一期人工全膝关节置换术治疗股骨髁上骨折合并膝骨关节炎

发布时间：2018-07-16 11:15

【摘要】：目的探讨一期人工全膝关节置换术(total knee arthroplasty,TKA)治疗股骨髁上骨折合并膝骨关节炎的临床疗效。方法 2012年1月—2015年3月,采用一期TKA治疗股骨髁上骨折合并膝骨关节炎患者19例(19膝)。其中,男8例,女11例;年龄60~85岁,平均69.6岁。体质量指数22.0~27.5 kg/m~2,平均22.6 kg/m~2。左膝13例,右膝6例。股骨髁上骨折原因:摔伤10例,交通事故伤8例,其他伤1例;骨折按AO/ASIF分型均为A型。受伤至手术时间为4~13 d,平均8.6 d。骨关节炎病程30~90个月,平均52.6个月。术后采用膝关节学会评分系统(KSS)并测量膝关节活动度(range of motion,ROM),评估膝关节功能;摄膝关节正侧位X线片,了解假体在位情况。结果术后切口均Ⅰ期愈合,无肺部感染、压疮及泌尿系统感染等早期并发症发生。19例患者均获随访,随访时间2~4年,平均2.6年。术后15 d及2年时患膝关节ROM及KSS功能评分、临床评分均较术前明显改善(P0.05);术后两时间点间比较差异亦有统计学意义(P0.05)。膝关节X线片复查示,下肢力线良好,2年时骨折均达骨性愈合,假体对位良好,无松动现象。结论一期TKA治疗股骨髁上骨折合并膝骨关节炎,在重建关节功能同时治疗骨关节炎及骨折,缩短了康复时间,降低并发症发生率,能够获得良好的临床疗效。
[Abstract]:Objective to investigate the clinical effect of one stage total knee arthroplasty (total knee arthroplasty) in the treatment of supracondylar fracture of femur with osteoarthritis of knee. Methods from January 2012 to March 2015, 19 patients (19 knees) with supracondylar fracture of femur and knee osteoarthritis were treated with TKA. Among them, there were 8 males and 11 females with an average age of 69.6 years (60 ~ 85 years). The body mass index (BMI) was 22.0 ~ 27.5 kg / m ~ (-2), with an average of 22.6 kg / m ~ (2). Left knee 13 cases, right knee 6 cases. The causes of supracondylar fracture of femur included fall in 10 cases, traffic accident in 8 cases and other injuries in 1 case. The time from injury to operation was 4 to 13 days, with an average of 8.6 days. The course of osteoarthritis was 30 ~ 90 months (mean 52.6 months). The knee joint function was evaluated by using the knee Joint Society score system (KSs) and (range of motion ROM, and the position of the prosthesis was observed by X ray film of the anterior and lateral position of the knee joint. Results all the patients were followed up for 2 ~ 4 years (mean 2.6 years). There was no pulmonary infection, pressure sore and urinary system infection. All the patients were followed up for 2 ~ 4 years. 15 days and 2 years after the knee ROM and KSS functional scores, clinical scores were significantly improved compared with the preoperative (P0.05), the difference between the two time points after surgery was also statistically significant (P0.05). X-ray examination of knee joint showed that the lower extremity force line was good, the fracture reached bone healing at 2 years, the prosthesis was in good position and no loosening. Conclusion one stage TKA treatment of supracondylar fracture of femur with knee osteoarthritis can shorten the rehabilitation time and reduce the incidence of complications, and can obtain good clinical effect in the reconstruction of joint function and the treatment of osteoarthritis and fracture.
【作者单位】：河南中医药大学第二附属医院关节科;河南中医药大学研究生院;
【分类号】：R687.4

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