【摘要】 目的探讨膝关节伸直位强直畸形患者行人工全膝关节置换术的手术要点和术后效果。方法 1996年1月至2006年6月,对8例(9膝)膝关节伸直位强直畸形患者行人工全膝关节置换术。术前膝关节活动度均为0°,KSS 膝关节评分平均为44分(10～68分),功能评分平均为17分(-10～55分)。结果 8例患者(9膝)围手术期出现的并发症包括髌腱止点撕脱1膝,髌骨下极部分撕脱骨折1膝,术后早期关节血肿1膝,皮肤浅表性感染1膝,经对症治疗后所有患者均治愈出院。术后平均随访40.4个月(7.0～120.0个月),术后膝关节平均活动度89°(50°～120°),术后 KSS 膝关节评分平均为81分(55～93分),功能评分平均为79分(50～90分)。2例2膝分别存在5°和25°的伸展滞缺。1例1膝因为关节不稳于术后1年行翻修术,更换加厚的胫骨平台垫片。结论膝关节伸直位强直畸形患者行人工全膝关节置换术难度大,并发症发生率较高,但如能恰当处理,仍可以取得较满意的临床效果。术中膝关节的充分暴露,保留足够的髌骨床厚度,保护髌腱和膝关节的血液供应以及正确的软组织平衡技术是手术的关键。更多还原

【Abstract】 Objective To discuss the outcomes and complications of total knee arthroplasty (TKA) for extension ankylosing deformity of the knee.Methods From January 1996 to June 2006,total knee arthroplasty was performed on 8 patients (9 knees) with extension ankylosing deformity.The preoperative ROM of all patients was 0°.Preoperative knee and function score of KSS were 44 points (from 10 to 68) and 17 points (from-10 to 55) respectively.Results The complications of all TKAs included patellar tendon avulsion in 1 knee,patial fracture of inferior patella in 1 knee,hematoma in 1,superficial infection in 1. All patients were followed up for an average of 40.4 months (from 7.0 to 120.0).The average postoperative ROM was 89° (from 50° to 120°).Postoperative knee and function score of KSS were 81 points (from 55 to 93) and 79 points (from 50 to 90) respectively.Extension lag occurred in 2 knees,one was 10° and the other was 25°.One knee had undergone re-revision of changing the thicker tibial spacer for the reason of instability of joint 1 year after revision.Conclusions TKA performed in extension ankylosing deformity can get less sastifactory clinical results comparing with fixed flexion deformity.Exposure of the knee joint and separation of the fused bones,providing a mobile joint space plays crucial procedure for the next step of surgery.Preservation of sufficient bone stock of patella,protection of patellar tendon and blood supply of the knee and proper soft tissue balance are the key to TKA for extension ankylosing deformity.更多还原