1336个人工膝关节置换术的临床特点分析

Clinic analysis of 1 336 total knee arthroplasty

目的 :通过对 14年所行 1336个人工膝关节置换术的分析 ,探讨我国行膝关节置换术病人的特点及不同的处理方法。方法 :1987年 4月～ 2 0 0 1年 12月 92 6名患者共 1336个膝关节置换 ,其中单膝关节置换术 5 16人 ,双膝同时置换 4 10人 82 0个膝关节。诊断分别为骨性关节炎、类风湿关节炎、强直性脊柱炎、色素绒毛结节性滑膜炎等。畸形包括内翻、外翻、屈膝挛缩、屈膝骨性强直、屈膝半脱位骨性强直及强直性脊柱炎和类风湿关节炎病人的多发关节破坏。结果 :有些被文献认为是膝关节表面置换禁忌的严重畸形 ,术后关节功能和生活质量均有明显改善。通过手术技术的改进 ,高度屈膝畸形的术后并发症比早期起步阶段明显减少。结论 :(1)我国人工膝关节置换术在病例的难度、传统观念、患者经济承受能力等方面比发达国家有更多的困难 ;(2 )假体选择必须早定型以便得到更好的临床效果 ;(3)康复对临床效果至关重要 ,应建立专职康复队伍 ;(4 )假体早日国产化 。

Objective: A retrospective analysis was conducted on 1 336 total knee replacements (TKR) during past 14 years, to study the characteristics of patients and knee deformi ties in our center, and to search for the right way to treat them. Meth ods: From April 1987 to December 2001, 1 336 total knee arthroplasties were performed in 926 patients . There were 516 unilateral TKRs in 516 patients, and 820 bilateral TKRs in 410 patients. Patients surfered from all the diseases below: osteoarthritis ( synovial chondromatosis and kaschin-beck disease), rheumatoid arthritis, ankyl o sing spondylitis, and some rare rheumatic diseases such as pigmented vi llonodular synovitis, tuberculous arthritis, Charcot arthritis, hemophilic arthr itis and psoriatic arthritis. Patients in our group also had several kinds of se vere deformities such as varus deformity with dislocation or medial plateau defe ct, valgus deformity, flexion contracture of knee, flexion deformity with bony f usion, flexion bony fusion with subluxation and deformity in the low extremitie s with multiple joints involved in junior ankylopoietic spondylarthrisis (JAS) patients and junior rheumatic arthritis (JRA) patients. Results: Some severe def ormities were considered as contraindication of surfacing TKR , but the life quality of patients got significant improvement after operation s. T hrough the improvement of surgical skill, the complications of severe knee flexi on deformity are now less than those in the early time. Conclusion:(1)Our TKR is facing more challenges and difficulties than that of the developed countries.(2 )The pr osthesis should be selected mature in order to get the good result.(3)Physical t herapy is very important in the rehabilitation after TKR, which is essen tial for a full-time physical therapist team.(4)TKR could not be developed rapi dly without home-made prosthesis in China.