全膝关节置换治疗严重膝关节疾病.doc

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1、屮国纠织丁巴硏究»2013,Vol.17»Issue(9):1535-1542DOI:10.3969/j.issn.2095-4344.2013.09.003人工假体artificialprosthesis全膝关节置换治疗严重膝关节疾病Totalkneearthroplastyforthetreatmentofseverekneedisease全文：PDF(501KB)摘要背景：膝关节畸形施行人工全膝关节置换难度人，涉及血多，包扌舌手术入路、术屮截骨、软组织松解顺序、方法及程度、软组织平衡等，专家学者各不相同，意见不统一，争议较多。目的：探讨全膝关节置换治疗成人严重膝

2、关节疾病的手术方法和临床疗效。方法：纳入42例(48膝)严重膝关节疾病合并畸形患者，均采用后稳左型假体进行全膝关节置换,由離骨内侧入路，正确截骨，选择性的软组织松解，恢复膝关节止常的力线和软组织平衡,获得膝关节稳泄，置换后采取针对性的康复训练，左期随访检杳膝关节活动度、故大屈曲度并进行HSS评分、W0MAC评分。结果与结论：所有患者均获得随访，随访时间为25・84个月，平均35.5个月。所冇患者宣换治疗后膝关节活动度、膝关节最人屈曲度、HSS评分、W0MAC评分较置换前比较，均显箸提高，差异有显著性意义(Pv0.01)。置换后切口均I期愈合，无膝关节僵彼、血管及神经损

3、伤、離骨骨折、離骨低位、假体松动等并发症发生，下肢力线均恢复」F•常。说明成人严重膝关节畸形经全膝关节置换，置换示畸形均得到纠止，功能较前明显改善，临床效果满意。关键词:骨关节植入物;人I】假体;全膝关节置换;畸形;后稳定假体;软纽织平衡:截宜：膝关节活动度、瑕大屈曲度、HSS评分;W0MAC评分;狀骨骨折;假体松动;fflAbstract:BACKGROUND:Totalkneearthroplastyusedforthetreatmentofkneejointdeformityisdifficultandinvolvesmulti-aspects,includin

4、gthesurgicalapproach,intraoperativeosteotomy,order,methodandextentofsofttissuereleaseandsofttissuebalance,Therearealotofcontroversiesduetodifferentscholarlyopinions.OBJECTIVE:Toexplorethesurgicalmethodsandclinicalefficacyoftotalkneearthroplastyforthetreatmentofseverekneedisease.METHODS:

5、Atotalof42cases(48knees)withseverekneediseaseandkneejointdeformitywereselected,andallthepatientsweretreatedwithtotalkneearthroplastyusingposteriorstabilizedprosthesis・Throughpatellarmedialapproachandcorrectosteotomy,selectivesofttissuereleasewasperformedtorestorenormalkneealignmentandso

6、fttissuebalaneetoharvestkneestability.Thetargetedrehabilitationtrainingwasperformedafterreplacementandthekneerangeofmotionandmaximumkneeflexdegreeweredetectedregularly.TheHospitalforSpecialSurgeryscoreandtheWesternOntarioandMcmasterUniversitiesArthritisIndexscorewereperformed・RESULTSAND

7、CONCLUSION:Allpatientswerefollowed-upfor25to84months,35.5monthsinaverage・Thekneerangeofmotion,maximumkneeflexdegree,HospitalforSpecialSurgeryscoreandtheWesternOntarioandMcmasterUniversitiesArthritisIndexscoreofallthepatientsweresignificantlyincreasedafterreplacementcomparedwith