摘要
目的比较松解术与全假体翻修术治疗全膝关节置换术(TKA)后关节纤维化所致僵硬的中长期临床疗效。方法回顾性分析2004年1月至2020年1月期间解放军总医院第四医学中心骨科医学部收治的20例(26膝)TKA后关节纤维化所致僵硬患者资料。根据治疗方式不同分为两组:松解组8例(10膝),男1例(2膝),女7例(8膝);年龄44.0(21.0,62.0)岁;采用松解术治疗。假体翻修组13例(16膝);男4例(6膝),女9例(10膝);年龄41.5(30.0,56.0)岁;采用全假体翻修术治疗。比较两组患者术前与末次随访时膝关节活动度、美国特种外科医院(HSS)膝关节评分及改善量,以及末次随访时患者满意度等。结果两组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。松解组患者术前膝关节活动度[55.0°(48.8°,61.3°)]和HSS膝关节评分[54.0(47.0,61.8)分]均显著高于假体翻修组患者[27.5°(6.3°,50.0°)、33.0(27.3,47.8)分],差异均有统计学意义(P<0.05);末次随访时松解组和假体翻修组患者的膝关节活动度[90.0°(65.0°,100.0°)、90.0°(63.5°,98.8°)]、HSS膝关节评分[(69.8±19.9)、(77.6±11.3)分]均较术前显著改善,差异均有统计学意义(P<0.05)。假体翻修组患者膝关节活动度改善量(48.9°±21.7°)高于松解组患者(34.5°±13.2°),但差异无统计学意义(P>0.05);而HSS膝关节评分改善量[39.5(25.3,57.0)分]显著高于松解组患者[16.0(10.5,25.3)分],差异有统计学意义(P<0.05)。假体翻修组和松解组分别有14、3膝患者非常满意或满意,两组比较差异有统计学意义(P<0.05)。结论松解术和全假体翻修术均可显著改善TKA后关节纤维化所致僵硬患者的膝关节活动度和HSS膝关节评分,但全假体翻修术在改善HSS膝关节评分和患者满意度方面较松解术更具优势,适合术前膝关节活动度较差的患者。
Objective To compare the mid-to long-term clinical outcomes of arthrolysis versus revision arthroplasty for arthrofibrosis-related stiffness following total knee arthroplasty(TKA).Methods A retrospective analysis was conducted of the 20 patients(26 knees)with post-TKA arthrofibrosis who had been treated at Department of Orthopedics,The Fourth Medical Center of Chinese PLA General Hospital between January 2004 and January 2020.The patients were divided into 2 groups based on their treatment:an arthrolysis group of 8 cases(10 knees)[1 male(2 knees)and 7 females(8 knees);median age:44.0(21.0,62.0)years]and a revision arthroplasty group of 13 cases(16 knees)[4 males(6 knees)and 9 females(10 knees);median age:41.5(30.0,56.0)years].The knee range of motion(ROM)and the American Hospital for Special Surgery(HSS)knee score as well as their improvements were compared between preoperation and the last follow-up,as well as between the 2 groups;the satisfaction of the patients at the last follow-up was compared between the 2 groups.Results No significant differences in the baseline characteristics were observed between the 2 groups,indicating comparability(P>0.05).The preoperative knee ROM[55.0°(48.8°,61.3°)]and HSS knee score[54.0(47.0,61.8)points]in the arthrolysis group were significantly higher than those in the revision group[27.5°(6.3°,50.0°),33.0(27.3,47.8)points](P<0.05).In the arthrolysis and revision arthroplasty groups,the knee ROMs[90.0°(65.0°,100.0°),90.0°(63.5°,98.8°)]and HSS knee scores[(69.8±19.9)points,(77.6±11.3)points]at the last follow-up were significantly improved compared with those before operation(P<0.05).In the revision arthroplasty group,the improvement in knee ROM(48.9°±21.7°)was insignificantly larger than that in the arthrolysis group(34.5°±13.2°)(P>0.05),but the improvement in HSS knee score[39.5(25.3,57.0)points]was significantly larger than that in the arthrolysis group[16.0(10.5,25.3)points](P<0.05).Respectively,14 and 3 knees in the revision arthroplasty group and the arthrolysis group resulted in patient satisfaction,showing a significant difference between the 2 groups(P<0.05).Conclusions Both arthrolysis and revision arthroplasty can significantly improve knee ROM and HSS knee score in post-TKA arthrofibrosis.However,since revision arthroplasty demonstrates superior improvements in HSS knee score and patient satisfaction,it is preferable for patients with lower preoperative knee ROM.
作者
高志森
丁浩凌
高天
张国强
李睿
柴伟
Gao Zhisen;Ding Haoling;Gao Tian;Zhang Guoqiang;Li Rui;Chai Wei(National Clinical Research Center for Orthopaedics,Sports Medicine,and Rehabilitation,Department of Orthopaedics,The Fourth Medical Center of Chinese PLA General Hospital,Beijing 100048,China)
出处
《中华创伤骨科杂志》
北大核心
2025年第6期499-506,共8页
Chinese Journal of Orthopaedic Trauma
基金
北京市科学技术委员会、中关村科技园区管理委员会“AI+健康协同创新培育”项目(Z221100003522014)
国家自然科学基金区域联合重点项目(U22A20355)
北京市自然科学基金-海淀原始创新联合基金(L232020)。
关键词
关节成形术
置换
膝
膝关节
纤维化
僵硬
全假体翻修术
松解术
Arthroplasty,replacement,knee
Knee joint
Fibrosis
Stiffness
Revision arthroplasty
Arthrolysis
作者简介
通信作者:柴伟,Email:chaiwei301@163.com。
