髌股关节置换术治疗单纯髌股关节骨关节炎

被引：14

作者：

伍卫刚

何荣新

王祥华

吴浩波

严世贵

机构：

[1] 杭州,浙江大学医学院附属第二医院骨科

来源：

中华骨科杂志 | 2015年 / 35卷 / 04期

关键词：

骨关节炎, 膝; 髌股关节; 关节成形术, 置换;

D O I：

暂无

中图分类号：

R687.4 [关节手术];

学科分类号：

100220 [骨科学];

摘要：

目的探讨髌股关节置换术治疗单纯髌股关节骨关节炎的疗效和影响因素。方法回顾性分析2006年3月至2014年12月, 采用髌股关节置换术治疗并获得随访的18例单纯髌股关节骨关节炎患者资料, 男3例, 女15例;年龄46～74岁, 平均54岁;术前美国特种外科医院膝关节评分(hospital for special surgery knee score, HSS)为44～63分, 平均(53.28±5.71)分;疼痛视觉模拟评分(visual analogue scale, VAS)为4～7分, 平均(5.33±0.99)分。术前根据临床症状、体征和影像学资料严格把握手术指征, 其中11例采用AVON髌股关节假体(Stryker公司), 7例采用Gender Solutions髌股关节假体(Zimmer公司)。术后第1天患膝即开始行主动和被动功能康复锻炼。结果 18例患者术后均获得随访, 随访时间6～104个月, 平均63.98个月。VAS, 术后1个月(1.17±0.79)分(范围, 0～3分), 术后3个月(0.72±0.67)分(范围, 0～2分), 术后9个月疼痛基本消失;HSS, 术后1个月(70.06±6.33)分(范围, 61～80分), 术后3个月(86.06±5.12)分(范围, 77～95分), 术后9个月(91.39±4.83)分(范围, 82～97分), 末次随访(92.06±4.05)分(范围, 84～97分), 其中优15例、良3例, 优良率100%, 较术前有明显改善。患者主观满意率94.4%(17/18)。1例患者术后2年再次出现上下楼梯时膝前疼痛, 给予非甾体类抗炎药和适当减少活动后症状缓解。随访期间无一例患者出现切口感染、髌骨脱位、假体松动等并发症。结论髌股关节置术后疗效与手术适应证、假体设计、手术技巧等因素密切相关, 在选用合适的髌股关节假体、严格把握手术适应证、掌握好手术技巧及积极术后康复功能锻炼等基础上, 采用髌股关节置换术治疗单纯髌股关节骨关节炎可以获得良好的疗效。

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