初次人工全膝关节表面置换术治疗膝关节骨关节病108例的疗效观察

Study in the effect of primary total knee arthroplasty for 108 knee arthroses

[目的]探讨初次人工全膝关节表面置换术(total knee arthroplasty,TKA)治疗膝关节病的临床疗效。[方法]对108例130个膝关节行TKA,男50例(60膝),女58例(70膝);年龄47～87岁,平均71.5岁,术前诊断骨性关节炎62例(70膝),类风湿性关节炎37例(51膝),创伤性关节炎4例,滑膜软骨瘤病2例,色素沉着绒毛结节性滑膜炎2例,陈旧关节结核1例,采用后方稳定假体80例(92膝),后交叉韧带保留假体28例(38膝)。[结果]108例患者均获随访,时间24～84个月,平均50.3个月。患者术后在疼痛、功能、活动度方面改善明显,采用HSS评分系统进行评分,由术前平均48.4分提高到89.3分。术后130个膝关节平均活动度为102°,126个膝关节术后力线正常,3例残留6°～8°内翻,1例后遗15°外翻畸形,手术优良率90.5%。[结论]TKA对治疗严重膝关节病效果满意,术中正确的选择切口,注意假体软组织平衡,精确截骨,注重术中髌骨轨迹的纠正是手术成功的关键。

[ Objective ] To investigate the effect of primary total knee arthropl asty for knee arthrosis. [ Method] Totally 108 cases （130 knees）of knee arthrosis were treated with primary total knee resurface arthroplasty. There were 50 male patients （60 knees） ,58 female patiewts （70 knees） ,their average age was 71.5 years, （ 47 to 87 years） ,preoperative diagnosis of the pa- tients included 62 cases（70 knees）of osteoarthritis ,37 cases（51 knees） of rhumatoid arthritis ,4 cases of traumatic arthritis ,2 cases of synoval chondroma,2 cases of pivillian synovitis, 1 case of old tubercrosis. Eighty cases （92 knees） were treated by posteri- or stabilize prosthesis,28 cases（38 knees） by PCL restore prosthesis. [ Result] All 108 cases were followed up for 24 -84 months, with 50.3 on average. All got pain relieves and function and range of motion （ ROM ） improved. According HSS scores, the scores were improved from 48.4 preoperatively to 89.3 postoperatively. The rang of motion（ROM） were 102° in average. Totally 126 knees got normal stress line recovery,while 3 got 6° -8°varus, 1 got 15°valgus. The excellent to good rate were 90.5%. [ Conclusion] Total knee resurface arthroplasty can provide satisfactory result in the treatment of knee arthrosis. Accurate osteoto- my, prosthesis choice, proper soft tissue release to get soft tissue balance and correction of patellar tract are keys for this operation.