可旋转铰链膝在晚期夏科氏膝关节病的应用

Rotating hinged total knee arthroplasty for end-stage Charcot's joint of the knee

[目的]探讨可旋转铰链全膝置换(total knee arthroplasty,TKA)在晚期夏科氏膝关节病的应用及近期临床效果.[方法] 2013年1月-2020年1月可旋转铰链膝置换治疗膝Charcot关节病11例12膝,观察围手术期、随访及影像学情况.[结果]所有患者均顺利完成手术,术中无神经、血管损伤等严重并发症,所有患者均获随访,随访时间18~84个月,平均(38.73±13.51)个月,末次随访AKSS临床评分、功能评分、SF-36评分、ROM均较术前显著增加,差异均有统计学意义(P<0.05).影像方面,末次随访,HKA较术前显著增加,而MPTA较术前显著减少,差异均有统计学意义(P<0.05),术前与末次随访PTS的差异无统计学意义(P>0.05).末次随访X线片均显示假体位置良好,无松动表现,无假体周围骨折.[结论]可旋转铰链全膝关节置换治疗晚期夏科氏膝关节病短期疗效确切,远期疗效有待进一步随访.

[Objective]To explore the short-term clinical outcomes of rotating hinged total knee arthroplasty(TKA)for end-stage Charcot joint of the knee.[Methods]From January 2013 to January 2020,11 patients with Charcot arthropathy of the knee were treated by rotating hinged total knee arthroplasty.The documents regarding to perioperative period,follow-up and radiographs were summarized.[Results]All the patients had operation completed successfully without neurovascular injuries and other serious complications.All patients were followed up for 18-84 months,with an average of(38.73±13.51)months.The AKSS clinical score and functional score,as well as SF-36 score and range of motion(ROM)significantly improved at the latest follow-up compared with those before operation(P<0.05).Radiographically,the hip-knee-ankle(HKA)angle significantly increased,whereas the medial proximal tibial angle(MPTA)significantly decreased at the latest follow up compared with those preoperatively(P<0.05),however,the posterior tibial slope(PTS)remained unchanged(P>0.05).By the time of last follow-up,the prostheses were in good position with no loosening and no periprosthetic fractures in anyone of them.[Conclusion]The rotating hinged total knee arthroplasty does achieve sound short-term clinical outcomes for treatment of end-stage knee neuroarthropathy,but its long-term outcome needs further follow-up.