目的探讨晚期类风湿关节炎(RA)伴重度膝外翻畸形和严重骨质疏松患者膝关节置换术假体选择及临床效果。方法选取2008—2014年兰州军区总医院全军骨科中心关节外科采用髌旁内侧入路、常规截骨加单纯外侧软组织松解方法治疗晚期RA伴重度膝...目的探讨晚期类风湿关节炎(RA)伴重度膝外翻畸形和严重骨质疏松患者膝关节置换术假体选择及临床效果。方法选取2008—2014年兰州军区总医院全军骨科中心关节外科采用髌旁内侧入路、常规截骨加单纯外侧软组织松解方法治疗晚期RA伴重度膝外翻畸形和严重骨质疏松患者27例(32膝)。18例(20膝)采用不保留后十字韧带型后稳定型常规假体:Nex Gen HF-Flex常规膝(后稳定型组),9例(12膝)采用Nex Gen HF-Flex常规膝+延长杆(后稳定型+延长杆组)。采用术前及末次随访时膝关节屈曲挛缩、关节活动度、股胫角等评价手术效果。结果手术时间60~120 min,平均75 min。随访时间2.0~7.5年,平均4.9年。后稳定型组和后稳定型+延长杆组末次随访时膝关节屈曲挛缩较术前减少、关节活动度较术前提高(P<0.05)。术前及末次随访时,后稳定型组与后稳定型+延长杆组膝关节屈曲挛缩、关节活动度比较,差异均无统计学意义(P>0.05)。所有患者外翻畸形得到纠正,后稳定型组和后稳定型+延长杆组末次随访时股胫角较术前减小(P<0.05)。术前及末次随访时,后稳定型组与后稳定型+延长杆组股胫角比较,差异均无统计学意义(P>0.05)。术后3例(3膝)有膝关节外侧不稳症状,给予膝关节支具保护;2例(3膝)术后1个月出现下肢静脉血栓,给予放置下腔静脉滤网;1例(1膝)术后发生腓总神经麻痹。其余患者随访期间未发生假体感染、假体周围骨折、异位骨化、假体松动及外翻等术后并发症。结论对晚期RA伴重度膝外翻畸形和严重骨质疏松患者在假体选择方面,后稳定型假体与后稳定型假体+延长杆在纠正外翻屈曲畸形、关节活动度和股胫角疗效等方面,未见差异,所有患者近期疗效满意,但对于此类患者而言,后稳定型假体+延长杆组稳定性较好,受RA病程进展影响较低。展开更多
Objective: Report of risk factors associated to knee osteoarthritis to improve management and functional prognosis of patients. Methods and patients: Transversal and analytic survey conducted in Brazzaville University...Objective: Report of risk factors associated to knee osteoarthritis to improve management and functional prognosis of patients. Methods and patients: Transversal and analytic survey conducted in Brazzaville University Teaching Hospital (Congo) on 13,041 patients between 2000 and 2012. The diagnosis of knee osteoarthritis was done before a mechanical knee pain and radiological signs according to Kellgren and Lawrence criterias. The functional disability has been appreciated by Lequesne functional pain rate. Results: 200 patients, 42 men (21%), 158 women (79%), sex ratio was 0.26. The average age was 57.4 years old, extremes were 25 - 82 years. The knee osteoarthritis predominated between 60 and 69 years for men (38%) and 50 - 59 years old for women (36%). Body mass index (BMI) average was 29.98 kg/m2. Co morbidities associated were arterial high blood pressure in 106 patients (53%) and diabetes mellitus (28.5%) and alcohol consumption (28%). Tobacco addiction was associated in 12%. 72.15% of women were post-menopausal, with an average length of menopause at 9.6 years. Obesity (45.5%) and overweight (35.5%) were associated with genu varum in 58.7% and genu valgum in 40.1%. Joint fluid was report in 30.5%. The functional disability evaluated by Lequesne functional pain rate was superior to 8 for more of 50% of patients. The knee osteoarthritis was mainly secondary in 81%. Conclusion: Age more than 57 years, female sex and menopause, obesity, genu varum or genu valgum, cardiovascular risk factors, were the main risk factors associated. Diagnosis was done too later and patients had an improvement functional disability.展开更多
Coronal plane deformity around the knee,also known as genu varum or genu valgum,is a common finding in clinical practice for pediatricians and orthopedists.These deformities can be physiological or pathological.If unt...Coronal plane deformity around the knee,also known as genu varum or genu valgum,is a common finding in clinical practice for pediatricians and orthopedists.These deformities can be physiological or pathological.If untreated,pathological deformities can lead to abnormal joint loading and a consequent risk of premature osteoarthritis.The aim of this review is to provide a framework for the diagnosis and management of genu varum and genu valgum in skeletally immature patients.展开更多
文摘目的探讨晚期类风湿关节炎(RA)伴重度膝外翻畸形和严重骨质疏松患者膝关节置换术假体选择及临床效果。方法选取2008—2014年兰州军区总医院全军骨科中心关节外科采用髌旁内侧入路、常规截骨加单纯外侧软组织松解方法治疗晚期RA伴重度膝外翻畸形和严重骨质疏松患者27例(32膝)。18例(20膝)采用不保留后十字韧带型后稳定型常规假体:Nex Gen HF-Flex常规膝(后稳定型组),9例(12膝)采用Nex Gen HF-Flex常规膝+延长杆(后稳定型+延长杆组)。采用术前及末次随访时膝关节屈曲挛缩、关节活动度、股胫角等评价手术效果。结果手术时间60~120 min,平均75 min。随访时间2.0~7.5年,平均4.9年。后稳定型组和后稳定型+延长杆组末次随访时膝关节屈曲挛缩较术前减少、关节活动度较术前提高(P<0.05)。术前及末次随访时,后稳定型组与后稳定型+延长杆组膝关节屈曲挛缩、关节活动度比较,差异均无统计学意义(P>0.05)。所有患者外翻畸形得到纠正,后稳定型组和后稳定型+延长杆组末次随访时股胫角较术前减小(P<0.05)。术前及末次随访时,后稳定型组与后稳定型+延长杆组股胫角比较,差异均无统计学意义(P>0.05)。术后3例(3膝)有膝关节外侧不稳症状,给予膝关节支具保护;2例(3膝)术后1个月出现下肢静脉血栓,给予放置下腔静脉滤网;1例(1膝)术后发生腓总神经麻痹。其余患者随访期间未发生假体感染、假体周围骨折、异位骨化、假体松动及外翻等术后并发症。结论对晚期RA伴重度膝外翻畸形和严重骨质疏松患者在假体选择方面,后稳定型假体与后稳定型假体+延长杆在纠正外翻屈曲畸形、关节活动度和股胫角疗效等方面,未见差异,所有患者近期疗效满意,但对于此类患者而言,后稳定型假体+延长杆组稳定性较好,受RA病程进展影响较低。
文摘Objective: Report of risk factors associated to knee osteoarthritis to improve management and functional prognosis of patients. Methods and patients: Transversal and analytic survey conducted in Brazzaville University Teaching Hospital (Congo) on 13,041 patients between 2000 and 2012. The diagnosis of knee osteoarthritis was done before a mechanical knee pain and radiological signs according to Kellgren and Lawrence criterias. The functional disability has been appreciated by Lequesne functional pain rate. Results: 200 patients, 42 men (21%), 158 women (79%), sex ratio was 0.26. The average age was 57.4 years old, extremes were 25 - 82 years. The knee osteoarthritis predominated between 60 and 69 years for men (38%) and 50 - 59 years old for women (36%). Body mass index (BMI) average was 29.98 kg/m2. Co morbidities associated were arterial high blood pressure in 106 patients (53%) and diabetes mellitus (28.5%) and alcohol consumption (28%). Tobacco addiction was associated in 12%. 72.15% of women were post-menopausal, with an average length of menopause at 9.6 years. Obesity (45.5%) and overweight (35.5%) were associated with genu varum in 58.7% and genu valgum in 40.1%. Joint fluid was report in 30.5%. The functional disability evaluated by Lequesne functional pain rate was superior to 8 for more of 50% of patients. The knee osteoarthritis was mainly secondary in 81%. Conclusion: Age more than 57 years, female sex and menopause, obesity, genu varum or genu valgum, cardiovascular risk factors, were the main risk factors associated. Diagnosis was done too later and patients had an improvement functional disability.
文摘Coronal plane deformity around the knee,also known as genu varum or genu valgum,is a common finding in clinical practice for pediatricians and orthopedists.These deformities can be physiological or pathological.If untreated,pathological deformities can lead to abnormal joint loading and a consequent risk of premature osteoarthritis.The aim of this review is to provide a framework for the diagnosis and management of genu varum and genu valgum in skeletally immature patients.
