全膝关节置换治疗晚期骨性关节炎

Treatment of osteoarthritis of the knee by total knee arthroplasty

目的探讨全膝关节置换(total knee arthroplasty,TKA)在膝关节骨性关节炎治疗中的疗效,手术要点及注意事项。方法对35例(41膝)晚期骨性关节炎患者行初次人工全膝关节置换术,采用膝前正中纵形切口和内侧髌旁入路,术后进行随访,对比术前术后膝关节功能评分(theHospital for Special Surgery Knee Score,HSS)及膝关节活动度(range ofmotion,ROM)以观察疗效。结果全部病例均得到平均24个月的随访,均未出现感染、下肢静脉血栓等并发症。HSS评分由术前平均(69±7)分提高到术后平均(91±4.6)分。膝关节活动范围由术前平均95°提高到术后平均115°。结论全膝关节置换是治疗晚期膝关节骨性关节炎的最佳治疗手段。选择恰当的病例,良好的假体设计,精确的手术技术,术后积极的康复锻炼是影响术后结果的主要因素。

Objective To explore the efficacy, operation points and points for attention of total knee replacement in the treatment of osteoarthritis of the knee. Methods We reviewed the results of 35 cases （41 knees） with initial total knee arthroplasty at our hospital, including 26 females （32 knees） and 9 males （9 knees） with age range from 50 to 78 years （mean, 64.9-year-old）, from January 2004 to January 2006. All knees were varus deformity mean, （12.8 ± 3° ）. Results A 11 cases were followed up with a mean period of 24 months without infections and deep vein thrombosis. According to the HSS knee scoring system, the scores were from 69 ＋ 7 preoperation to 91 ± 4.6 postoperation. The knee ROM increased from 95° to 115°too. Conclusions Total knee arthroplasty is the best treatment for advanced knee osteoarthritis. Selecting appropriate cases, a good prosthesis design, precise surgical technique, postoperative rehabilitation exercise can result in the best functional results.