CAJ | 학술논문

背景:膝关节畸形施行人工全膝关节置换难度大,涉及面多,包括手术入路、术中截骨、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,均采用后稳定型假体进行全膝关节置换,由髌骨内侧入路,正确截骨,选择性的软组织松解,恢复膝关节正常的力线和软组织平衡,获得膝关节稳定,置换后采取针对性的康复训练,定期随访检查膝关节活动度、最大屈曲度并进行 HSS 评分、WOMAC 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.所有患者置换治疗后膝关节活动度、膝关节最大屈曲度、HSS 评分、WOMAC 评分较置换前比较,均显著提高,差异有显著性意义(P <0.01).置换后切口均Ⅰ期愈合,无膝关节僵硬、血管及神经损伤、髌骨骨折、髌骨低位、假体松动等并发症发生,下肢力线均恢复正常.说明成人严重膝关节畸形经全膝关节置换,置换后畸形均得到纠正,功能较前明显改善,临床效果满意.
배경:슬관절기형시행인공전슬관절치환난도대,섭급면다,포괄수술입로、술중절골、연조직송해순서、방법급정도、연조직평형등,전가학자각불상동,의견불통일,쟁의교다.목적:탐토전슬관절치환치료성인엄중슬관절질병적수술방법화림상료효.방법:납입42례(48슬)엄중슬관절질병합병기형환자,균채용후은정형가체진행전슬관절치환,유빈골내측입로,정학절골,선택성적연조직송해,회복슬관절정상적력선화연조직평형,획득슬관절은정,치환후채취침대성적강복훈련,정기수방검사슬관절활동도、최대굴곡도병진행 HSS 평분、WOMAC 평분.결과여결론:소유환자균획득수방,수방시간위25-84개월,평균35.5개월.소유환자치환치료후슬관절활동도、슬관절최대굴곡도、HSS 평분、WOMAC 평분교치환전비교,균현저제고,차이유현저성의의(P <0.01).치환후절구균Ⅰ기유합,무슬관절강경、혈관급신경손상、빈골골절、빈골저위、가체송동등병발증발생,하지력선균회복정상.설명성인엄중슬관절기형경전슬관절치환,치환후기형균득도규정,공능교전명현개선,림상효과만의.
@@@@BACKGROUND: Total knee arthroplasty used for the treatment of knee joint deformity is difficult and involves multi-aspects, including the surgical approach, intraoperative osteotomy, order, method and extent of soft tissue release and soft tissue balance, There are a lot of controversies due to different scholarly opinions. OBJECTIVE: To explore the surgical methods and clinical efficacy of total knee arthroplasty for the treatment of severe knee disease. METHODS: A total of 42 cases (48 knees) with severe knee disease and knee joint deformity were selected, and al the patients were treated with total knee arthroplasty using posterior stabilized prosthesis. Through patel ar medial approach and correct osteotomy, selective soft tissue release was performed to restore normal knee alignment and soft tissue balance to harvest knee stability. The targeted rehabilitation training was performed after replacement and the knee range of motion and maximum knee flex degree were detected regularly. The Hospital for Special Surgery score and the Western Ontario and Mcmaster Universities Arthritis Index score were performed. RESULTS AND CONCLUSION: Al patients were fol owed-up for 25 to 84 months, 35.5 months in average. The knee range of motion, maximum knee flex degree, Hospital for Special Surgery score and the Western Ontario and Mcmaster Universities Arthritis Index score of al the patients were significantly increased after replacement compared with those before replacement (P < 0.01). The wound was in stage Ⅰ recovery. No knee joint rigidity, blood vessel and nerve injury, patel a fracture, patel a low-site and prosthesis loosening were observed after replacement. The lower limb alignment was restored to normal level. The adult severe knee deformity can be corrected through total knee arthroplasty, and the function is improved significantly with satisfactory clinical results.