膝关节置换术后非感染性翻修的回顾性分析

发布时间：2018-03-09 09:50

本文选题：关节置换术　切入点：膝　出处：《北京协和医学院》2017年硕士论文　论文类型：学位论文

【摘要】：目的探讨膝关节置换术后非感染性翻修手术的原因、治疗方案以及功能恢复情况。方法检索北京协和医院骨科1991年5月至2016年11月期间所有入院行膝关节翻修的病例。排除重复住院、非膝关节翻修手术以及资料丢失病例,并进一步排除诊断膝关节感染,以及关节液或关节组织培养阴性,但关节液呈脓性并按膝关节感染处理的病例后,共获得27例患者入院进行非感染性翻修手术。根据非感染性翻修的病因进行分组,总结各组翻修手术处理方式,分析翻修手术距离初次手术的间隔时间,对翻修前后关节力线及关节功能(HSS评分)进行评估。翻修手术与初次TKA的间隔时间主要进行描述分析;翻修前后的关节力线及关节功能KSS评分先行Kolmogorov-Smirnov检验,若数据服从正态分布,则行独立样本t检验分析。结果共筛选出27例(29膝)患者入院进行非感染性膝关节翻修术。翻修病因包括:假体无菌性松动14膝[48.3%(14/29)],其中6膝翻修部分置换了胫骨侧假体,其余8膝均行全膝关节翻修术;膝关节僵直7膝[24.1%(7/29)],其中5膝行手术松解(关节镜下粘连松解1膝),另有2膝行部分膝关节翻修术;初次置换术后有2膝[6.9%(2/29)]出现垫片脱位而行垫片置换手术;2膝[6.9%(2/29)]出现严重的垫片磨损,均行全膝关节翻修术;假体周围骨折的2膝[6.9%(2/29)]行全膝关节翻修术;关节腔异物1膝[3.5%(1/29)],行膝关节后路异物取出术;髌骨外翻半脱位1膝[3.5%(1/29)],行髌骨外侧支持带松解、内侧紧缩术。66.7%(8/12)的膝关节力线不良在翻修术后得到恢复,术后平均纠正7.9± 1.7度,差异具有统计学意义(t=4.612,P0.05),膝关节功能术后HSS评分平均为(81.1 ±7.4)分,较术前(54.5± 17.1)分改善明显(t=-4.520,P=0.001)。结论导致膝关节无菌性翻修的病因是综合性的,其中主要原因是初次膝关节置换术后假体无菌性松动(48.3%)、关节僵直(24.1%)。翻修术中面对严重的骨缺损,使用垫块修补缺损并加用延长杆是保证假体稳定性的重要手术策略。针对初次全膝关节置换术后出现假体无菌性松动、关节僵直、假体周围骨折等问题,全膝关节置换翻修术能够有效地恢复关节力线及膝关节功能。
[Abstract]:Objective to investigate the causes of non-infectious revision surgery after knee arthroplasty. Methods all patients admitted to the Department of Orthopaedics of Peking Union Union Hospital from May 1991 to November 2016 were searched for knee revision, excluding repeated hospitalization, non-knee revision surgery and data loss. The diagnosis of knee joint infection and the negative tissue culture of the joint fluid or joint were further excluded, but the joint fluid was purulent and treated according to the knee joint infection. A total of 27 patients were admitted to hospital for non-infectious revision surgery. According to the etiology of non-infectious revision, the treatment methods were summarized, and the interval between the revision operation and the first operation was analyzed. The interval between the revision operation and the initial TKA was mainly described and analyzed. The Kolmogorov-Smirnov test was performed before and after revision of the joint force line and the KSS score of the joint function. If the data is normally distributed, Results A total of 27 patients (29 knees) were selected for non-infectious knee revision. The causes of revision included aseptic loosening of 14 knees (48.3% 14 / 29), in which 6 knees were partially replaced with lateral tibial prosthesis. Total knee arthroplasty was performed in the remaining 8 knees, knee stiffness was achieved in 7 knees [24. 1 / 29 / 29], among which 5 knees underwent surgical release (1 knee arthroscopic adhesion release, 2 knee partial knee revision surgery). After the first replacement, 2 knees [6.9 / 29] had dislocation of gasket, 2 knees (6.910 / 29) had severe wear of gasket, 2 knees of periprosthetic fracture (6.910 / 29) were treated with total knee arthroplasty, 2 knees with periprosthetic fracture were treated with total knee arthroplasty, and 2 knees (6.920 / 29) with periprosthetic fracture were treated with total knee arthroplasty. Foreign body in articular cavity (1 knee [3. 5 / 1 / 29], posterior approach of knee joint foreign body extraction, patellar valgus subluxation 1 knee [3. 5 / 1 / 29], lateral patellar retinaculum loosening, medial contraction .66. 7% / 8 / 12) recovery after revision, average correction of 7. 9 卤1. 7 degrees after operation. The difference was statistically significant (P 0.05). The average score of HSS after knee joint operation was 81.1 卤7.4, which was significantly better than that before operation (54.5 卤17.1). Conclusion the cause of aseptic revision of knee joint is comprehensive. The main causes are aseptic loosening of the prosthesis after the first knee arthroplasty, 48.3% of the prosthetic loosening and 24.1% stiffness of the joint. Serious bone defects were encountered during the revision operation. Repair of defects with pad and extension rod is an important operative strategy to ensure the stability of prosthesis. After the initial total knee arthroplasty, the prosthesis becomes aseptic loosening, joint stiffness, fracture around the prosthesis, etc. Total knee arthroplasty and revision can effectively restore the joint force line and knee joint function.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4

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