胫骨延长柄在重度肥胖患者初次全膝关节置换中的临床应用

发布时间：2018-05-25 02:35

本文选题：肥胖 + 延长柄　；参考：《新乡医学院》2015年硕士论文

【摘要】：背景目前全膝关节置换术(total knee arthrolasty,TKA)已经成为治疗终末期膝关节疾病的主要方法,能够有效缓解疼痛,改善膝关节功能,提高生活质量。而随着肥胖人群的显著增加,以及我国的人口老龄化趋势日益严峻,TKA正面临越来越多的肥胖老龄患者。但肥胖被认为是膝关节置换失败的主要危险因素之一,大量相关文献报道肥胖患者TKA术后假体无菌性松动、感染、手术切口并发症和关节翻修率远高于非肥胖患者。关节外科医师对肥胖在TKA术后的影响以及手术方式的选择进行了很多的研究。本研究应用普通假体结合胫骨延长柄行TKA治疗重度肥胖患者膝关节骨性关节炎,探讨并评价其临床疗效。目的探讨胫骨延长柄在重度肥胖患者全膝关节置换中的临床应用并评价其临床疗效。方法回顾性分析我院2009年5月至2012年5月期间19例(23膝)终末期骨性关节炎在初次TKA中应用胫骨延长柄的临床病例资料,其中男性4例,女性15例,平均年龄65.2岁(53-78岁),单侧置换15例(左侧9例,右侧6例),双侧置换4例,所有患者均为重度肥胖,BMI均值为37.77±1.27kg/m2。应用美国膝关节学会评分(knee society score, KSS)系统和WOMAC评分对手术前后膝关节进行评估,各组数据采用SPSS 17.0进行统计学分析,以评价临床疗效及假体生存率。结果17例(21膝)获得随访,2例(2膝)失访,平均随访44月(27-65月)。术后有1例(1膝)出现手术切口脂肪液化,无一例出现感染、假体松动、VTE等并发症。术后下肢力线良好,关节稳定,髌骨轨迹良好,无腓总神经损伤、髌腱撕裂等术中并发症。末次随访时患者临床及影像学结果显示无一例出现假体周围骨折、感染、无菌性松动、假体高悬、髌骨骨折等并发症,也未发现明显的骨质溶解。膝评分从术前20.9±4.5分提高到术后末次90.7±3.5分,膝功能评分从术前25.7±4.7分提高到术后末次87.0±3.7分,术前WOMAC评分为157.1±20.0分,术后末次WOMAC评分改善为42.5±18.6分,其中轻度18膝(85.7%),中度3膝(14.3%),重度0膝(0%),差异均具有统计学意义(P0.05)。结论重度肥胖的膝关节骨性关节炎患者接受初次TKA治疗时,应用胫骨延长柄可以传导并分散胫骨平台应力,增强假体稳定性,降低假体翻修率与术后并发症,可获得良好的临床疗效。
[Abstract]:Background Total knee arthroplasty has become the main method for the treatment of end-stage knee diseases, which can effectively relieve pain, improve knee function and improve the quality of life. With the significant increase of obese population and the aging trend of population in China, TKA is facing more and more obese elderly patients. However, obesity is considered to be one of the main risk factors for the failure of knee replacement. A large number of related literature reported that the rate of prosthetic loosening, infection, surgical incision complications and joint revision after TKA in obese patients is much higher than that in non-obese patients. Joint surgeons have done a lot of research on the influence of obesity after TKA and the choice of surgical methods. In this study, TKA was used to treat knee osteoarthritis in patients with severe obesity. Objective to investigate the clinical application of tibial lengthening handle in total knee arthroplasty in patients with severe obesity. Methods the clinical data of 19 patients with end-stage osteoarthritis treated with tibial lengthening in primary TKA from May 2009 to May 2012 were retrospectively analyzed, including 4 males and 15 females. The mean age was 65.2 years old and 53-78 years old, 15 cases were unilateral replacement (9 cases on left side, 6 cases on right side and 4 cases on bilateral replacement). The mean BMI of all patients was 37.77 卤1.27 kg / m ~ (2). The knee joint before and after operation was evaluated by the American knee Society society score, KSS) system and WOMAC score. The data of each group were analyzed statistically by SPSS 17.0 to evaluate the clinical effect and the survival rate of prosthesis. Results 17 cases (21 knees) were followed-up 2 cases (2 knees) lost, the average follow-up time was 44 months, 27 to 65 months. After operation, 1 case (1 knee) had incision fat liquefaction, no infection, VTE and other complications. Postoperative lower limb force line was good, joint was stable, patella track was good, no common peroneal nerve injury, patellar tendon laceration and other intraoperative complications. The clinical and imaging results of the patients at the last follow-up showed that there were no complications such as periprosthetic fracture, infection, aseptic loosening, high suspension of prosthesis, patellar fracture, and no obvious osteolysis. The knee score increased from 20.9 卤4.5 before operation to 90.7 卤3.5 at the last postoperative time, the knee function score increased from 25.7 卤4.7 to 87.0 卤3.7, the WOMAC score before operation was 157.1 卤20.0, and the last WOMAC score improved 42.5 卤18.6 after operation. The difference was statistically significant in 18 knees (85.7%), 3 knees (14.3%) and 0 knees (severe 0). The difference was statistically significant (P 0.05). Conclusion the tibia lengthening handle can conduct and disperse the stress of the tibial plateau, enhance the stability of the prosthesis, reduce the rate of revision and postoperative complications when the patients with severe obesity osteoarthritis of the knee are treated with TKA for the first time. Good clinical effect can be obtained.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.42

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