Lee D C, Kim D H, Scott R D, Suthers K
Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts, USA.
J Arthroplasty. 1998 Aug;13(5):500-3. doi: 10.1016/s0883-5403(98)90047-x.
To assess a method of predicting the final postoperative flexion in individual cases after total knee arthroplasty, 364 primary posterior cruciate-retaining total knee arthroplasties were reviewed retrospectively. The knees were subdivided into three preoperative flexion groups--I: poor motion (0 degrees to 85 degrees), II: intermediate motion (90 degrees to 110 degrees), and III: good motion (115 degrees to 140 degrees). There were 302 cases of osteoarthritis and 62 rheumatoid knees (12 juvenile rheumatoid). Correlation was made between preoperative; intraoperative, and postoperative (minimum 2-year follow-up) passive knee flexion for individuals. Intraoperative flexion against gravity was measured after capsular closure by passively flexing the patient's hip 90 degrees and allowing the weight of the lower leg to flex the knee joint. The overall mean value of postoperative flexion for all three groups was similar to preoperative and intraoperative flexion in both osteoarthritis and rheumatoid arthritis. In the poor motion group (I), postoperative flexion (103 degrees) was increased over preoperative flexion (84 degrees) but similar to intraoperative flexion (104 degrees). In the intermediate group (II), postoperative flexion (110 degrees) was similar to both the preoperative flexion (108 degrees) and intraoperative flexion (110 degrees). In the good group (III), postoperative flexion (119 degrees) tended to be less than preoperative flexion (123 degrees) and more than intraoperative flexion (116 degrees), but the differences were not statistically significant. When comparing preoperative and intraoperative flexion to postoperative flexion for individual cases, 55% of knees had postoperative flexion +/-10 degrees of their preoperative value, while 97% of knees had postoperative flexion +/-10 degrees of their intraoperative value. This study indicates that the final postoperative mean flexion for a group of patients with poor preoperative flexion (<85 degrees) and for individual cases (regardless of their preoperative mobility) can best be predicted by intraoperative flexion against gravity rather than by a preoperative value.
为评估一种预测全膝关节置换术后个体最终术后屈曲度的方法，对364例初次后交叉韧带保留型全膝关节置换术进行了回顾性研究。将膝关节分为三个术前屈曲组——I组：活动度差（0度至85度），II组：活动度中等（90度至110度），III组：活动度良好（115度至140度）。其中骨关节炎患者302例，类风湿性膝关节患者62例（12例幼年类风湿性关节炎）。对个体的术前、术中和术后（至少2年随访）被动膝关节屈曲度进行相关性分析。在关节囊闭合后，通过被动屈曲患者髋关节90度并让小腿重量使膝关节屈曲来测量术中抗重力屈曲度。在骨关节炎和类风湿性关节炎患者中，所有三组术后屈曲度的总体平均值与术前和术中屈曲度相似。在活动度差的组（I组）中，术后屈曲度（103度）比术前屈曲度（84度）有所增加，但与术中屈曲度（104度）相似。在中等活动度组（II组）中，术后屈曲度（110度）与术前屈曲度（108度）和术中屈曲度（110度）相似。在良好活动度组（III组）中，术后屈曲度（119度）往往小于术前屈曲度（123度）且大于术中屈曲度（116度），但差异无统计学意义。当比较个体病例的术前和术中屈曲度与术后屈曲度时，55%的膝关节术后屈曲度与其术前值相差±10度，而97%的膝关节术后屈曲度与其术中值相差±10度。本研究表明，对于术前屈曲度差（<85度）的一组患者以及个体病例（无论其术前活动度如何），术后最终平均屈曲度最好通过术中抗重力屈曲度而非术前值来预测。
