人工膝关节表面置换治疗膝关节病86例98膝

Total knee replacement for 98 knees of 86 gonarthrosis patients

背景:人工全膝关节表面置换是治疗膝关节病的有效治疗方法,但疗效与诸多因素相关。目的:观察分析人工全膝关节表面置换治疗严重膝关节骨关节病的效果。方法:1999-07/2008-06收治严重膝关节骨关节病86例(98膝)行全膝关节表面置换,不置换髌骨。采用膝关节表面后稳定型假体84例95膝,其中Plus公司假体92膝,美国施赛克公司后稳定性假体3膝;京航公司生产保留后交叉韧带假体1例双膝,国产爱康假体1例单膝。置换后定时随访,应用美国John.N.Insall评分系统进行膝关节功能评估。结果与结论:所有病例获1～9年随访,平均5.2年。至最后一次随访,5例7膝膝关节屈曲<90°,2例伸膝>-10°,1例双膝为类风湿性关节炎,1例双膝使用的为早期国产膝关节假体。1例置换后1年反复出现关节积液,保守治疗治愈,但活动度丢失。根据John?N?Insall评分标准,膝关节置换后在疼痛、关节功能及活动度等方面均有明显的改善,优良率为90.7%。提示全膝关节表面置换是治疗膝关节病的有效方法;严格选择置换适应证,规范置换操作及系统地康复训练,可获得满意疗效。

BACKGROUND： The total knee arthroplasty is an effective method to treat the gonarthrosis, but the curative effect is related with many factors. OBJECTIVE： To explore the result for the treatment of gonarthrosis with total knee arthroplasty. METHODS： From July 1999 to June 2008, the total knee arthroplasty was performed in 86 gonarthrosis patients （98 knees）, no whirbone was replaced. A total of 95 knees in 84 cases were treated with posterior stabilized total knee prosthesis, including 92 knees prosthesis from Plus company and 3 posterior stabilized prosthesis from U.S. Stryker; one case used posterior cruciate ligament prosthesis （BCAE, Beijing, China） in both knees, and one case used Aikang prosthesis in one knee. Patients were regularly followed up after replacement, and knee joint function was evaluated using U.S. John.N.Insall scoring system. RESULTS： The average follow-up time in 86 cases was 5.2 years （range 1-9 years）. To the last visit of follow-up, the knee joints flexion was less than 90° in 5 cases of 7 knees and extension was more than-10° in 2 cases. Among these cases, 1 case of 2 knees was rheumarthritis patient, 1 case of 2 knees used domestic implant of knee joint in early time. One case exhibited repeated joint effusion within one year after operation, and was cured by conservative treatment, but the knee joint activity was lost. According to John.N.Insall scale, the excellent and good rate was 90.7%. It was improved distinctly in ache degree, joint function and activity after total knee arthroplasty. It is suggested that total knee arthroplasty is an effective method of treating gonarthrosis. It can acquire satisfactory effect with strict choice of surgical indication, standard surgical operation and systematic recovery training.