CAJ | 학술논문

目的探讨陈旧性股骨髁骨折合并膝关节骨关节炎一期全膝关节置换(total knee arthroplasty,TKA)的可行性和疗效.方法 2003年1月至2010年12月对陈旧性股骨髁骨折合并膝关节骨关节炎患者11例行一期TKA手术,男4例,女7例;年龄38～77岁,平均58.3岁.股骨髁上骨折8例,髁间骨折3例.其中2例伴有膝纤维性强直及轻度肌肉萎缩,2例合并膝关节侧副韧带损伤,2例合并股骨髁上纤维性愈合,2例为感染性骨不愈合.结果所有患者均获得随访,随访时间6～72个月,平均41.3个月.美国特种外科医院(The Hospital for Special Surgery,HSS)膝关节评分从术前平均(6.65±7.01)分(0～13分)提高至末次随访时平均(88.5±6.18)分(81～95分).膝关节活动度由术前平均32.7°±17.6°(0°～50°)提高至末次随访时平均101.3°±9.8°(85°～115°).活动度平均增加77.7°.1例患者术后6年出现感染,反复清创失败后行膝关节离断术.其余患者均无感染、假体松动、下肢深静脉血栓形成、膝关节不稳及双下肢不等长等并发症.结论陈旧性股骨髁骨折合并膝关节骨关节炎的一期TKA手术难度大,合理的手术方案是手术成功的关键.术后短期随访效果良好.
목적 탐토진구성고골과골절합병슬관절골관절염일기전슬관절치환(total knee arthroplasty,TKA)적가행성화료효.방법 2003년1월지2010년12월대진구성고골과골절합병슬관절골관절염환자11례행일기TKA수술,남4례,녀7례;년령38～77세,평균58.3세.고골과상골절8례,과간골절3례.기중2례반유슬섬유성강직급경도기육위축,2례합병슬관절측부인대손상,2례합병고골과상섬유성유합,2례위감염성골불유합.결과 소유환자균획득수방,수방시간6～72개월,평균41.3개월.미국특충외과의원(The Hospital for Special Surgery,HSS)슬관절평분종술전평균(6.65±7.01)분(0～13분)제고지말차수방시평균(88.5±6.18)분(81～95분).슬관절활동도유술전평균32.7°±17.6°(0°～50°)제고지말차수방시평균101.3°±9.8°(85°～115°).활동도평균증가77.7°.1례환자술후6년출현감염,반복청창실패후행슬관절리단술.기여환자균무감염、가체송동、하지심정맥혈전형성、슬관절불은급쌍하지불등장등병발증.결론 진구성고골과골절합병슬관절골관절염적일기TKA수술난도대,합리적수술방안시수술성공적관건.술후단기수방효과량호.
Objective To investigate the feasibility and clinical effect of one-stage total knee arthroplasty for old femoral condyle fractures combined with knee osteoarthritis.Methods From January 2003 to December 2010,11 patients with old femoral condyle fracture combined with knee osteoarthritis,including 4males and 7 females,aged from 38 to 77 years (average,58.3 years),underwent one-stage total knee arthroplasty.There were 8 cases of supracondylar fracture,and 3 cases of intercondylar fracture.Moreover,there were 2 cases of knee fibrous ankylosis with mild amyotrophy,3 cases of collateral ligaments injury of the knee,2 cases of fibrous union,and 2 cases of infective nonunion.Results All patients were followed up for 6 to 72 months (average,41.3 months).The HSS score improved from preoperative 6.65±7.01 (range,0-13)to 88.5±6.18 (range,81-95) at final follow-up.The range of motion of the knee improved from preoperative 32.7°±17.6° (range,0°-50°) to 101.3°±9.8° (range,85°- 115°) at final follow-up.One case underwent knee disarticulation 6 years after operation owing to infection.For other patients,there were no complications such as infection,deep vein thrombosis,knee instability,component loosening and inequality of lower limb.Conclusion One-stage total knee arthroplasty is a technically difficult but effective method for patients with old femoral condyle fracture and knee osteoarthritis.