中置型GenesisⅡ人工膝关节置换近期疗效报道

Short-term clinical results of total knee arthroplasty with neutrally positioned Genesis Ⅱ

目的 报道应用GenesisⅡ假体进行全膝置换的近期疗效及其技术特点。方法 2 0 0 3年 6～ 9月 ,采用GenesisⅡ骨水泥人工假体对 2 8例 32膝行膝关节置换术。原发性膝骨关节炎 2 4膝、类风湿性关节炎 4膝、创伤性关节炎 3膝和痛风性关节炎 1膝。 17例 18膝应用CR假体 ;11例 14膝应用PS假体。 13例 15膝行髌骨表面置换术 ,其中 10膝采用嵌入式髌骨固定技术。结果 采用纽约特种外科膝关节评分 (HSS)法评估临床疗效 ,术前平均为 4 3分 ,术后 4周和 12周分别为 86和 92分 ;4周时优良 2 5膝 ,可 7膝 ;12周时优良 2 8膝 ,可4膝。术前平均膝关节屈伸活动度为 86° ,术后 4周和 12周分别为 115°和 12 0°。术后 2周内有轻度深静脉栓塞5例 ,所有患者均未出现早期感染、脱位等并发症。结论 近期疗效显示 ,GenesisⅡ膝关节假体因股骨后髁的不对称设计 ,安置时仅需中立位截骨 ,无需外旋 ,可有效避免放置后旋转对线不良 ;滑车沟为解剖型 ,活动时髌股完全接触 ,术后膝前痛明显改善。远期疗效尚需进一步观察。

Objective To report the short term outcome of total knee arthroplasty with Genesis Ⅱ and its technical characteristics. Methods From Jun. 2003 to Sep.2003, 28 patients underwent primary TKA with cemented Genesis Ⅱ prostheses in 32 knees. Twenty four knees were osteoarthritic, 4 rheumatoid, 3 posttraumatic and 1 gouty arthritis. CR prosthesis was used in 18 knees of 17 patients, and PS prosthesis in 14 knees of 11 patients. Patellar resurfacing was performed in 13 patients (13 knees) with inlay technique in 10. Results The Hospital for Knee Society (HSS) Scoring System was used to evaluate the clinical outcome. The mean value of the HSS score was 43 preoperatively, 86 at the 4 th postoperative week and 92 at the 12 th postoperative week. The followed up for 4 weeks after operation, the result was good in 25 knees and fair in 7, and the followed up for 12 weeks showed good in 28 and fair in 4. The mean motion range increased from 86° preoperatively to 115° and 120° at 4 and 12 weeks after operation, respectively. Deep vein thrombosis occurred in 5 patients two weeks postoperatively, but no complication as infection or dislocation occurred.Conclusion The short term clinical results show that Genesis Ⅱ with an asymmertrical design in its posterior condyles reguiring only neutrally positioned osteotomy instead of lateral rotation of 3° can, thus avoid malrotation alignment, Genesis Ⅱ possesses an anatomical trochlear groove with complete patellofemoral contact motion during can reduce the anterior knee pain much more postoperatively. Long term results need further observation.