摘要
目的探讨影响人工全膝关节置换术患者术后屈膝的因素，以及获得相对最大屈曲度的技术。方法自2002年3月至2007年3月，85例患者102膝行高屈曲度人工全膝关节置换术（LPS—Flexkneearthroplasty，LF．KA），男16例17膝，女69例85膝；年龄35±79岁，平均64．9岁。膝关节骨关节炎94膝，类风湿关节炎8膝。膝内翻畸形82膝（平均12．8°±3．1°），膝外翻畸形7膝（平均5．1°±2．4°），屈曲畸形31膝（平均15．6°±4．9°）。骨缺损5膝。膝关节骨关节炎患者术前活动度为61°-135°，平均110．5°；类风湿关节炎患者为41°±120°，平均85．5°。手术均采用NexGen，LPS—Flex假体。临床疗效以HSS评分为标准，根据影像学资料评估膝关节假体位置、下肢力线以及骨缺损修复情况。结果66例81膝随访24-60个月，平均39个月。术前HSS平均（69．6±7.4）分，术后平均（90．9±4．8）分。优64膝，良11膝，中4膝，差2膝，优良率为92．6％。膝关节活动度由术前平均100．5°，改善至术中平均136．8°，终末随访时平均127．5°。结论膝关节活动度的改善对满足患者的日常生活需要尤为重要。患者术前活动度、手术技术、特殊的假体设计以及积极的术后锻炼都是实现全膝关节置换术后最大屈曲度的重要因素。但肥胖、有膝关节手术史、强直性脊柱炎等患者，人工全膝关节置换术后的活动度都会受到一定的限制。
Objective To explore the affective factors towards the patients knee flexion and the technique to obtain the most relative flexion degree after TKA （total knee arthroplasty）. Methods From March 2002 to March 2007, 85 patients （102 knees） underwent high flexion total knee arthroplasty, including 16 males 07 knees） and 69 females （85 knees） with the age range from 35 to 79 years （mean, 64.9 years）. Osteoarthritis occurred in 94 knees and Rheumatoid arthritis in 8 knees. 82 knees were complicated with varus deformity （mean, 12.8°±3.1°）, 7 knees with valgus deformity （mean, 5.1°±2.4°）, and 31 with flexion de- formity （mean, 15.6°±4.9°）. 5 knees suffered bone defect. The range of motion （ROM） in OA patients ranged from 61° to 135°,with the mean 110.5°, while in RA patients ranged 41° to 120° ,with the mean 85.5°. All the procedures used the NexGen prosthesis （Zimmer, LPS-Flex）. HSS scores were used to evaluate the clini- cal effect. Position of the prosthesis, alignment of the lower limb and the repair of bone defect were evaluated by X-ray. Results 66 cases （81 knees） were followed up with a mean period of 39 months （range, 24-60 months）. According to the HSS knee scoring system, the scores were 69.6±7.4 preoperative and 90.9±4.8 postoperative, respectively, including 64 knees rated as excellent, 11 as good, 4 as fair and 2 as poor. In this case the excellent-good rate was 92.6%. The knee ROM also increased fi＇om 100.5° before operation to 136.8° during operation and 127.5° after operation respectively. Conclusion The increase in the knee ROM is very important to improve the patients＂ quality of daily life after TKA, which is affected by the fol- lowing factors, such as ROM preoperative, thorough procedure, individualized prosthesis and rigorous reha- bilitation. But to the patients with obese, history of knee surgery or AS, postoperative ROM may be limited to some extent.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2008年第10期828-832,共5页
Chinese Journal of Orthopaedics
关键词
关节成形术
置换
膝
假体设计
活动范围
关节
Arthroplasty, replacement, knee
Prosthesis design
Range of motion, articular
