Giori Nicholas J, Lewallen David G
Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MI 55905, USA.
J Bone Joint Surg Am. 2002 Jul;84(7):1157-61. doi: 10.2106/00004623-200207000-00010.
Little information is available regarding the results and complications of total knee arthroplasty in limbs affected by poliomyelitis with severe knee degeneration.
We performed a retrospective chart and radiograph review of patients with a history of poliomyelitis involving a limb that subsequently underwent primary total knee arthroplasty between 1970 and 2000. Sixteen total knee arthroplasties were performed in limbs affected by poliomyelitis in fifteen patients. Eleven patients were followed for a minimum of two years, one (two knees) died before the minimum two-year follow-up could be completed, and three were followed for less than two years. No patient was lost to follow-up.
There were two periprosthetic fractures, one peroneal nerve palsy, one avulsion of the patellar tendon, and four cases of recurrent instability. These complications were related to the poor bone quality, valgus deformity, patella baja, poor musculature, and attenuated soft tissues commonly found in knees affected by poliomyelitis. Knee Society pain and knee scores were improved postoperatively for all nine knees with a two-year follow-up that had had at least antigravity quadriceps strength prior to surgery. However, Knee Society function scores remained at 0 or worsened for six of the eleven knees followed for at least two years, including those with less than antigravity strength, and four of the nine knees with at least antigravity strength. None of the prostheses loosened.
Pain and knee scores improved following total knee arthroplasty in patients with a history of poliomyelitis and antigravity quadriceps strength, but there was less pain relief in patients with less than antigravity quadriceps strength. Recurrence of instability and progressive functional deterioration is possible in all knees affected by poliomyelitis that have undergone total knee replacement, but they appear to occur more commonly in more severely affected knees.
关于脊髓灰质炎所致严重膝关节退变肢体行全膝关节置换术的结果及并发症的信息较少。
我们对1970年至2000年间有脊髓灰质炎病史且随后接受初次全膝关节置换术的肢体患者进行了回顾性病历及影像学检查。15例患者的16个受脊髓灰质炎影响的肢体接受了全膝关节置换术。11例患者至少随访了两年，1例（双膝）在完成至少两年随访前死亡，3例随访时间不足两年。无患者失访。
发生了2例假体周围骨折、1例腓总神经麻痹、1例髌腱撕脱和4例复发性不稳定。这些并发症与脊髓灰质炎所致膝关节常见的骨质质量差、外翻畸形、髌骨低位、肌肉组织差及软组织薄弱有关。对于术前至少有抗重力股四头肌力量且随访两年的所有9个膝关节，膝关节协会疼痛和膝关节评分术后均有改善。然而，在至少随访两年的11个膝关节中，有6个膝关节协会功能评分仍为0或恶化，包括那些抗重力力量不足的膝关节，以及9个至少有抗重力力量的膝关节中的4个。无一例假体松动。
有脊髓灰质炎病史且有抗重力股四头肌力量的患者行全膝关节置换术后疼痛和膝关节评分有所改善，但抗重力股四头肌力量不足的患者疼痛缓解较少。所有接受全膝关节置换的脊髓灰质炎所致膝关节都可能出现不稳定复发和功能逐渐恶化，但似乎在受影响更严重的膝关节中更常见。
