【作者】 张冰；

【导师】 王建民；

【作者基本信息】 兰州大学 ， 临床医学·外科学（专业学位）， 2018， 硕士

【摘要】 目的:探讨全膝关节置换术治疗膝关节骨性关节炎合并轻中度膝外翻畸形的早期临床疗效和手术技巧。方法:收集兰州大学第一医院骨科2015年10月~2018年3月膝关节骨性关节炎合并膝外翻畸形并初次进行人工全膝关节表面置换术的患者共31人33例膝关节进行回顾性研究。其中29人行单侧全膝关节置换术,2人双膝关节置换术均为同一次住院期间分两次手术完成,两次手术间隔时间约1周。31名患者中男性占12人(12膝),女性占19人(21膝),年龄分布在57~78岁之间,平均年龄为67.5岁。所有患者术前均拍摄双下肢全长DR正位片及膝关节侧位片,测量膝外翻角(FTA,Femorotibial angle)、膝关节活动度(ROM,Range of motion)并进行美国特种外科医院膝关节评分(HSS,Hospital for special surgery knee score);术后2周及术后3月复查以上指标,通过随机配对t检验比较患者手术前后病情改善状况。结果:所有患者均未出现感染、假体松动、下肢深静脉血栓等并发症,1例患者术后切口脂肪液化,更换为广谱抗生素并适当延长使用时间,加强局部换药于术后3周拆除缝线。FTA外翻角术前与术后2周相比差异有统计学意义(P<0.05);术前与术后3月相比差异有统计学意义(P<0.05);术后2周与术后3月相比差异无统计学意义(P>0.05);膝ROM术前与术后2周相比差异有统计学意义(P<0.05);术前与术后3月相比差异有统计学意义(P<0.05);术后2周与术后3月相比差异无统计学意义(P>0.05)。HSS评分术前与术后2周相比差异有统计学意义(P<0.05);术前与术后3月相比差异有统计学意义(P<0.05);术后2周与术后3月相比差异无统计学意义(P>0.05);结论:全膝关节置换术治疗膝关节骨性关节炎合并膝外翻畸形的疗效显著,值得推广,但在手术入路、截骨、软组织平衡等方面仍需不断探索。更多还原

【Abstract】 Objecitive:To investigate the early clinical efficacy and surgical techniques of total knee arthroplasty on patients with knee osteoarthritis combined with mild to moderate valgus knee deformity.Methods:To collect the first hospital of lanzhou university orthopaedic in October 2015 to March 2018 knee osteoarthritis with genu valgus and first artificial total knee arthroplasty in patients with a total of 31 people were 33 column of knee joint were retrospectively studied.Among them,29 of them had unilateral total knee arthroplasty,and two patients underwent two surgeries during the same hospitalization,and the interval between two surgeries was about one week.Of the 31 patients(12 knees),19 women(21 knees),aged between 57 and 78,the average age was 67.5 years.All patients were photographed with full-length DR orthotopic and knee joint tablets before surgery,measuring the Angle of flanging,knee ROM and HSS score.The above indicators were reviewed within 2 weeks after surgery,and the patients’ condition was improved before and after the operation by randomly paired test.Results: None of the patients had complications such as infection,prosthesis loosening,lower limb deep venous thrombosis.One column of patients underwent postoperative incision fat liquefaction,replacement of antibiotics and extended use time,and the suture line was removed 3weeks after the surgery.There were statistically significant differences between the two weeks before and after the surgery(P<0.05).The difference was statistically significant before and after surgery(P < 0.05).There was no significant difference between 2 weeks and 3 months after surgery(P>0.05).The difference between knee ROM and postoperative 2 weeks was statistically significant(P < 0.05).The difference was statistically significant before and after surgery(P <0.05).There was no significant difference between 2 weeks and 3 months after surgery(P >0.05).The difference of HSS score before and after 2 weeks was statistically significant(P <0.05).The difference was statistically significant before and after surgery(P<0.05).There was nosignificant difference between 2 weeks and 3 months after surgery(P>0.05).Conclusion:Total knee replacement treatment of knee osteoarthritis with genu valgus curative effect is distinct,worthy of promotion,but in the surgical approach,cut bone,soft tissue balance aspects still need to continuously explore.更多还原