不同股骨髁间截骨膝关节假体在膝关节置换术中的应用

Application of different knee prostheses of femoral condyle osteotomy in total knee arthroplasty

[目的]探讨不同股骨髁间截骨膝关节假体在膝关节置换术中的应用。[方法]自2005年5月～2010年10月本科行TKA术的患者107例（122膝）。使用深盘型后稳定假体62例（72膝），使用桩柱型后稳定假体45例（50膝）。对比两组术前、术后KSS评分、功能评分、测量膝关节ROM。[结果]两组术后与术前的KSS评分、功能评分、膝关节ROM比较，差异均有统计学意义（P〈0．05）。两组术后KSS评分、功能评分、膝关节ROM比较，差异均无统计学意义（P〉0．05）。深盘型后稳定假体组有1例，术后出现膝关节假体周围感染，经过一期骨水泥旷置，3个月行二期翻修；桩柱型膝关节假体组有1例术中发生股骨外髁骨折，术中及时发现给予螺钉内固定，1例术后7个月股骨假体周围骨折，给予钢板内固定术，患者均痊愈出院。两组术后随访x线片观察膝关节假体位置、力线、固定性能等均显示良好，无松动、透亮线等异常表现。[结论]两种不同术式股骨髁间截骨膝关节假体行TKA临床疗效满意，术后膝关节功能良好。

[ Objective] To explore the application of different knee prostheses of femoral condyle osteotomy in TKA （total knee arthroplasty） . [Methods] TKA was conducted for 107 patients （122 knees） from May 2005 to October 2010. The posterior stabilized prostheses of deep disc type were used for 60 patients （72 knees）, and the posterior stabilized prostheses of pile columnar type were used for 45 patients （50 knees） . KSS score, function score and knee joint ROM of preoperation and posto- peration were analyzed. [ Results ] KSS score, function score and knee joint ROM between preoperation and postoperation were significant in the two groups （ P 〈 0. 05 ） . KSS score, function score and knee joint ROM of postoperative between the two groups were not significant （ P 〉 0.05 ） . A patient was infected postoperatively around the prosthesis in the group of posterior stabilized prostheses of deep disc type, and was given bone cement exclusion and provided a secondary repair after three months. A patient appeared a femoral condyle fracture during the course of operation in the group of posterior stabilized prostheses of pile columnar type and was provided a timely fixation using screws. Another patient appeared a fracture around prosthesis in the 7th month after operation and was provided a fixation using plates. All the patients were cured. The position, lines of force and fixed performance were fine from follow - up X - ray for the knee prostheses in the two groups. There were no loosening, radiolucent line and so on. [ Conclusion ] The two kinds of knee prostheses of femoral condyle osteotomy are satisfactory in curative effect for TKA and the function of prostheses is good after operation.