Shi Ming-guo, Lü Hou-shan, Guan Zhen-peng
Arthritis Clinic and Research Center, Peking University People's Hospital, Beijing 100044, China.
Zhonghua Wai Ke Za Zhi. 2006 Aug 15;44(16):1101-5.
To retrospectively analyze the influence of preoperative range of motion (ROM) and maximal flexion degree on the early clinical outcome of total knee arthroplasty (TKA).
From January 2000 to December 2003, 97 knees of 65 patients that were underwent total knee arthroplasty with Scorpio posterior-stabilized knee prosthesis were reviewed. There were 55 osteoarthritis patients (81 knees), and 10 rheumatoid arthritis (16 knees). Thirty-three patients were underwent unilateral TKA, 32 patients were underwent bilateral TKA. According to the preoperative ROM of knee, these patients were divided into two groups, one <or= 90 degrees (range, 5 degrees - 90 degrees ) and the other > 90 degrees (range, 95 degrees - 140 degrees ). Finally the clinical outcomes of two groups (include ROM, maximal flexion degree, KSS score and function score) were evaluated. Three days later after operation, continuous passive motion (CPM) and active functional exercise of the knee were begun, and the wound healed well in all patients. All these operations were primary total knee arthroplasty.
The patients were followed up for average 2 years 5 months (range, 10 months to 3 years 8 months). The average ROM of knee was improved to 101.6 degrees (range, 40 degrees - 140 degrees ) after operation from 84.2 degrees (range, 5 degrees - 140 degrees ) before operation (P = 0.000); the average maximal flexion degree was decreased from 103.5 degrees (range, 25 degrees - 140 degrees ) before operation to 101.6 degrees (range, 40 degrees - 140 degrees ) after operation (P = 0.439); KSS of knee joint was improved to 78.8 points after operation (range, 50 - 95 points) from 19.5 points (-24 - 62 points) before operation (P = 0.000). There was statistically difference between the clinical outcomes (ROM, maximal flexion degree, KSS score and function score) in the two groups before and after operation. Those knees with good preoperative ROM tend to lose flexion, while those with poor preoperative ROM gain flexion after TKA. No revision and deep infection happened.
TKA is a complex operation, the clinical outcome of TKA is mainly determined by the good operation skill, abundant clinical experience and the familiarity with the prosthesis of the surgeon. At the same conditions such as same surgeon, same prosthesis and same physical therapy, preoperative range of motion of knee influence on the early clinical outcome of total knee arthroplasty, knees that have good preoperative ROM have better clinical outcomes postoperatively than those with poor preoperative ROM.
回顾性分析术前膝关节活动度（ROM）及最大屈曲度对全膝关节置换术（TKA）早期临床疗效的影响。
回顾2000年1月至2003年12月间65例患者的97个膝关节，均采用天蝎座后稳定型膝关节假体行全膝关节置换术。其中骨关节炎患者55例（81个膝关节），类风湿关节炎患者10例（16个膝关节）。33例行单侧TKA，32例行双侧TKA。根据术前膝关节ROM将患者分为两组，一组≤90°（范围5°-90°），另一组＞90°（范围95°-140°）。最后评估两组的临床疗效（包括ROM、最大屈曲度、KSS评分及功能评分）。术后3天开始膝关节持续被动活动（CPM）及主动功能锻炼，所有患者伤口愈合良好。所有手术均为初次全膝关节置换术。
患者平均随访2年5个月（范围10个月至3年8个月）。术后膝关节平均ROM由术前的84.2°（范围5°-140°）提高至101.6°（范围40°-140°）（P = 0.000）；平均最大屈曲度由术前的103.5°（范围25°-140°）降至术后的101.6°（范围40°-140°）（P = 0.439）；膝关节KSS评分由术前的19.5分（-24-62分）提高至术后的78.8分（范围50-95分）（P = 0.000）。两组术前及术后的临床疗效（ROM、最大屈曲度、KSS评分及功能评分）差异有统计学意义。术前ROM良好的膝关节术后屈曲度往往丢失，而术前ROM差的膝关节TKA术后屈曲度增加。无翻修及深部感染发生。
TKA是一项复杂的手术，TKA的临床疗效主要取决于术者良好的手术技巧、丰富的临床经验及对假体的熟悉程度。在同一术者、同一假体及相同物理治疗等相同条件下，术前膝关节活动度影响全膝关节置换术的早期临床疗效，术前ROM良好的膝关节术后临床疗效优于术前ROM差的膝关节。
