初次全膝关节置换中应用股四头肌V-Y成形术暴露强直或僵硬膝关节
Exposure of an ankylosed or stiff knee with V-Y quadricepsplasty in primary total knee arthroplasty
刘霄阳 1陈绪明 1赵恩泽 1周宗科1
作者信息
- 1. 四川大学华西医院骨科,成都 610041
- 折叠
摘要
目的 分析初次全膝关节置换(total knee arthroplasty,TKA)中应用股四头肌V-Y成形术暴露强直或僵硬膝关节的中长期疗效.方法 回顾性分析2010年5月至2019年2月于四川大学华西医院因膝关节强直或僵直采用股四头肌V-Y成形术显露的TKA患者12例,男7例、女5例,年龄(53.9±14.9)岁(范围24～72岁),左侧6例、右侧6例.术前诊断:骨关节炎7例、类风湿关节炎2例、创伤性关节炎1例、血友病性关节炎2例.记录患者手术前后膝关节疼痛视觉模拟评分(visual analogue scale,VAS)、关节活动度、股四头肌肌力、美国膝关节协会评分(Knee Society score,KSS)及术后并发症.结果 所有患者均顺利完成手术并获得随访,随访时间为(102.2±31.1)个月(范围51～141个月).手术时间为(87.0±15.7)min(范围73～123 min),术中出血量为(823.6±237.7)ml(范围555～1 471 ml),住院时间为(13.3±6.3)d(范围6～28 d).所有患者术后VAS评分均降低,手术前后比较差异有统计学意义(F=132.000,P＜0.001).术后3个月和末次随访的VAS评分分别为(2.2±0.7)分和(1.2±0.4)分,小于术前的(5.2±0.7)分,差异有统计学意义(P＜0.05).所有患者术后KSS膝评分均升高,手术前后比较差异有统计学意义(F=40.960,P＜0.001).术后3个月和末次随访的KSS膝评分分别为(56.0±14.1)分和(74.3±16.1)分,大于术前的(26.1±7.8)分,差异有统计学意义(P＜0.05).所有患者术后KSS功能评分均升高,手术前后比较差异有统计学意义(F=24.332,P＜0.001).术后3个月和末次随访的KSS功能评分分别为(52.9±19.4)分和(79.2±19.6)分,大于术前的(27.1±15.6)分,差异有统计学意义(P＜0.05).所有患者术后膝关节活动度均升高,手术前后比较差异有统计学意义(F=24.145,P＜0.001).术后3个月和末次随访的膝关节活动度分别为57.5°±22.2°和70.0°±25.9°,大于术前的12.5°±14.1°,差异有统计学意义(P＜0.05).术前股四头肌肌力3级2例,4级10例;末次随访时4级1例,5级11例,肌力较术前改善,差异有统计学意义(Z=1 1.000,P＜0.001).末次随访时无一例出现伤口渗液、延迟愈合、浅表或深部软组织感染、假体周围感染及松动、下肢深静脉血栓形成及肺栓塞等并发症.结论 对接受TKA的膝僵直或强直患者,采用股四头肌V-Y成形术可增加显露,从而可改善膝关节活动度和股四头肌肌力.
Abstract
Objective To analyze the medium-and long-term outcomes of V-Y quadricepsplasty in primary total knee ar-throplasty(TKA)to expose an ankylosed or stiff knee joint.Methods From May 2010 to February 2019,a total of 12 patients with TKA revealed by V-Y quadricepsplasty in West China Hospital of Sichuan University due to knee ankylosis or stiffness were retrospectively analyzed,including 7 males and 5 females,aged(53.9±14.9)years(range,24 to 72 years),6 patients on the left side and 6 patients on the right side.Preoperative diagnosis:7 cases of osteoarthritis,2 cases of rheumatoid arthritis,1 case of trau-matic arthritis,and 2 cases of haemophilic arthritis.Visual analogue scale(VAS),range of motion,quadriceps muscle strength,Knee Society score(KSS)and postoperative complications were recorded before and after operation.Results All patients success-fully completed the operation and were followed up for 102.2±31.1 months(range,51-141 months).The operation time was 87.0±15.7 min(range,73 to 123 min),the intraoperative blood loss was 823.6±237.7 ml(range,555 to 1 471 ml),and the hospital stay was 13.3±6.3 d(range,6 to 28 d).Postoperative VAS scores were decreased in all patients,and the difference before and after op-eration was statistically significant(F=132.000,P＜0.001).The VAS scores at 3 months and the last follow-up were 2.2±0.7 points and 1.2±0.4 points,respectively,lower than those before operation(5.2±0.7 points),and the difference was statistically significant(P＜0.05).KSS knee scores were higher in all patients after operation,and the difference was statistically significant before and af-ter operation(F=40.960,P＜0.001).KSS knee scores at 3 months and the last follow-up were 56.0±14.1 points and 74.3±16.1 points,respectively,higher than those before operation(26.1±7.8 points),and the difference was statistically significant(P＜0.05).Postoperative KSS functional scores were increased in all patients,and the difference before and after operation was statistically significant(F=24.332,P＜0.001).The KSS functional scores at 3 months and the last follow-up were 52.9±19.4 points and 79.2±19.6 points,respectively,higher than those before operation(27.1±15.6 points),and the difference was statistically significant(P＜0.05).Postoperative knee joint motion was increased in all patients,and the difference was statistically significant before and after operation(F=24.145,P＜0.001).The range of motion of the knee joint at 3 months and the last follow-up was 57.5°±22.2° and 70.0°±25.9°,respectively,which was higher than the preoperative 12.5°±14.1°,and the difference was statistically significant(P＜0.05).Preoperative quadriceps muscle strength was grade 3 in 2 cases and grade 4 in 10 cases;at the last follow-up,grade 4 in 1 case and grade 5 in 11 cases,and the muscle strength was improved compared with that before operation,the difference was statis-tically significant(Z=1 1.000,P＜0.001).At the last follow-up,there were no complications such as wound seepage,delayed heal-ing,superficial or deep soft tissue infection,periprosthesis infection and loosening,deep vein thrombosis and pulmonary embo-lism.Conclusion In patients with ankylosed or stiff knee receiving TKA,the use of V-Y quadricepsplasty can increase the expo-sure,thereby improving the range of knee motion and quadriceps muscle strength.
关键词
关节成形术,置换,膝/四头肌/活动范围,关节Key words
Arthroplasty,replacement,knee/Quadriceps muscle/Range of motion,articular引用本文复制引用
基金项目
国家重点研发计划(2022YFC2503100)
国家重点研发计划(2022YFC2503104)
出版年
2024
NETL
NSTL
万方数据