Zeng Min, Hu Yihe, Xie Jie, Li Mingqing, Lin Shaoru
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2014 Jan;28(1):7-12.
To evaluate the mid-term effectiveness of rotating hinge knee prosthesis for severe knee deformity.
A retrospective analysis was made on the clinical data of 24 patients (24 knees) who received rotating hinge knee prosthesis for total knee arthroplasty between January 2003 and June 2011. There were 14 males and 10 females, aged from 60 to 81 years (mean, 70 years). The disease causes included osteoarthritis in 5 cases, rheumatoid arthritis in 7 cases, traumatic arthritis in 9 cases, and Charcot's arthropathy in 3 cases. The disease duration ranged from 5 to 25 years (mean, 14.5 years). Of them, 13 cases had flexion deformity, 7 cases had valgus deformity, and 16 cases had varus deformity. The operation time, the amount of bleeding between operation and drainage-tubes removal, hospitalization time, incision healing, and complications were recorded. The results were evaluated according to Knee Society Score (KSS), visual analogue scale (VAS), and the range of motion (ROM) of knee. Short-form 36 health survey scale (SF-36) was used to evaluate the life quality of patients. The position of prosthesis was observed through X-ray examination.
The operation time ranged from 70 to 90 minutes (mean, 78 minutes). The amount of bleeding between operation and drainage-tubes removal ranged from 400 to 1 000 mL (mean, 650 mL). The hospitalization time ranged from 14 to 18 days (mean, 15.2 days). Patellar fracture occurred in 1 case (4.17%) during operation, swelling and effusion of incision in 1 case (4.17%), and periprosthetic infections in 2 cases (8.33%) after operation. All patients were followed up 2-10 years (mean, 5.5 years). The X-ray films showed no evidence of obvious radiolucent line, osteolysis, prosthesis subsidence, and limb alignment change. The results of KSS, VAS socres, and ROM of knee at 1 year postoperatively and last follow-up were significantly better than preoperative ones (P < 0.05), but no significant difference was found between at 1 year postoperatively and last follow-up (P > 0.05). The physiological function and body pain scores were significantly lower than the reference value of urban men over 60 years old from Sichuan province (t = 2.42, P = 0.02; t = 5.26, P = 0.00), but no significant difference was found in the other scores of the SF-36 when compared with the reference value (P > 0.05).
The mid-term effectiveness of total knee arthroplasty using rotating hinge knee for severe knee prosthesis deformity is satisfactory. But complications of postoperative infection should be emphasized.
评估旋转铰链式膝关节假体治疗严重膝关节畸形的中期疗效。
回顾性分析2003年1月至2011年6月期间接受旋转铰链式膝关节假体全膝关节置换术的24例患者（24膝）的临床资料。其中男性14例，女性10例，年龄60～81岁，平均70岁。病因包括骨关节炎5例，类风湿关节炎7例，创伤性关节炎9例，夏科氏关节病3例。病程5～25年，平均14.5年。其中屈曲畸形13例，外翻畸形7例，内翻畸形16例。记录手术时间、手术至拔除引流管期间的出血量、住院时间、切口愈合情况及并发症。根据膝关节协会评分（KSS）、视觉模拟评分法（VAS）及膝关节活动范围（ROM）评估结果。采用健康调查简表36（SF-36）评估患者生活质量。通过X线检查观察假体位置。
手术时间70～90分钟，平均78分钟。手术至拔除引流管期间的出血量400～1000ml，平均650ml。住院时间14～18天，平均15.2天。术中发生髌骨骨折1例（4.17%），术后切口肿胀积液1例（4.17%），假体周围感染2例（8.33%）。所有患者随访2～10年，平均5.5年。X线片显示无明显透亮线、骨溶解、假体下沉及肢体对线改变。术后1年及末次随访时的KSS、VAS评分及膝关节ROM结果均显著优于术前（P<0.05），但术后1年与末次随访时比较差异无统计学意义（P>0.05）。生理功能和身体疼痛评分显著低于四川省60岁以上城市男性参考值（t=2.42，P=0.02；t=5.26，P=0.00），但与参考值比较，SF-36其他评分差异无统计学意义（P>0.05）。
旋转铰链式膝关节假体全膝关节置换术治疗严重膝关节畸形的中期疗效满意，但应重视术后感染等并发症。
