全膝关节置换中的改良截骨

Improved osteotomy in total knee arthroplasty

背景:近年来全膝关节置换在临床应用普遍,置换技术及假体设计理念均获得极大改善和提高,但尚无截骨顺序方面的研究。目的:探讨改良截骨方法在全膝关节置换过程中应用的临床效果。方法:对60例患者的60膝行全膝关节置换,原发疾病包括骨关节炎52例,类风湿性关节炎6例,创伤性关节炎2例,均为后稳定型膝关节,应用强生PFC-Sigma PS型假体或LINK Gemini PS型假体。在极度屈膝下,先行股骨截骨,包括股骨远端前方后方斜面截骨(某些类型还包括股骨髁间截骨)。髌骨不常规置换,再行胫骨平台截骨。记录手术时间,置换后引流量,置换前及置换后6,12周膝关节活动度及美国特种外科医院膝关节评分,并进行统计学分析。结果与结论:60例患者均获得随访,随访时间3-14个月。手术时间平均(51.3±12.5)min,置换后引流量平均(302±39)mL。置换后6,12周患者膝关节活动度及美国特种外科医院膝关节评分均较置换前明显改善(P<0.01)。2例患者置换后1个月出现低度感染,经抗感染治疗后好转,未出现假体排异反应。提示全膝关节置换过程中先行股骨截骨可以为胫骨的操作获得更大的空间,方便切除半月板,并可安全地进一步松解周围软组织。操作简便,可以缩短手术时间,减少术中失血,具有良好的修复效果。

BACKGROUND： Recently, total knee arthroplasty has been widely applied in clinic, and the replacement techniques and prosthetic design concept have been greatly improved. But osteotomy order has not been reported.OBJECTIVE： To discuss the clinical effect of the improved osteotomy in total knee athroplasty.METHODS： The total knee arthroplasty was performed in 60 patients （60 knees）, including 52 cases of osteoarthritis, six cases of rheumatoid arthritis and two cases of traumatic arthritis, and posterior stabilized knee joints were used for total knee arthroplasty, such as the PFC-Sigma PS prosthesis or LINK Gemini PS prosthesis. The femoral osteotomy was performed firstly under extreme knee bending, including oblique osteotomy anterior and posterior to the distal femur （some types contained intercondylar osteotomy）. Patella un-conventional replacement was performed followed by the tibial plateau osteotomy. The operation time, postoperative drainage volume, range of motion of knee joint as well as Hospital for Special Surgery knee scores before replacement and 6 and 12 weeks after replacement were recorded and statistically analyzed.RESULTS AND CONCLUSION： All the 60 patients were followed-up for 3-14 months. The average operation time was （51.3±12.5） minutes; the postoperative drainage volume was （302±39） mL. The range of motion of knee joint and Hospital for Special Surgery knee scores 6 and 12 weeks after replacement were improved compared with those before replacement （P 〈 0.01）. At 1 month after replacement, two cases had low-grade infection which was improved after anti-infection therapy without prosthesis rejection. Femoral osteotomy before total knee arthroplasty can obtain the great space for tibial operation, which is beneficial to removal of the meniscus, and further loosens the surrounding soft tissue safely. This method has the advantages of simple operation, shortening the operation time, reducing the intraoperative blood loss, and better repairing effect.