膝关节极重度屈曲畸形患者行旋转铰链式全膝关节置换术近期疗效观察

Short term effect of rotational hinge total knee arthroplasty in patients with extremely severe knee flexion deformity

目的观察膝关节极重度屈曲畸形患者行旋转铰链式全膝关节置换术后的近期疗效。方法雅安市中医医院骨科2011年1~12月收治了24例(29膝)膝关节极重度屈曲畸形患者,均行旋转铰链式全膝关节置换术,术后3个月、6个月门诊随访后,每年门诊随访1次至2017年1月,末次随访评价膝关节功能恢复情况。结果所有患者的平均手术时间为(88.7±13.1)min,术中平均失血量为(226.7±32.9)m L;所有患者切口均一期愈合;术后膝关节X线片显示假体无松动、无下沉,髌骨轨迹、假体位置均良好,连续观测假体周围无进行性透亮线出现。随访至2017年1月,失访2例,22例患者中位随访时间54.8个月,膝关节HSS评分中疼痛、功能、活动度、屈曲畸形、稳定性和总分均明显高于术前,差异均有统计学意义(P<0.05);肌力与术前比较差异无统计学意义(P>0.05);术后1例患者发生血供障碍,并发症发生率为4.17%,随访期间无一例发生感染和假体松动。结论膝关节极重度屈曲畸形患者行旋转铰链式全膝关节置换术操作简单,近期疗效可靠。

Objective To observe the short-term effect of the rotational hinge total knee arthroplasty （TKA） in patients with the extremely severe flexion deformity of the knee joint. Methods A total of 24 patients with knee joint extreme flexion deformity （29 knee）, who admitted to Department of Orthopaedics of the Traditional Chinese Medicine Hospital of Ya＆#39;an City from January 2011 to December 2011, were selected and underwent rotating hinged total knee re-placement. After the outpatient follow-up in postoperative 3 months and 6 months, and one outpatient follow-up for each one year to January 2017, knee joint function recovery was evaluated at the last follow-up. Results The average surgi-cal time for all patients was （88.7±13.1） min, and the median intraoperative blood loss was （226.7±32.9） mL. All patients had the first phase healing of incision. After surgery, the knee joint X-ray showed no looseness, no sinking, and the patel-la track and the prosthesis were all good, There was no progressive transmission line around the false body. During the follow-up to January 2017, 2 cases were lost to follow-up, and 22 cases had a median follow-up time of 54.8 months. Knee pain in HSS score, buckling deformation, stability, function, mobility and total score before surgery were signifi-cantly higher than those after the surgery （P〈0.05）, while there was no statistically significant difference in muscle strength （P〉0.05）. One patient had a blood supply disorder after surgery, and the complication rate was 4.17%. No infec-tion and loosening of artificial joint occurred during the follow-up period. Conclusion Rotational hinge total knee ar-throplasty is a simple and reliable method for patients with extremely severe knee flexion deformity.