半限制性假体治疗Charcot膝关节病的疗效分析

An effect analysis of semi-restrictive prosthesis in Charcot arthropathy of the knee

目的探讨半限制性假体全膝关节置换（total knee arthroplasty,TKA）在膝关节Charcot关节病中的应用及近期临床效果。方法 2003年7月至2013年6月,对行TKA的12例Charcot关节病患者（12膝）进行回顾分析。12例中,男5例,女7例;年龄30-70岁,平均48岁。所有患者均使用半限制性假体,其中7膝加用延长杆。本组12例术后1、3、6、12个月以及以后每年随访1次,12例均获14个月-11年随访,平均6.5年。12例每次随访,均摄患肢膝关节正侧位X线片、并行HSS、KSS评分、膝关节活动度、关节稳定性、假体固定情况（有无假体松动）等评价。结果 1例术后2年出现感染、假体松动,行分期手术。一期清创,抗生素骨水泥临时假体植入,待感染控制后,行二期翻修术,术后恢复较好。其余病例术后疼痛完全消失,膝关节畸形矫正,稳定性及功能均良好,无感染、假体松动、深静脉血栓等并发症。术后X线片显示假体位置及下肢力线恢复良好。末次随访时,膝关节HSS评分平均87.7（82-96）分,较术前平均为51.5（32-72）分,差异有统计学意义（P〈0.01）。膝关节KSS临床评分：平均为87.5（80-95）分,较术前平均为57.9（35-70）分,差异有统计学意义（P〈0.01）。膝关节KSS功能评分平均为86.9（80-95）分,较术前的平均为56.8（30-70）分,差异有统计学意义（P〈0.01）。膝关节活动度（ROM）平均115°（110-130）°,较术前的平均为96.5°（85-110）°,差异有统计学意义（P〈0.01）。随访时HSS评分、KSS评分和ROM与术前比较,差异均有统计学意义（P〈0.01）。患者对功能及关节的稳定性满意。结论半限制性膝关节假体TKA是治疗膝关节Charcot关节病的有效方法,术中采取适度的软组织松解及正确的截骨、合理的骨缺损处理、选择适当的假体和术后康复,Charcot关节病患者可以通过TKA获得良好的近期结果,远期效果有待于随访观察。

Objective To evaluate the application and clinical results of semi-restrictive prosthesis in total knee arthroplasty（ TKA） for Charcot arthropathy of the knee.Methods Twelve patients（ 5 males and 7 females,12 knees） with Charcot arthropathy of the knee in our hospital from July 2003 to June 2013 were performed TKA and clinical results were reviewed and analyzed.The mean age was 48 years（ range：30-70 years）.Semi-restrictive prostheses were used in all knees,including 7 knees with extension rod.Patients were followed up postoperatively at 1 month,3 months,6 months,12 months,and annually thereafter.The mean follow-up period was 6.5 years（ range：14 months-11 years）.Anteroposterior and lateral X-ray was taken in each follow-up.Hospital for Special Surgery（ HSS）,American Knee Society Score（ KSS）,knee range of motion（ ROM）,stability,and prosthesis location were evaluated.Results One deep infection had developed with acute hematogenous pattern at 2 years and was successfully treated with 2-stage revision.X-ray film showed good recovery positions of the prostheses and lower limb force lines in other patients.Postoperatively,pain completely disappeared,knee joint deformity was corrected,stability and functions were good,no prosthetic loosening or deep venous thrombosis（ DVT） was developed.The mean Hospital for Special Surgery（ HSS） knee score increased from 51.5 points（ range：32-72 points） before surgery to 87.7 points（ range：82-96 points） at the final follow-up with statistical significance（ P〈0.01）.The mean clinical Knee Society Score（ KSS） was 87.5 points（ range：80-95 points） postoperatively and 57.9 points（ range：35-70 points） preoperatively with statistical significance（ P〈0.01）.The mean functional Knee Society Score（ KSS） was 86.9 points（ range：80-95 points） postoperatively and 56.8 points（ range：30-70 points） preoperatively with statistical significance（ P〈0.01）.The preoperative range of motion（ ROM） averaged 96.5°（ range：85°-110°） preoperatively and 115°（ range：110°-130°） postoperatively with statistical significance（ P〈0.01）.All patients were satisfied with the clinical results at the lastest follow-up.Conclusions Semi-restrictive prosthesis in TKA is effective for Charcot arthropathy of knee.Patients of Charcot arthropathy can receive good midterm results by proper soft tissue release,accurate osteotomy,suitable repair of bone defects,correct prosthesis selection,and postoperative rehabilitation.However,long-term effect remains to be further investigated.