半限制性假体治疗重度畸形膝关节病的疗效分析

Efficacy analysis of the semi-restrictive prosthesis in patients with severe deformity of the knee joint disease

目的观察使用半限制性假体全膝关节置换术治疗膝关节骨关节病重度畸形的近期疗效。方法对23例（28膝）重度畸形的膝关节退行性骨关节病患者使用半限制性假体行全膝关节置换术。术前拍负重位下肢全长X线片,测量膝关节内翻、外翻角度。本组病例外翻膝外翻角均〉15°,内翻膝内翻角均〉20°,同时伴有程度不同的屈曲及旋转畸形。行全膝关节置换术,术中使用半限制性假体,使用金属垫块修复骨缺损。所有病例均进行跟踪随访与资料积累分析。结果术中关节畸形可有效修复,承载假体可靠;术后X线片显示假体位置及下肢力线恢复良好。术前HSS评分平均33.9分,术后随访6月~3年,平均随访2.3年,HSS评分平均87.6分。23例（28膝）中15例（18膝）为优,6例（8膝）为良,2例（2膝）尚可;其优良率92.9%。结论半限制性假体对严重畸形造成的骨缺损及软组织疲劳亏损导致的松弛能够进行满意的弥补。其设计及操作流程的科学性、可控性及合理性减少该类患者发生早期关节不稳定、下肢力线偏移、假体松动的几率。后期疗效有待于进一步观察随访。

Objective To observe the short-term efficacy of the semi-restrictive prosthesis in total knee arthroplasty in treatment of severe deformity of knee joint.Methods Twenty-three severe deformity patients（28 knees） with semi-restrictive prosthesis in total knee arthroplasty were included in the study.The X-ray of the total length of weight-bearing lower extremity was taken,the knee varus and valgus angle were measured.Valgus knee and valgus angle were bigger than 15 °,and varus knee and varus angle were bigger than 20 °,accompanied by varying degrees of flexion and rotation deformity.Total knee arthroplasty,intraoperative use of a semi-restrictive prosthesis,repair of bone defects were performed.All patients were followed up and the accumulated data were analyzed accordingly.Results Joint deformity was effectively repaired,and bearing prosthesis was reliable.Postoperative X-ray film showed a good recovery position of the prosthesis and lower limb force line.Preoperative HSS score was 33.9 points on average,postoperative followed-up ranged from 6 months to 3 years with an average of 2.3 years.The average HSS score was 87.6 points.Among 23 patients（28 knees）,15 patients（18 knees） were excellent,6 patients（8 knees） good,and 2 patients（2 knees） acceptable.The excellent rate reached 92.9%.Conclusion Semi-restrictive prosthesis is effective in repairing bone defects caused by severe deformity and relaxation caused by fatigue of soft tissues.Its design and operation process are scientific,controllable and reasonable.It can reduce the incidence rate of early joint instability,lower limb power line offset,loosening of the prosthesis.However,the long-term efficacy remains to be further investigated.