旋转铰链式膝关节假体置换治疗复杂膝关节疾病

Knee arthroplasty using rotating hinged knee systems for complex knee disease

目的：观察旋转铰链式膝关节假体置换在治疗复杂膝关节疾病中的临床应用疗效。方法：选择2003-06/2008-05中南大学湘雅二医院骨科收治的膝关节疾病患者18例（20膝,左侧11膝,右侧9膝）,男11例,女7例,年龄34-66岁,平均58.7岁。原发疾病为类风湿性关节炎8例,骨性关节炎10例,类风湿性关节炎及骨性关节炎均合并膝关节20°-30°内外翻畸形,或25°-40°固定性屈曲畸形,其中2例双膝置换。置换前X射线测量内外翻角度,采用AORI对骨缺损进行分型。全部患者采用可旋转铰链稳定型假体进行膝关节置换,均为初次置换。采用HSS评分标准对置换疗效进行评价。结果：18例患者膝关节置换均顺利完成,每膝置换时间95-147min,平均129min。全部病例均获得了随访,随访时间11个月-6年,平均随访4.2年。置换后所有病例膝关节疼痛消失或基本消失,内外翻和屈曲挛缩畸形均纠正,关节活动范围达100°-136°,所有患者均能不扶拐独立行走。置换后未出现浅部或深部感染,无假体下沉、移位及骨折骨吸收发生。膝关节HSS评分置换前平均42分（25-56分）,置换后86分（78-95分）,优11例,良6例,一般1例,优良率94%。结论：对于膝关节严重内外翻或屈曲挛缩畸形患者,行旋转铰链膝关节置换早期效果满意,可以解除膝关节疼痛,矫正畸形,改善关节功能及提高生活质量。

OBJECTIVE： To explore the clinical results of rotating hinged knee systems in the treatment of complex knee diseases. METHODS： A total of 18 patients （11 males and 7 females, aged 58.7 years, ranging 34-66 years） with complex knee diseases were selected from Second Xiangya Hospital of Central South University, who underwent 20 primary knee arthroplasties （11 left and 9 right knees） using rotating hinged prosthesis from June 2003 to May 2008. These cases included 8 rheumatoid arthritis and 10 osteoarthritis, and presented 20°-30° varus or valgus deformity or 25°-40° fixed flexion deformity. Two patients underwent bilateral knee arthroplasty. Preoperatively bone loss and deformities in all cases was evaluated by AORI and X-ray. Postoperatively the clinical results were evaluated by the HSS knee rating score system. RESULTS： Knee arthroplasty was performed in all patients successfully and unilateral operative time was 95-147 minutes （average 129 minutes）. The patients were followed up form 11 months to 6 years （average 4.2 years）. All the knee pain was released and the deformities were corrected. The range of joint movements was up to 100°-136°. The patients could walk without assistance of walking stick. No light or deep infection, prosthesis subsidence, dislocation or fracture resorption was found. The average HSS score was 86 （78-95 scores） post-operation while 42 （25-56 scores） pre-operation. Excellent results were received in 11 cases, good in 6 cases. The rate of excellent or good was 94%. CONCLUSION： The knee arthroplasty using rotating hinged knee systems is an effective method to treat complex knee diseases such as severe extroversion or varus. It can release the knee pain and improve joint function and the quality of life.