旋转铰链型膝关节假体在复杂初次全膝关节置换术的应用和临床疗效

Application and clinical effect of rotating hinge knee prosthesis in primary complex total knee arthroplasty

目的探讨旋转铰链型膝关节假体（RHK,Endo-model）在复杂的初次全膝关节置换术（TKA）中应用的临床疗效。方法 2004年1月至2013年12月,选择解放军总医院骨科非骨肿瘤患者接受初次TKA采用旋转铰链型（RHK）（Endo-model,Link）膝关节假体78例患者82膝,男性患者33例,女性患者45例,平均年龄45.6岁（23~78岁）;随访时间2.2~9.5年,平均4.5年。采用美国特种外科医院（HSS）膝关节功能评分评估患者功能,记录患者屈伸活动度,调查患者对手术满意度,分为非常满意、一般满意,不满意三个等级,并记录原因。采用SPSS 19.0统计软件进行统计学分析,术前和末次随访膝关节功能评分和关节屈伸活动度采用配对样本t检验,以P〈0.05表示差异具有统计学意义。结果 HSS功能评分由术前平均（35±5）分提高至末次随访平均（78±21）分,膝关节功能明显好转（t=5.8,P〈0.05）。膝关节屈伸活动度由术前平均（46±8）°提高至末次随访（73±8）°,差异具有统计学意义（t=2.7,P〈0.05）。在随访的78例患者中有67例患者（85.90%）患者对手术效果非常满意,5例患者一般满意,尚有6例患者因出现严重的并发症对手术效果不满意。并发症总体发生率15.9%。结论旋转铰链型假体在初次复杂TKA置换中期随访满意,临床应用需严格把握适应证。

Objective To investigate the clinical effect of the rotating hinge knee prosthesis（ RHK）（ Endo-model,Link） in the primary complex total knee arthroplasty（ TKA）. Methods From January 2004 to December 2013,Endo-model rotating hinge implants were used in 82 knees of 78 patients in primary TKA,including 33 men and 45 women. The mean age was 45 years（ 23-78 years）,and the follow-up time was 2. 2-9. 5 years,4. 5 years in average. The hospital for special surgery scoring system（ HSS） knee function score was used to evaluate the function of the patients. The satisfactory questionaire were recorded. The patients were divided into three grades as satisfactory,fair and dissatisfactory. Results The HSS function score of knee joint was improved from（ 35 ± 5） preoperatively to（ 78 ± 21）postoperatively,and the average score of knee joint function was significantly improved（ t = 5. 8,P〈0. 05）. The range of knee flexion and extension was increased from（ 46 ± 8） ° before the operation to（ 73 ± 8） ° at the end of the follow-up. In the follow-up of the 78 patients,67 patients（ 85. 90%） were very satisfied with the results of surgery, five patients were fair. Six patients were found severe complications due to the effects of the operations which was not satisfactory. The overall complication rate was 15. 9%. Conclusion The outcome of mid-term follow-up for the rotating hinge prosthesis in the primary complex knee replacement is satisfactory. The clinical indications for the prosthesis should be strict.