This study aimed to examine the clinical and radiographic outcomes of primary total knee arthroplasy（TKA） with use of Nex Gen#174; Legacy#174; Constrained Condylar Knee（CCK） prosthesis for severe knee deformity. C...This study aimed to examine the clinical and radiographic outcomes of primary total knee arthroplasy（TKA） with use of Nex Gen#174; Legacy#174; Constrained Condylar Knee（CCK） prosthesis for severe knee deformity. Clinical data of 46 patients（48 knees in total, aged 61 years on average） with severe knee deformity who underwent TKA with Nex Gen#174; Legacy#174; CCK prosthesis between December 2007 and February 2012 were retrospectively analyzed. There were 34 knees with severe valgus with incompetent medial collateral ligament, 11 knees with severe flexion contracture with inability to achieve knee balancing in flexion and extension by posterior soft tissue release, 2 knees with Charcot arthritis with severe varus and bone loss, and 1 with traumatic osteoarthritis with severe varus and ligamentous instability. The mean duration of follow-up was 71 months（range 40–90 months）. The New Knee Society scoring（NKSS） system and the Hospital for Special Surgery（HSS） score were used to evaluate the functional and clinical outcomes. Visual Analogue Scale（VAS） was used for pain measurement and Knee Society criteria for evaluation of radiological images. The results showed that, in the total 48 knees, 1 case of loosening due to short-stem tibial component at 3 months post-operatively underwent revision. The 6-year prosthesis survival rate in this cohort was 97.9%. There was no component infection occurring within 6 years. Significant post-operative improvements were found in NKSS and HSS scores. Patient satisfaction was significantly increased. Pain score was decreased significantly. Total functional score was improved from 31.46±11.43 to 86.42±8.87, range of motion（ROM） from 42.42°±23.57° to 95.31°±23.45° and the flexion contracture from 5.31°±7.87° to 0.92°±1.80°. Preoperative radiographic study showed excessive valgus（≥7°） in 37 knees, and varus deformity in 3 knees. Post-operative femorotibial alignment was valgus 3.88°±1.76° in 48 knees. Antero/posterior（A/P） view of X-ray films showed 4 radiolucent lines（RLL） in 48 tibial components. It was concluded that TKA with CCK is effective for the treatment of the severe unstable knee that cannot be balanced by soft tissue.展开更多
目的:探讨利伐沙班联合中药熏洗治疗全膝关节置换术后患者瘀斑的临床疗效。方法:选取74例全膝关节置换术后瘀斑患者,随机分为观察组和对照组,每组37例。对照组给予利伐沙班治疗,观察组在对照组基础上进行中药熏洗治疗。比较两组瘀斑面...目的:探讨利伐沙班联合中药熏洗治疗全膝关节置换术后患者瘀斑的临床疗效。方法:选取74例全膝关节置换术后瘀斑患者,随机分为观察组和对照组,每组37例。对照组给予利伐沙班治疗,观察组在对照组基础上进行中药熏洗治疗。比较两组瘀斑面积、肿胀程度、皮温、疼痛视觉模拟评分(visual analogue scale,VAS)、炎症因子水平、美国特种外科医院膝关节评分(the hospital for special surgery,HSS)、临床疗效、不良反应、血红蛋白(hemoglobin,Hb)及尿白蛋白(urine albumin,Alb)水平。结果:与对照组比较,观察组治疗后瘀斑面积、皮温、肿胀程度评分、VAS评分、C反应蛋白水平、一氧化碳水平更低(P<0.05),HSS评分更高(P<0.05),Hb与Alb水平差异无统计学意义(P>0.05)。观察组总有效率[97.3%(36/37)]高于对照组[81.1%(30/37)](P<0.05);观察组不良反应发生率[2.7%(1/37)]低于对照组[18.9%(7/37)](P<0.05)。结论:采用利伐沙班联合中药熏洗治疗全膝关节置换术后瘀斑患者,可降低肿胀及疼痛程度,维持正常皮温,降低炎症因子水平,提高临床疗效,降低不良反应发生率。展开更多
目的分析膝前后联合入路手术治疗复杂过伸型胫骨平台骨折的安全性与有效性。方法2015年2月~2020年2月我院创伤骨科收治的复杂过伸型胫骨平台骨折病人92例,联合组48例,接受膝前后联合入路手术治疗,正中组44例,接受传统膝前正中入路手术...目的分析膝前后联合入路手术治疗复杂过伸型胫骨平台骨折的安全性与有效性。方法2015年2月~2020年2月我院创伤骨科收治的复杂过伸型胫骨平台骨折病人92例,联合组48例,接受膝前后联合入路手术治疗,正中组44例,接受传统膝前正中入路手术治疗。比较两组病人围手术期情况、随访期指标及影像学指标。结果联合组病人术中出血量、射线曝光时间、术后引流量及住院时间等围手术期指标均低于正中组,差异有统计学意义(P<0.05)。末次随访时,联合组病人的不良反应发生率低于正中组,差异有统计学意义(6.82%vs.13.16%,P<0.05)。术后3个月及末次随访时,联合组和正中组膝关节美国特种外科医院(hospital for special surgery,HSS)评分分别为(64.57±0.47)分和(56.39±0.46)分,Rasmussen评分分别为(16.42±0.46)分和(12.39±0.41)分,两组比较差异有统计学意义(P<0.05);末次随访时,联合组和正中组病人内翻角分别为(84.16±4.89)°和(89.14±6.78)°,股胫角分别为(176.64±4.21)°和(167.65±3.83)°,后倾角分别为(11.54±0.79)°和(9.65±0.83)°,两组比较差异有统计学意义(P<0.05)。结论联合入路手术治疗复杂过伸型胫骨平台骨折在恢复膝关节功能、缓解疼痛症状、促进骨折愈合、尽可能避免手术创伤对康复的影响等方面具有满意的疗效。展开更多
目的观察耳穴疗法用于全膝关节置换术围手术期镇痛的效果。方法选择ASAⅠ～Ⅲ级行单侧全膝关节置换骨性关节炎患者60例,随机分为耳穴镇痛组和对照组,每组30例,所有患者手术均由同一组医师施行,实施气管插管全身麻醉。耳穴镇痛组患者术...目的观察耳穴疗法用于全膝关节置换术围手术期镇痛的效果。方法选择ASAⅠ～Ⅲ级行单侧全膝关节置换骨性关节炎患者60例,随机分为耳穴镇痛组和对照组,每组30例,所有患者手术均由同一组医师施行,实施气管插管全身麻醉。耳穴镇痛组患者术前用王不留行籽按压耳穴配合术后患肢局部穴位敷贴镇痛,对照组采用常规治疗,两组患者均术前1天口服塞来昔布400 mg,术后口服塞来昔布每日2次,每次200 mg。当视觉模拟评分(visual analogue scales,VAS)>7分时,予盐酸布桂嗪0.1 g补救。术后两组采用相同的锻炼方法。记录静息时的VAS评分,镇静满意度,发生不良反应情况,术后膝关节活动度(range of motion,ROM)及美国特种外科医院膝关节评分(hospital for special surgery scores,HSS)。结果耳穴镇痛组患者术后6、24 h的静息VAS疼痛评分分别为(5.99±0.67)、(4.26±0.59)分,均明显低于对照组患者(7.02±0.85,4.92±0.43,P<0.01);两组患者术后1、48 h VAS评分差异无统计学意义(P>0.05);两组患者镇静满意程度总体相似;与对照组比较,耳穴镇痛组患者并发症发生率减少,但差异无统计学意义(4:11,P>0.05);ROM和HSS评分方面,耳穴镇痛组术前ROM为75.63°±5.74°,对照组术前ROM为75.43°±5.63°,差异无统计学意义(P>0.05);耳穴镇痛组术后2周主动与被动ROM分别为96.50°±3.79°、107.8°±3.37°,对照组分别为93.50°±3.50°、105.27°±3.25°,均有统计学意义(P<0.05);耳穴镇痛组术前HSS评分为(60.23±3.44)分,对照组为(61.70±2.83)分,差异无统计学意义(P>0.05);术后HSS评分分别为(86.97±2.33)、(85.37±2.30)分,差异有统计学意义(P<0.05)。结论膝关节置换术围手术期配合应用耳穴疗法有助于减轻患者的术后疼痛,减少术后总的麻醉剂使用量,有助于患者的早期康复,同时有着费用低、并发症少、操作简单、安全的优点。展开更多
目的确定膝骨关节炎患者全膝关节置换后美国特种外科医院膝关节评分(hospital for special surgery knee score,HSS)的最小临床重要差异(minimal clinically important difference,MCID)。方法回顾性分析2017年1月-2018年6月解放军总医...目的确定膝骨关节炎患者全膝关节置换后美国特种外科医院膝关节评分(hospital for special surgery knee score,HSS)的最小临床重要差异(minimal clinically important difference,MCID)。方法回顾性分析2017年1月-2018年6月解放军总医院第一医学中心关节外科诊断为膝骨关节炎并行单侧全膝关节置换治疗的患者。记录患者术前HSS评分、术后1年的HSS评分及术后1年满意度调查结果。采用锚法(Anchor-based approach)将患者满意度作为分组指标,简单线性回归分析确定HSS评分的MCID。结果413例患者的平均年龄(66.0±7.8)岁,男性93例(22.5%),女性320例(77.5%)。全膝关节置换后1年HSS评分平均提高34.33分(95%CI:33.11~35.54)。术后1年满意度评价极其满意59例,非常满意131例,满意177例,一般34例,不满意/糟糕12例;各组患者术前和术后1年HSS评分均有改变:极其满意组44.96(95%CI:42.51~47.41),非常满意组38.44(95%CI:36.74~40.14),比较满意组32.26(95%CI:30.71~33.81),一般组20.45(95%CI:17.35~23.55),不满意/糟糕组8.08(95%CI:2.83~13.34)。HSS评分的MCID为9.18(95%CI:6.37~11.98)。结论本研究确定了膝骨关节炎患者全膝关节置换后HSS评分的最小临床重要差异为9.18分,建议膝骨关节炎患者全膝关节置换治疗1年后HSS评分变化高于此分数作为有临床意义的评价阈值。展开更多
基金supported by a grant from the National Nature Science Foundation of China(No.81371973)
文摘This study aimed to examine the clinical and radiographic outcomes of primary total knee arthroplasy（TKA） with use of Nex Gen#174; Legacy#174; Constrained Condylar Knee（CCK） prosthesis for severe knee deformity. Clinical data of 46 patients（48 knees in total, aged 61 years on average） with severe knee deformity who underwent TKA with Nex Gen#174; Legacy#174; CCK prosthesis between December 2007 and February 2012 were retrospectively analyzed. There were 34 knees with severe valgus with incompetent medial collateral ligament, 11 knees with severe flexion contracture with inability to achieve knee balancing in flexion and extension by posterior soft tissue release, 2 knees with Charcot arthritis with severe varus and bone loss, and 1 with traumatic osteoarthritis with severe varus and ligamentous instability. The mean duration of follow-up was 71 months（range 40–90 months）. The New Knee Society scoring（NKSS） system and the Hospital for Special Surgery（HSS） score were used to evaluate the functional and clinical outcomes. Visual Analogue Scale（VAS） was used for pain measurement and Knee Society criteria for evaluation of radiological images. The results showed that, in the total 48 knees, 1 case of loosening due to short-stem tibial component at 3 months post-operatively underwent revision. The 6-year prosthesis survival rate in this cohort was 97.9%. There was no component infection occurring within 6 years. Significant post-operative improvements were found in NKSS and HSS scores. Patient satisfaction was significantly increased. Pain score was decreased significantly. Total functional score was improved from 31.46±11.43 to 86.42±8.87, range of motion（ROM） from 42.42°±23.57° to 95.31°±23.45° and the flexion contracture from 5.31°±7.87° to 0.92°±1.80°. Preoperative radiographic study showed excessive valgus（≥7°） in 37 knees, and varus deformity in 3 knees. Post-operative femorotibial alignment was valgus 3.88°±1.76° in 48 knees. Antero/posterior（A/P） view of X-ray films showed 4 radiolucent lines（RLL） in 48 tibial components. It was concluded that TKA with CCK is effective for the treatment of the severe unstable knee that cannot be balanced by soft tissue.
文摘目的:探讨利伐沙班联合中药熏洗治疗全膝关节置换术后患者瘀斑的临床疗效。方法:选取74例全膝关节置换术后瘀斑患者,随机分为观察组和对照组,每组37例。对照组给予利伐沙班治疗,观察组在对照组基础上进行中药熏洗治疗。比较两组瘀斑面积、肿胀程度、皮温、疼痛视觉模拟评分(visual analogue scale,VAS)、炎症因子水平、美国特种外科医院膝关节评分(the hospital for special surgery,HSS)、临床疗效、不良反应、血红蛋白(hemoglobin,Hb)及尿白蛋白(urine albumin,Alb)水平。结果:与对照组比较,观察组治疗后瘀斑面积、皮温、肿胀程度评分、VAS评分、C反应蛋白水平、一氧化碳水平更低(P<0.05),HSS评分更高(P<0.05),Hb与Alb水平差异无统计学意义(P>0.05)。观察组总有效率[97.3%(36/37)]高于对照组[81.1%(30/37)](P<0.05);观察组不良反应发生率[2.7%(1/37)]低于对照组[18.9%(7/37)](P<0.05)。结论:采用利伐沙班联合中药熏洗治疗全膝关节置换术后瘀斑患者,可降低肿胀及疼痛程度,维持正常皮温,降低炎症因子水平,提高临床疗效,降低不良反应发生率。
文摘目的分析膝前后联合入路手术治疗复杂过伸型胫骨平台骨折的安全性与有效性。方法2015年2月~2020年2月我院创伤骨科收治的复杂过伸型胫骨平台骨折病人92例,联合组48例,接受膝前后联合入路手术治疗,正中组44例,接受传统膝前正中入路手术治疗。比较两组病人围手术期情况、随访期指标及影像学指标。结果联合组病人术中出血量、射线曝光时间、术后引流量及住院时间等围手术期指标均低于正中组,差异有统计学意义(P<0.05)。末次随访时,联合组病人的不良反应发生率低于正中组,差异有统计学意义(6.82%vs.13.16%,P<0.05)。术后3个月及末次随访时,联合组和正中组膝关节美国特种外科医院(hospital for special surgery,HSS)评分分别为(64.57±0.47)分和(56.39±0.46)分,Rasmussen评分分别为(16.42±0.46)分和(12.39±0.41)分,两组比较差异有统计学意义(P<0.05);末次随访时,联合组和正中组病人内翻角分别为(84.16±4.89)°和(89.14±6.78)°,股胫角分别为(176.64±4.21)°和(167.65±3.83)°,后倾角分别为(11.54±0.79)°和(9.65±0.83)°,两组比较差异有统计学意义(P<0.05)。结论联合入路手术治疗复杂过伸型胫骨平台骨折在恢复膝关节功能、缓解疼痛症状、促进骨折愈合、尽可能避免手术创伤对康复的影响等方面具有满意的疗效。
文摘目的观察耳穴疗法用于全膝关节置换术围手术期镇痛的效果。方法选择ASAⅠ～Ⅲ级行单侧全膝关节置换骨性关节炎患者60例,随机分为耳穴镇痛组和对照组,每组30例,所有患者手术均由同一组医师施行,实施气管插管全身麻醉。耳穴镇痛组患者术前用王不留行籽按压耳穴配合术后患肢局部穴位敷贴镇痛,对照组采用常规治疗,两组患者均术前1天口服塞来昔布400 mg,术后口服塞来昔布每日2次,每次200 mg。当视觉模拟评分(visual analogue scales,VAS)>7分时,予盐酸布桂嗪0.1 g补救。术后两组采用相同的锻炼方法。记录静息时的VAS评分,镇静满意度,发生不良反应情况,术后膝关节活动度(range of motion,ROM)及美国特种外科医院膝关节评分(hospital for special surgery scores,HSS)。结果耳穴镇痛组患者术后6、24 h的静息VAS疼痛评分分别为(5.99±0.67)、(4.26±0.59)分,均明显低于对照组患者(7.02±0.85,4.92±0.43,P<0.01);两组患者术后1、48 h VAS评分差异无统计学意义(P>0.05);两组患者镇静满意程度总体相似;与对照组比较,耳穴镇痛组患者并发症发生率减少,但差异无统计学意义(4:11,P>0.05);ROM和HSS评分方面,耳穴镇痛组术前ROM为75.63°±5.74°,对照组术前ROM为75.43°±5.63°,差异无统计学意义(P>0.05);耳穴镇痛组术后2周主动与被动ROM分别为96.50°±3.79°、107.8°±3.37°,对照组分别为93.50°±3.50°、105.27°±3.25°,均有统计学意义(P<0.05);耳穴镇痛组术前HSS评分为(60.23±3.44)分,对照组为(61.70±2.83)分,差异无统计学意义(P>0.05);术后HSS评分分别为(86.97±2.33)、(85.37±2.30)分,差异有统计学意义(P<0.05)。结论膝关节置换术围手术期配合应用耳穴疗法有助于减轻患者的术后疼痛,减少术后总的麻醉剂使用量,有助于患者的早期康复,同时有着费用低、并发症少、操作简单、安全的优点。
文摘目的确定膝骨关节炎患者全膝关节置换后美国特种外科医院膝关节评分(hospital for special surgery knee score,HSS)的最小临床重要差异(minimal clinically important difference,MCID)。方法回顾性分析2017年1月-2018年6月解放军总医院第一医学中心关节外科诊断为膝骨关节炎并行单侧全膝关节置换治疗的患者。记录患者术前HSS评分、术后1年的HSS评分及术后1年满意度调查结果。采用锚法(Anchor-based approach)将患者满意度作为分组指标,简单线性回归分析确定HSS评分的MCID。结果413例患者的平均年龄(66.0±7.8)岁,男性93例(22.5%),女性320例(77.5%)。全膝关节置换后1年HSS评分平均提高34.33分(95%CI:33.11~35.54)。术后1年满意度评价极其满意59例,非常满意131例,满意177例,一般34例,不满意/糟糕12例;各组患者术前和术后1年HSS评分均有改变:极其满意组44.96(95%CI:42.51~47.41),非常满意组38.44(95%CI:36.74~40.14),比较满意组32.26(95%CI:30.71~33.81),一般组20.45(95%CI:17.35~23.55),不满意/糟糕组8.08(95%CI:2.83~13.34)。HSS评分的MCID为9.18(95%CI:6.37~11.98)。结论本研究确定了膝骨关节炎患者全膝关节置换后HSS评分的最小临床重要差异为9.18分,建议膝骨关节炎患者全膝关节置换治疗1年后HSS评分变化高于此分数作为有临床意义的评价阈值。
