摘要
[目的]探讨对重度膝关节畸形采用ACCK髁限制性假体行初次人工全膝关节置换术的初期临床疗效。[方法]回顾分析2014年1月~2014年9月采用ACCK髁限制性假体行初次人工膝关节置换术的18例重度膝关节畸形病例。男4例,女14例;平均年龄69.5岁（50~74岁）。左膝8例,右膝10例。病因：原发性骨关节炎8例,类风湿性关节炎7例,创伤性关节炎2例,夏科关节病1例。内翻畸形11例,外翻畸形7例。胫骨侧骨缺损,AORIⅠ型5例,Ⅱ型13例。记录手术时间,观察切口愈合及并发症发生情况,使用Gross方程评估围手术期失血量。记录术后X线髋膝踝角、冠状股骨角、冠状胫骨角和胫骨后倾角。随访期测量膝关节屈伸活动度,检测KSS评分。[结果]手术时间平均85 min（70~100 min）。围手术期平均失血量681.8 ml（440~1 360 ml）。术后髋膝踝角度平均为（179.8±1.5）°,冠状股骨角度平均为（89.7±1.4）°,冠状胫骨角平均为（90.1±1.5）°,胫骨后倾角平均为（6.6±1.5）°。18例获平均12.3个月随访（6~15个月）,切口均Ⅰ期愈合。在随访期内均无感染、髌骨骨折、骨溶解、假体松动、下肢力线改变等并发症。末次随访时膝关节屈伸活动度和膝关节KSS评分均显著优于术前,差异有统计学意义（P〈0.001）。[结论]在初次膝关节置换术中采用ACCK髁限制性假体治疗重度膝关节畸形的初期临床疗效较好。
[Objective] To evaluate the initial clinical outcomes of ACCK constrained condylar prosthesis for severe knee deformity. [Methods] A retrospective analysis was made on the clinical data of 18 severe deformity patients（ 18 knees） who received ACCK constrained condylar prosthesis for primary total knee arthroplasty between January 2014 and September2014. There were 4 males and 14 females,with average age of 69. 5 years（ range,50 ~ 74 years）. There were 8 left knees and10 right knees. The disease causes included osteoarthritis in 8 cases,rheumatoid arthritis in 7 cases,traumatic arthritis in 2 cases,and Charcot＇s arthropathy in 1 cases. Of them,there were 11 knees with varus deformity,and 7 knees with valgus deformity. The bone defect in tibial plateau was classified as AROI type I in 5 knees and type II in 13 knees. The operation time,the incision conditions and complications were recorded. Gross Equations was used to calculate the total blood loss in the perioperative period. The hip- knee- ankle angle（ HKA）,coronal femoral angle（ CFA）,coronal tibial angle（ CTA） and posterior tibial slope（ PTS） were observed through X- ray examination. The results were evaluated according to the range of motion（ ROM） of knee and the Knee Society Score（ KSS）. [Results] The average operation time was 85 minutes（ range,70 ~100 minutes）. The average volume of blood loss was 681. 8 ml（ range,440 ~ 1360ml）. The HKA,CFA,CTA and PTS were（ 179. 8 ± 1. 5） °,（ 89. 7 ± 1. 4） °,（ 90. 1 ± 1. 5） °,（ 6. 6 ± 1. 5） ° respectively. On the following 6 ~ 15 months（ mean,12. 3 months）,the incision in all patients had got primary healing. There were no infections,patella problems,osteolysis,prosthetic loosening,or limb alignment change. The results of ROM of knee and KSS scores at last follow- up were significantly better than preoperative ones,with significant difference（ P〈0. 001）. [Conclusion] The initial clinical outcome of primary total knee arthroplasty using ACCK constrained condylar prosthesis for severe knee deformity is satisfactory.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2015年第15期1368-1371,共4页
Orthopedic Journal of China
