| 晚期类风湿性关节炎合并屈膝位强直的人工全膝关节置换术 |
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Received:April 14, 2014
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| 作者 | Author | 单位 | Unit | E-Mail |
| 甄平 |
ZHEN Ping |
兰州军区兰州总医院全军骨科中心关节外科, 甘肃兰州 730050 |
Department of Orthopaedics, the General Hospital of PLA, Lanzhou 730050, Gansu, China |
zhenpingok@163.com |
| 李慎松 |
LI Shen-song |
兰州军区兰州总医院全军骨科中心关节外科, 甘肃兰州 730050 |
Department of Orthopaedics, the General Hospital of PLA, Lanzhou 730050, Gansu, China |
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| 李旭升 |
LI Xu-sheng |
兰州军区兰州总医院全军骨科中心关节外科, 甘肃兰州 730050 |
Department of Orthopaedics, the General Hospital of PLA, Lanzhou 730050, Gansu, China |
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| 任民 |
REN Min |
兰州军区兰州总医院全军骨科中心关节外科, 甘肃兰州 730050 |
Department of Orthopaedics, the General Hospital of PLA, Lanzhou 730050, Gansu, China |
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| 邵宏斌 |
SHAO Hong-bin |
兰州军区兰州总医院全军骨科中心关节外科, 甘肃兰州 730050 |
Department of Orthopaedics, the General Hospital of PLA, Lanzhou 730050, Gansu, China |
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| 期刊信息：《中国骨伤》2015年28卷，第3期，第272-275页 |
| DOI：10.3969/j.issn.1003-0034.2015.03.018 |
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目的:探讨重症类风湿性关节炎膝关节屈曲位强直患者行全膝关节置换的正确截骨及后关节囊软组织松解方法和疗效。
方法:对2009年11月至2012年1月收治的15例晚期类风湿性关节炎患者17个屈膝位强直的膝关节行人工膝关节表面置换手术。男7例,女8例;年龄22～75岁,平均58.7岁;单膝13例,双膝2例。15例17膝均表现为屈膝位纤维性强直或僵直畸形,膝关节屈伸活动度(3.2±1.7)°。术前膝关节学会评分系统(KSS)临床评分23.3±12.5,功能评分35.2±9.8.术中在准确截骨的基础上,对不同程度的膝关节屈曲强直畸形采取不同的后关节囊软组织松解方法。
结果:15例均获随访,时间1.6个月～3年,平均2.3年。末次随访时KSS 临床评分81.7±6.5,较术前提高;功能评分82.8±9.3,较术前提高。2例3膝遗留5°～7°屈膝畸形,但患膝关节功能良好。
结论:正确的截骨及有效的后关节囊软组织松解是矫正屈膝位强直畸形和假体置换的关键,其中有针对性的膝关节后房室结构松解的方法和步骤可避免过量截骨并获得满意的换膝间隙。 |
| [关键词]:关节炎,类风湿 膝关节 畸形 关节成形术,置换,膝 |
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| Posterior capsule releasing in total knee arthroplasty for patients with rheumatoid arthritis with stiff knees in flexion |
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Abstract:
Objective:To investigate the correct method of bone resection and posterior capsular soft tissue releasing in total knee arthroplasty(TKA) for the patients with rheumatoid arthritis with stiff knee in flexion.
Methods:From November 2009 to January 2012,15 patients with rheumatoid arthritis with stiff knee in flexion underwent primary TKA and releasing of the posterior soft tissues. There were 7 males and 8 females,aged 22 to 75 years old (58.7 years old on average). The preoperative range of movement(ROM) was (3.2±1.7)°。 According to Knee Society score (KSS) criterion,the preoperative clinical score was 23.3±12.5 and functional score was 35.2±9.8. Based on the correct osteotomy,effective releasing of posterior structures was used for different degrees of flexion contracture during the TKA procedure.
Results:All the patients were followed up,and the average duration was 2.3 years (1.6 to 3 years). At the latest follow-up,the KSS clinical score was 81.7±6.5 and functional score was 82.8±9.3. The flexion and extension ROM of the knee joint was (103.5±13.1)°。 Three knees remained 5° flexion contracture deformity,but the function of the affect knees was good.
Conclusion:The effective releasing of the soft tissue of posterior capsule is a major management for correction of the flexion contracture in TKA. The correct releasing of posterior structure can not only achieve fundamental gap of TKA but also effectively avoid bone over-resection. |
| KEYWORDS:Arthritis,rheumatoid Knee joint Abnormalities Arthroplasty,replacement,knee |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 甄平,李慎松,李旭升,任民,邵宏斌.晚期类风湿性关节炎合并屈膝位强直的人工全膝关节置换术[J].中国骨伤,2015,28(3):272~275 |
| 英文格式: | ZHEN Ping,LI Shen-song,LI Xu-sheng,REN Min,SHAO Hong-bin.Posterior capsule releasing in total knee arthroplasty for patients with rheumatoid arthritis with stiff knees in flexion[J].zhongguo gu shang / China J Orthop Trauma ,2015,28(3):272~275 |
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