人工全膝关节表面置换术治疗膝关节重度骨关节炎15例

Effect of Total Knee Replacement on 15 cases of Severe Osteoarthritis of Knee Joints

目的探讨人工全膝关节表面置换术(total knee arthopasty,TKA)治疗膝关节重度骨关节炎的临床疗效。方法 2007年3月-2011年6月应用人工全膝关节表面置换术治疗膝关节重度骨关节炎患者15例16膝,男性5例,女性10例,年龄45～84岁,平均61.3岁;均有严重疼痛、活动受限,10例跛行,5例扶拐行走。术前HSS评分平均25分,平均随访时间21.6个月(2～72个月)。其中2例合并外翻畸形,角度8°～16°;13例合并内翻畸形,角度10°～25°。术前表现为膝关节疼痛进行性加重,行走困难,经长期保守治疗无效。按TKA原则施术,重建膝关节负重力线,截骨达到伸屈间隙相等,维持软组织平衡,保持髌骨中置位,获取膝关节充分活动度。结果随访时间2～72个月,平均21.6个月。2膝切口局部脂肪液化,经换药愈合。所有手术患者均未出现切口及关节内感染。经X线片检查所有手术患者均未出现假体松动情况。伸膝受限3膝(5°～15°)。屈膝90°～130°(平均112°)。疗效地评估采用HSS膝关节评分系统,总分100分,大于85分为优,小于59分为差,评估内容包括关节疼痛、功能以及活动度,还包括关节的稳定性、肌力、屈膝畸形等。经术后随访显示本组HSS评分平均86分。结论对有疼痛、畸形、功能障碍,经长期保守治疗无效的重症骨关节炎患者,选择TKA治疗,疗效满意。

Objective To explore the therapeutic efficacy total of knee arthroplasty（ total knee arthroplasty,TKA） in the treatment of severe osteoarthritis of knee joint. Methods From March,2007 through June,2011,15 patients（ 16 knees） with severe osteoarthritis underwent the artificial TKA ; there were 5 man and 10 women, age 45 to 84 year old（ average 61.3 ）. All cases were with severe pain and limited activity, 10 cases with claudication,5 cases walked with crutches. Preoperative average HSS scoring were 25 points, the mean follow-up time were of 21.6 months （2 -72 months）. 2 patients were with valgus deformity, the angle was 8° to 16°;13 patients were with varus deformity, angle was 10° to 25°. The preoperative clinical manifestations were aggravated knee pains,walking difficult, and no response to the conservative treatments. According to the TKA principle of application, the weight-bearing axis of the knee joint was reconstructed, osteotomy was made to balance the flexion/extension gap and restore the soft tissue balance and the patella was kept in midline. The range of motion was satisfactorily restored. Results All cases were followed up for 2 -72 months（ mean 21.6 months）. 2 knees were with local fat liquefaction in incision,and were cured by changing dressing. There was no incision and intra-articular infection. No case was by X-ray with of prosthetic loosening. 3 knees were with extension restriction between 5 degrees and 15 degrees ,flexion between 90° to 130°（ mean 112°）. The efficacy was evaluated by Hospital for Special Surgery（HSS） knee scoring system. The indexed included joint pain, function, range of motion, muscle strength, knee flexion deformity and joint stability etc. In total 100 points, more than 85 points was for the gifted,less than 59 points was for poor. The follow-up showed that the score of HSS were averaged 86 points. Conclusion TKA treatment can a- chieve a good curative efficacy in severe osteoarthritis patients with pain, deformity and dysfunction and the long-term invalid con- servative treatment.