of Orthopedics Shaanxi Provincial People＇s Hospital, including 4 males and 9 females; aged 70.5 years （ranging from 65 to 75 years）; 5 cases of left keen injury and 8 cases of right knee injury. Twelve of the 13 cases were caused by tumbling and only one case caused by falling from a high place; all were fresh fractures. Among the 13 cases, 8 were complicated by osteoarthritis, 5 by rheumatoid Arthritis, 2 by diabetes, 7 by varying degrees of cerebral-cardiovascular diseases, and 9 by different degrees of osteoporosis （1 with severe osteoporosis）. All patients underwent hinged knee replacement. The duration of operation, amount of blood loss during the operation, length of stay post operation, HSS score and perioperative complications were recorded; standard anteroposterior and lateral X-ray film of knee joint was taken to examine the position of the prosthesis. A total of 13 patients were followed up for an average of 14.3 months. Duration of operation was 107 minutes （ranging 100 150 minutes）. After knee replacement, one patient developed lower limb venous thrombosis, treated with thrombolytic therapy; 2 cases developed pulmonary infection and managed by anti-infective therapy ＆ inhalation therapy. Post operative and follow-up X-ray displayed that the prosthesis was imbedded in correct position and in-line-traction with no evidence of loosening. After the replacement, knee varus, valgus and flex contracture deformity were corrected; knee joint kept valgus of 6 degrees and flex mobility reaches 0°～ 120°. Pre-replacement, the HSS score for 13 cases was at 40 （ranging 21-57 points）, HSS score at the final visit was 83.5 （ranging 68-90 points）, including 8 excellent, 4 good and Kolmert was 92.3%. Results indicate that hinged knee replacement is a preferable operation procedure for aged comminuted fracture of femoral condyle combined with knee joint diseases, which can evidently improve knee function and quality of life.