【作者】 陈涛；

【导师】 刘锋；

【作者基本信息】 南京医科大学 ， 骨科学， 2011， 硕士

【摘要】 目的:回顾总结高屈曲型假体置换治疗膝关节骨关节炎的临床疗效。方法:对南京医科大学第一附属医院关节外科自2005年1月至2007年12月之间,因膝关节骨关节炎采用高屈曲型假体(Nexgen- LPS- FLEX)施行的初次膝关节置换病例进行随访,共随访182例(258膝)。对术前和随访时患者的膝关节HSS评分、功能评分和疼痛评分,膝关节活动度,膝关节X线片,患者满意度以及出现的各种并发症等进行总结和分析,并对髌骨置换与否的临床效果进行比较。随访结果使用SPSS17.0统计软件包进行统计学分析。结果:实际随访到170例(237膝),随访率为93.41%。平均随访52.12月(36～60月)。膝关节HSS评分从术前平均40.28分(16～78分)增加到末次随访时的85.31分(69～98分)(P<0.05),优良率为88.82%。膝关节功能和疼痛评分分别由术前的8.6分( 0～19分)和13.6分( 5～23分)增加到17.6分(14～22分)和25.3分(18～30分)(P<0.05)。术前膝关节最大屈曲度平均为98.2°(10°～112.5°),末次随访时为130.8°(105.5°～138°) (P<0.05)。膝关节活动度也有明显改善。81.18%的患者对治疗效果满意。术后有28例(35膝)(16.43%)遗留不同程度的膝前痛。10例(13膝)(5.88%)残留≥5°的屈曲畸形。2例(2膝)(1.18%)术后发生下肢深静脉血栓,其中1例继发肺栓塞。2例(2膝)(1.18%)发生迟发性感染。2例(2膝)(1.18%)发生胫骨假体无菌性松动。1例假体周围出现无症状非进展性透亮线。其余膝关节假体位置及力线良好,股骨、胫骨以及髌骨假体周围无松动。结论:高屈曲型假体置换术治疗膝关节骨关节炎总体疗效满意,能提高患者的生活质量,改善关节功能,有效缓解疼痛。对晚期膝关节骨关节炎患者来说。膝关节置换术是一个较好的选择。更多还原

【Abstract】 Objective:To analyse and summarize the clinical results of total knee arthroplasty (TKA) on knee osteoarthritis(OA) retrospectively.Methods:182 patients (258 knees) with OA accepted primary total knee arthroplasty (TKA) with Nexgen-LPS-FLEX prosthesis between January 2005 and December 2007 from the First Affiliated Hospital of Nanjing Medical University were followed-up. The scores of knee HSS, pain and function, range of motion (ROM), post-operative x-rays of the knees, patients’satisfaction rate and the complications were evaluated. And the results of patellar retention or resurfacing were compared. The data were analyzed with SPSS 17.0 software.Results:Out of 182 patients (258 knees), 170cases (237 knees) had been followed up for an average of 52.12 months(ranged, 36~60 months) with a visted rate of 93.41%. The scores of HSS, function and pain increased respectively from 40.28 points(ranged, 16～78 points), 8.6 points(ranged, 0-19 points) and 13.6 points(ranged, 5～23 points) preoperatively to 85.3 points(ranged, 69-98 points), 17.6 points(ranged, 14-22 points) and 25.3 points(ranged, 18-30 points) (P<0.05) at the final followed-up. The excellent and good rate of knee HSS scores was 88.82%. Maximum degree of flexion increased from 98.2degrees(ranged, 10～112.5 degrees) to 130.8degrees(ranged, 105.5～138 degrees) (P<0.05), and the range of motion(ROM) were improved significantly. Patients’ satisfactory rate was 81.18%. There was anterior knee pain remained in 28cases (35 knees)(16.43%) after the surgeries. Flexion deformity of greater than or equal to 5°was occurred in 10cases(13knees)(5.89%) and the deep vein thrombosis(DVT) occurred in 2 cases(2 knees)(1.18%), delayed infection in 2 cases(2 knees)(1.18%) and aseptic loosening of tibial components in 2 cases(2 knees)(1.18%). The asymptomatic, unprogressive periprosthetic lucent line was found in the X-ray film in one case. The position of the components and the alignment of the lower extremity were good.Conclusion:Total knee arthroplasty(TKA) used in the treatment of patients with knee OA has a good effect as a whole, which can significantly improve the life quality and the function of knee joint, ease the pain effectively. TKA is a good chioce for the patients’ with OA knees.更多还原