胫骨延长柄在重度肥胖患者初次全膝关节置换术中的应用及疗效观察

The application and observation of total knee arthroplasty with tibial stem extension for the severe obese patients

目的：探讨胫骨延长柄在重度肥胖的终末期膝骨性关节炎患者初次全膝关节置换术（ TKA）中的应用及疗效。方法回顾性分析河南省人民医院骨科2009年5月—2012年5月在初次TKA中应用胫骨延长柄治疗的19例（23膝）终末期膝骨性关节炎患者的临床资料,其中男4例、女15例,年龄53~78岁,BMI （37．7±1．75） kg/m2。单侧置换15例（左侧9例、右侧6例）,双侧置换4例。应用美国膝关节学会评分（ KSS）系统,记录患者手术前后KSS膝评分及膝功能评分,采用SPSS 17．0进行统计学分析,以评价临床疗效及假体生存率。结果17例（21膝）获得随访,平均随访44个月（27~65个月）；2名患者失访。术后下肢力线良好,关节稳定,随访患者均无假体松动等相关并发症。17例患者末次随访时,21膝评分从术前的（20．8±4．5）分提高到（90．7 ± 3．4）分,膝功能评分从术前的（25．7 ± 4．8）分提高到（87．0 ± 3．7）分,差异均有统计学意义（P值均〈0．01）；经侧方应力试验,17例患者均未出现内翻和外翻类型的关节不稳；未出现假体周围骨折、感染、无菌性松动、髌骨骨折等并发症,假体生存率为100%。结论重度肥胖的终末期膝骨性关节炎患者接受初次TKA治疗时,应用胫骨延长柄可以分散应力,增强假体稳定性,降低术后并发症,可获得良好的临床疗效。

Objective To analyze the application and therapeutic effect of total knee arthroplasty （TKA） with tibial stem extension for the severe obese patients. Methods From May 2009 to May 2012, 19 patients （23 knees） were retrospectively followed. There were 4 males and 15 females with an average age of 65. 2 years （53 -78）. Fifteen patients received one-side TKA with tibial stem extension （left 9 cases, right 6 cases）, and 4 patients received both-side TKA. Knees were evaluated by the knee society score （KSS） system, including knee score and knee function score. The preoperative and postoperative scores were statistically analyzed to evaluate the clinical therapeutic effect and the implant survival rate with the SPSS 17. 0. Results Two patients were lost to follow-up and 17 patients （21 knees） had a mean follow-up time of 44 months （27-65 months）. The mean knee score was improved from （20. 8 ± 4. 5） points to （90. 7 ± 3. 4） points. The mean function score was improved from （25. 7 ± 4. 8） points to （87. 0 ± 3. 7） points. There were statistically significant differences（all P values 〈0. 01）. All patients had excellent lower limb alignment and knees stability. None of patients had prosthesis loosening and related complications. Conclusions For severe obese patients undergoing total knee replacement treatment using tibial stem extension can disperse stress, enhance the stability of prostheses, reduce revision rate and postoperative complications, therefore obtain an excellent therapeutic effect.