严重畸形和不稳定膝关节的初次旋转铰链膝关节置换

Primary rotating hinge knee arthroplasty for knees with severe deformity and instability

目的 :探讨初次旋转铰链膝关节置换术治疗膝关节非肿瘤病变的适应证、并发症和近期疗效。方法 :回顾性研究 1999～ 2 0 0 3年间使用旋转铰链膝关节假体进行初次全膝关节置换术合并严重畸形和不稳定的病例 ,共 15例 2 0膝。平均年龄 67 9岁 ( 60～ 77岁 )。原发疾病分别为骨关节病合并严重的膝内翻、膝外翻畸形 ,类风湿性关节炎合并膝关节不稳定和骨缺损 ,色素绒毛结节性滑膜炎合并膝关节骨缺损和不稳等。术前膝关节活动度平均 89 0°( 10～ 14 0°) ,合并屈曲挛缩畸形者 16膝 ,平均 15 0° ( 5～ 60°)。术前膝关节HSS评分平均 44 8分 ( 2 1～ 63分 )。平均随访 3 4 8个月 ( 6～ 5 2个月 )。结果 :所有病例疼痛明显缓解 ,行走、上下楼梯等功能较术前明显改善。HSS评分从术前的 44 8分增加到术后的平均 90分 ( 80～ 98分 )。膝关节活动范围平均 114 2° ( 90～ 13 0°)。髌股关节并发症最常见 ,3例出现髌股排列异常 ,并有轻度的前膝痛和伸膝力弱。结论 :旋转铰链膝关节假体早期效果满意 ,但要注意适应证的选择 ,旋转铰链膝关节假体最好只用于活动量要求较低。

Objective:To study the indications,complications and early results of using rotating hinge knee prosthesis for primary total knee arthroplasty in patients with no oncologic disease.Method:Twenty knees in 15 patients with severe deformity and instability received a rotating hinge knee prosthesis for primary total knee arthroplasty between 1999 and 2003.The average age were 67.9 years old.Indications for the rotating hinge knee prosthesis were:severe genu varus or valgus deformity,bone loss and instability.Sixteen knees had flexion contraction deformity and average degree were 15.0°(5～60°).The average duration of follow-up were 34.8 months(6～52 months).Result:All the patients had the excellent pain relief,restoration of walking capability,and stabilization of knee.The average HSS score improved from 44.8 points (range,21～63 points)before surgery to 90 points (range,80 to 98 points) after surgery.The average ROM improved from 89.0° to 114.2°.Malalignment of patella and light anterior knee pain were the main complications of patellofemoral joint.Conclusion:The use of rotating hinge knee prosthesis for severe knee deformity or instability in elderly patients with low physical demands can resulte in significant pain relief and improved function.