摘要
背景:膝关节炎合并挛缩畸形限制了膝关节的活动度,严重影响患者的生活质量;而对该类患者进行全膝关节置换是否可以有效解决这一问题?目的:探讨膝关节炎合并挛缩畸形行全膝关节置换术后的疗效,同时总结挛缩等相关问题的处理。方法:本组患者50例,男30例,女20例;年龄60~75岁,平均69岁。膝关节骨关节炎25例,类风湿关节炎合并挛缩畸形17例,类风湿关节炎屈曲挛缩合并外翻畸形8例。对全膝关节置换中的截骨、挛缩组织松解、屈伸间隙不平衡、假体放置角度等问题的处理进行总结,并通过手术前后下肢机械轴、股骨外翻角、胫骨外翻角、活动度、KSS评分、WOMAC评分的对照分析,综合评价患者术后膝关节功能改善情况。结果:术后膝关节的挛缩畸形被矫正;类风湿关节炎合并挛缩畸形的膝关节前伸功能由术前155°±4°恢复至172°±7°,骨关节炎患者的膝关节前伸功能由术前170°±7°恢复至178°±5°;胫骨外翻角、KSS评分、WOMAC评分均具有统计学差异(P<0.05)。结论:对膝关节炎合并挛缩畸形进行全膝关节置换效果可靠,但应对全膝关节置换的软组织平衡等问题进行合理的处理,做到个体化诊治。
Background： Contracture gonarthritis limits the knee activity and seriously affects the life quality of patients. How is the efficacy of total knee arthroplasty （TKA） for contracture gonarthritis？ Objective：To evaluate the clinical out-come of TKA for contracture gonarthritis and to summarize the contracture-related problems. Methods：Fifty patients under-going TKA were enrolled in this study. There were 30 males and 20 females with a mean age of 69 years （range, 60-75 years）. There were 25 patients with knee osteoarthritis, 17 with rheumatoid arthritis in combination with contracture deformity, and 8 with rheumatoid arthritis in combination with flexion contracture and valgus deformity. Osteotomy, tissue release, gap imbalance and prosthetic alignment were explored. The mechanical axis, femoral valgus angle, tibial valgus an-gle, KSS score and WOMAC score were recorded before and after operation. Results：Contracture was corrected by TKA in all the patients. The postoperative protraction of knee joints in patients with rheumatoid arthritis in combination with contracture deformity was 172°±7°, which was significantly improved than preoperative one （155°±4°）. The postoperative protraction of knee joints in patients with knee osteoarthritis was 178°±5°, which was also significantly improved than preoperative one （170° ± 7° ）. There were significant differences in the tibial valgus angles, KSS score and WOMAC score before and after surgery （P〈0.05）. Conclusions：TKA is effective for contracture gonarthritis. Soft tissue balancing should be reasonably dealed with in TKA for individuation treatment.
出处
《中国骨与关节外科》
2017年第2期104-108,共5页
Chinese Journal of Bone and Joint Surgery
关键词
全膝关节置换
挛缩畸形
软组织平衡
活动度
胫骨外翻角
WOMAC评分
Total Knee Arthroplasty
Contracture Deformity
Soft Tissue Balancing
Range of Motion
Tibial Valgus An-gle
WOMAC Score
