目的 比较不同强直位膝关节置换手术方式的临床疗效。方法 选取2009年1月—2015年3月采用膝关节表面置换术治疗的强直膝畸形患者80例(100膝),随机分为两组,分别施行传统膝关节置换术和膝关节置换配合胫骨结节截骨入路术,术后比较两组患者的X线片、膝关节活动度(ROM)、美国膝关节协会评分(KSS)和功能评分情况,并随访3个月。结果 两种手术方式对强直位膝关节置换均具明显效果。与传统膝关节置换术相比,膝关节置换配合胫骨结节截骨入路术术后ROM、KSS和功能评分值均较高(P<0.05),术后并发症及感染情况两组比较差异无统计学意义(P>0.05)。结论 膝关节置换配合胫骨结节截骨入路术临床效果明显,较常规膝关节置换术更佳,值得临床参考。
Objective To compare the clinical effects of different stiff knee replacement surgery methods.Methods From January 2009 to March 2015, 80 cases (100 knees) of ankylosis were randomized into two groups according to the knee replacement surgeries they received: traditional knee replacement and knee replacement with tibial tubercle osteotomy. X-ray images, the rang of motion (ROM), knee society score (KSS), and functional scores were compared between the two groups after operation and were followed up for 3 months.Results Both methods had significant effects on stiff knee replacement. Compared with traditional knee replacement, ROM, KSS, and functional scores after knee replacement with tibial tuberosity osteotomy were higher (P<0.05). Postoperative complications and infection rates were not different between the two groups (P>0.05).Conclusion Knee replacement combined with tibial tubercle osteotomy has a better effect than conventional knee replacement, which is worthy of clinical application.
[1] 白真龙,何耀华.医用壳聚糖与透明质酸钠关节腔内注射治疗膝骨关节炎的疗效比较[J].外科研究与新技术,2015,4(3):163-168.
[2] Zhou K, Ling T, Wang H, et al.Influence of tourniquet use in primary total knee arthroplasty with drainage:a prospective randomised controlled trial[J].J Orthop Surg Res,2017,12(1):172.
[3] Fan L, Xu T, Li X, et al.Morphologic features of the distal femur and tibia plateau in Southeastern Chinese population:A cross-sectional study[J].Medicine (Baltimore),2017,96(46):e8524.
[4] Akalan NE, Kuchimov S, Apti A, et al.Weakening iliopsoas muscle in healthy adults may induce stiff knee pattern[J].Acta Orthop Traumatol Turc,2016,50(6):642-648.
[5] 季磊,陶巍栋.全膝关节置换术髌骨旁内侧入路和股内侧肌下入路对比研究[J].实用骨科杂志,2016,22(8):678-682.
[6] 吕厚山,王东.全膝关节置换术中胫骨近端倾斜型骨缺损的重建[J].中华骨科杂志,2003,23(8):466-469.
[7] Inui H, Taketomi S, Yamagami R, et al.Twice cutting method reduces tibial cutting error in unicompartmental knee arthroplasty[J].Knee,2016,23(1):173-176.
[8] Bohinc K, Vantur N, Torkar D, et al.Knee stiffness and viscosity:New implementation and perspectives in prosthesis development[J].Bosn J Basic Med Sci,2017,17(2):164-171.
[9] Otto-Lambertz C, Yagdiran A, Wallscheid F, et al.Periprosthetic infection in joint replacement[J].Dtsch Arztebl Int,2017,114(20):347-353.
[10] 黄润华,尚希福,胡飞,等.人工全膝关节置换术治疗老年膝关节病变合并膝外翻畸形的疗效分析[J].临床骨科杂志,2017,20(3):310-313.
[11] 付映旭,胥伯勇,阿斯哈尔江·买买提依明,等.人工全髋关节置换术治疗中青年髋关节非功能位骨性强直[J].中国修复重建外科杂志,2014,28(9):1058-1061.
[12] Magnussen RA, Demey G, Lustig S, et al.Total knee arthroplasty for secondary osteoarthritis following ACL reconstruction: a matched-pair comparative study of intra-operative and early post-operative complications[J].Knee,2012,19(4):275-278.
[13] 冯宾,翁习生,林进,等.初次全膝关节置换术后并发症及翻修手术的原因分析[J].中华外科杂志,2015,53(2):106-109.
[14] Radulescu R, Badila A, Nutiu O, et al.Extended exposure in difficult total knee arthroplasty using tibial tubercle osteotomy[J].Maedica (Buchar),2013,8(4):380-383.