CAJ | 학술논문

背景:全膝置换术(total knee arthroplasty,TKA)中熟练掌握胫骨假体置放的正确位置,是术后患者膝关节功能恢复的重要影响因素.目的:探讨人工全膝关节置换术中胫骨假体放置的点、线、面定位及其相互关系,以提高手术后患肢膝关节功能和关节稳定性.设计:前后对照研究.单位:一所大学医院骨科的病房.对象:1999-05/2004-09徐州医学院附属医院骨科收治的严重骨关节病及类风湿性关节炎需行膝关节置换患者12例,男4例,女8例;双侧膝置换1例,单侧置换11例;左膝关节4个,右膝关节9个.方法:按标准手术方法手术,着重胫骨假体的放置兼顾点、线、面定位及其相互关系.于手术前后进行膝关节侧方稳定性评估和HSS膝关节功能系统评价.主要观察指标:①患者手术前后膝关节侧方稳定性.②膝关节功能系统评分(包括疼痛、功能、活动范围、肌力、屈曲畸形和稳定性).③X射线观察结果.结果:12例按照Knee-Society-Scores标准KSS系统评价,术前轻度侧方不稳3例,中度不稳7例,严重不稳2例;术后仅轻度侧方不稳1例,中重度不稳者未见.按照HSS系统评价术前评分平均为41分,术后随访时评分平均为89分,术后优良率达91.7%(11/12).结论:TKA注意胫骨假体的点、线、面定位及其相互关系,可以增强膝关节稳定性,明显改善患者疼痛、关节功能及关节活动度.
배경:전슬치환술(total knee arthroplasty,TKA)중숙련장악경골가체치방적정학위치,시술후환자슬관절공능회복적중요영향인소.목적:탐토인공전슬관절치환술중경골가체방치적점、선、면정위급기상호관계,이제고수술후환지슬관절공능화관절은정성.설계:전후대조연구.단위:일소대학의원골과적병방.대상:1999-05/2004-09서주의학원부속의원골과수치적엄중골관절병급류풍습성관절염수행슬관절치환환자12례,남4례,녀8례;쌍측슬치환1례,단측치환11례;좌슬관절4개,우슬관절9개.방법:안표준수술방법수술,착중경골가체적방치겸고점、선、면정위급기상호관계.우수술전후진행슬관절측방은정성평고화HSS슬관절공능계통평개.주요관찰지표:①환자수술전후슬관절측방은정성.②슬관절공능계통평분(포괄동통、공능、활동범위、기력、굴곡기형화은정성).③X사선관찰결과.결과:12례안조Knee-Society-Scores표준KSS계통평개,술전경도측방불은3례,중도불은7례,엄중불은2례;술후부경도측방불은1례,중중도불은자미견.안조HSS계통평개술전평분평균위41분,술후수방시평분평균위89분,술후우량솔체91.7%(11/12).결론:TKA주의경골가체적점、선、면정위급기상호관계,가이증강슬관절은정성,명현개선환자동통、관절공능급관절활동도.
BACKGROUND: The proper placement of the prosthesis during total knee arthroplasty(TKA) is a key factor that will affect the restored function of the knee.OBJECTIVE: To probe into the position and axial alignment of the tibial prosthesis in order to improve knee function and stability after TKA.DESIGN: A self-control study.SETTING: Orthopaedic department in the affiliated hospital of a university.PARTICIPANTS: A total of 12 patients(4 males and 8 females) received TKA due to severe osteoarthropathy or rheumatic arthritis in the Orthopaedic Departnent of the Affiliated Hospital, Xuzhou Medical College, from May 1999 to September 2004. One received bilateral TKA and 11 received unilateral TKA(4 in the left knee and 9 in the right knee).METHODS: TKA was performed in standard procedure and special attention was paid to the proper placement of the tibial prosthesis. Evaluation on lateral genual stability and HSS knee function was made before and after operation.MAIN OUTCOME MEASURES: ① Lateral genual stability before and after TKA. ② Genual function scale ( concerning pain, function, range of motion, muscle strength, flexion deformity and stability).③X-ray observation.RESULTS: Knee-Society-Scores were evaluated in the 12 patients. Before TKA, 3 knees had mild lateral instability, 7 moderates and 2 severe instabilitys. After TKA, only one knee was mildly unstable and no knee had moderate or severe instability. The mean scores of HSS scale increased from 41 before operation to 89 after operation with the effective rate of 91.7% (11/12).CONCLUSION: The precise placement of tibial prosthesis can increase stability of the knee and relieve pain as well as improve knee function and motion.