胫骨平台骨折术后继发创伤性膝关节炎行全膝关节置换术的疗效分析

Effect of total knee arthroplasty on secondary traumatic arthritis after the treatment of tibia plateau fracture

目的：探讨人工全膝关节置换（Total knee arthroplasty，TKA）治疗胫骨平台骨折术后继发创伤性膝关节炎的临床疗效。方法：对2005年1月至2014年2月期间的胫骨平台骨折术后继发创伤性关节炎患者21例（21膝）行人工全膝关节置换术。术后进行随访，采用HSS评分标准及X线检查对手术疗效进行评价。结果：21例病人手术顺利，术后平均随访4.7年（1.2-10.3年），无一例出现假体松动、深部感染及伤口不愈合等并发症，3例术后出现关节活动差，经手法松解及CPM机被动锻炼后，患膝活动度均明显改善，平均达95o。根据膝关节HSS评分，从术前（46.6±3.78）分上升至术后（83.82±4.91）分，治疗前后的HSS评分比较，差异有统计学意义（P〈0.05）。其中优10膝，良7膝，总优良率达81%。结论：全膝关节置换术治疗胫骨平台骨折术后继发创伤性关节炎可获得较为满意的临床疗效。

ObjectiveTo explore the outcomes of total knee arthroplasty（TKA） in treating secondary traumatic arthritis after the operation of tibia plateau fracture. Methods： TKA were performed in 21 patients（21 knees） who had secondary traumatic arthritis after tibia plateau fracture operation between Jan 2005 and Feb 2014. Patients were followed-up,and the effect of TKA was evaluated through HSS rating scale and X-ray. Results All patients were followed-up, for an average of 4.7 years （range from 1.2 to 10.3 years）. No complications such as loose prosthesis, deep infection and wound disunion occurred. Three of them showed poor joint motion and accepted maneuver relaxation under lumbar anesthesia, then took passive exercises by CPM until the mean range of knee was improved to 95o. The mean HSS score from 46.6±3.78 points before TKA increased to 83.82±4.91 points postoperatively. The difference of the HSS scores between preoperative and postoperative had statistical significance （P〈0.05）. ConclusionSatisfactory outcomes can be obtained in patients with secondary traumatic arthritis after the treatment of tibia plateau fracture through TKA.