髁限制性假体治疗严重毁损性血友病性膝关节炎的疗效观察

发布时间：2018-07-12 13:57

本文选题：血友病 + 髁限制性假体　；参考：《中国修复重建外科杂志》2017年03期

【摘要】：目的探讨采用髁限制性假体行人工全膝关节置换术(total knee arthroplasty,TKA)治疗严重毁损性血友病性膝关节炎的临床疗效。方法 2007年9月—2015年7月采用髁限制性假体行TKA治疗8例(8膝)严重毁损性血友病性膝关节炎患者。患者均为男性;年龄22~56岁,平均35岁。均为甲型血友病;病程3~30年,平均17.3年。术前膝关节活动度(68.1±32.6)°;8例均存在屈曲挛缩畸形,达(14.38±16.13)°。6例患者合并外翻畸形,达7~35°,平均17.3°,其中1例合并固定性髌骨脱位;1例合并内翻畸形(15°)。美国特种外科医院(HSS)评分为(52.5±12.9)分。术前X线片示膝关节间隙明显变窄,关节软骨及软骨下骨破坏囊性变。结果患者手术切口均Ⅰ期愈合。8例术后均获随访,随访时间1~9年,平均5年。术中1例出现延长杆突破胫骨远端皮质,术后1例出现张力性水疱伴腓总神经损伤,均经相应处理后治愈。末次随访时,膝关节活动度为(98.1±8.9)°,屈曲挛缩畸形为(0.63±1.77)°,均较术前显著改善(t= 2.527,P=0.036;t=2.396,P=0.047)。术后2周及末次随访时HSS评分分别为(77.3±11.0)、(85.0±9.0)分,与术前比较差异均有统计学意义(P0.05)。X线片复查示,术前合并内、外翻畸形患者术后均恢复正常力线。结论采用髁限制性假体行TKA治疗严重毁损性血友病性膝关节炎,可获得良好疗效。
[Abstract]:Objective to investigate the clinical effect of condylar limited prosthesis (total knee arthroplasty (TKA) in the treatment of severe hemophilia knee arthritis. Methods from September 2007 to July 2015, 8 patients (8 knees) with severe hemophilia genu arthritis were treated with TKA. All the patients were male, aged 22 to 56 years (mean 35 years). All of them were hemophilia A, the course of disease was 3 ~ 30 years (mean 17.3 years). Flexion contracture deformities were found in 8 patients with knee joint motion (68.1 卤32.6) 掳before operation, and (14.38 卤16.13) 掳in 6 patients with valgus deformity, with an average of 17.3 掳. One case was complicated with fixed dislocation of patella and 1 case with varus deformity (15 掳). The score of American Special surgery Hospital (HSS) was (52.5 卤12.9). Preoperative X-ray films showed that the space of knee joint narrowed obviously and the destruction of articular cartilage and subchondral bone became cystic. Results all the patients were followed up for 1 ~ 9 years (mean 5 years). In one case, the lengthening rod broke through the distal tibia cortex, and the tension blister accompanied with common peroneal nerve injury occurred in 1 case after operation. All cases were cured by corresponding treatment. At the last follow-up, the range of motion of the knee joint was (98.1 卤8.9) 掳and the flexion contracture deformity was (0.63 卤1.77) 掳. After 2 weeks and the last follow-up, the HSS score was (77.3 卤11.0), (85.0 卤9.0), which was significantly different from that before operation (P0.05). Conclusion TKA with condylar limiting prosthesis is effective in the treatment of severe hemophilia knee arthritis.
【作者单位】：中国医学科学院·北京协和医学院·北京协和医院骨科;
【分类号】：R687.4;R554.1

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