CAJ | 학술논문

背景:随着新材料和新假体的出现和发展,全膝关节表面置换用于治疗骨性关节炎、类风湿性关节炎已经成为常规的手术方式.但仍然有许多问题困绕着术者. 目的:探讨人工膝关节置换术中如何选择合适的假体及手术中影响疗效的主要因素及对患者关节活动功能的影响.设计:自身前后对照研究.单位:西安交通大学第一医院骨科.对象:研究对象为2000-02/2003-09年西安交通大学第一医院骨科收治的36例实施了全膝关节置换术的患者.方法:回顾分析了36例实施全膝关节置换术患者的48膝,用美国JohnN Install评分系统评估膝关节功能,通过比较每个患膝在术前和术后的得分评定手术效果.主要结局观察:每个患膝在术前后的得分评定膝关节功能.结果:术前平均评分39分,随访后平均评分85分,优良率95%.术后疼痛减轻,关节伸屈功能和活动功能有明显的改善.结论:若人工全膝关节置换术中切除后交叉韧带,选用后稳定性假体,术后患者伸屈功能改善程度优于保留后交叉韧带术式,且手术简单,并发症少.术中的软组织力学平衡也是影响手术疗效的重要因素,膝关节周围组织应松解充分,否则将引起关节不稳或活动受限.围手术期采用抗凝治疗预防深静脉血栓形成及术后鼓励病员进行康复训练也是影响手术效果的重要环节.
배경:수착신재료화신가체적출현화발전,전슬관절표면치환용우치료골성관절염、류풍습성관절염이경성위상규적수술방식.단잉연유허다문제곤요착술자. 목적:탐토인공슬관절치환술중여하선택합괄적가체급수술중영향료효적주요인소급대환자관절활동공능적영향.설계:자신전후대조연구.단위:서안교통대학제일의원골과.대상:연구대상위2000-02/2003-09년서안교통대학제일의원골과수치적36례실시료전슬관절치환술적환자.방법:회고분석료36례실시전슬관절치환술환자적48슬,용미국JohnN Install평분계통평고슬관절공능,통과비교매개환슬재술전화술후적득분평정수술효과.주요결국관찰:매개환슬재술전후적득분평정슬관절공능.결과:술전평균평분39분,수방후평균평분85분,우량솔95%.술후동통감경,관절신굴공능화활동공능유명현적개선.결론:약인공전슬관절치환술중절제후교차인대,선용후은정성가체,술후환자신굴공능개선정도우우보류후교차인대술식,차수술간단,병발증소.술중적연조직역학평형야시영향수술료효적중요인소,슬관절주위조직응송해충분,부칙장인기관절불은혹활동수한.위수술기채용항응치료예방심정맥혈전형성급술후고려병원진행강복훈련야시영향수술효과적중요배절.
BACKGROUND: With the development of new materials and the improvement of prosthesis design, total knee arthroplasty(TKA), a commonly used surgery, has exhibited satisfying effect on the treatment of rheumatoid arthritis and osteoarthrosis. However, many problems still remain a headache to operation performers.OBJECTIVE: To discuss how to select the prosthesis for total knee replacement and to summarize the key factors that affect the curative effect.DESIGN: A controlled study of the effect before and after the operation.SETTING: Department of Orthopedics, First Hospital of Xi'an Jiaotong University.PARTICIPANTS: Thirty-six patients(24 males and 12 females) who received TKA in the Department of Orthopaedics, First Hospital of Xi'an Jiaotong University during February 2000 to September 2003 were included in this study.METHODS: A retrospective study was carried out. Thirty-six patients(48knees) underwent total knee replacement, and the knee joint function was evaluated with American John N Install scoring system. The post-operation effect was evaluated by comparing the scores of each diseased knee before and after the operation.MAIN OUTCOME MEASURES: The function of knees and the score of every knee before and after operation were evaluated.RESULTS: The mean score before operation was 39, but it was 85 after follow-up visit. Totally 95% of them were up to the standard. The pain was reduced after the operation. The flexion-extension function and mobility of the knee joints improved obviously.CONCLUSION: TKA with posterior stabilized prosthesis and resection of posterior cruciate ligament(PCL) improved the function of the diseased knees after the operation. And the operation was simple and without complications. The key factors that affect the curative effect include the mechanical balance of the soft tissues during the operation, perioperative anticoagulant treatment for the prevention of deep vein thrombosis(DVT) and postoperative rehabilitation training. Peripheral tissue of knee joints should be released adequately; otherwise, it may cause unstable joint or limitation of joint activity.