可旋转铰链膝在晚期夏科氏膝关节病的应用

Rotating hinged total knee arthroplasty for end-stage Charcot’s joint of the knee

摘要:

[目的]探讨可旋转铰链全膝置换(total knee arthroplasty, TKA)在晚期夏科氏膝关节病的应用及近期临床效果。[方法] 2013 年 1 月—2020 年 1 月可旋转铰链膝置换治疗膝 Charcot 关节病 11 例 12 膝，观察围手术期、随访及影像学情况。[结果] 所有患者均顺利完成手术，术中无神经、血管损伤等严重并发症，所有患者均获随访，随访时间 18~84 个月，平均 (38.73±13.51)个月，末次随访 AKSS 临床评分、功能评分、SF-36 评分、ROM 均较术前显著增加，差异均有统计学意义(P＜ 0.05)。影像方面，末次随访，HKA 较术前显著增加，而 MPTA 较术前显著减少，差异均有统计学意义(P＜0.05)，术前与末次随访 PTS 的差异无统计学意义(P＞0.05)。末次随访 X 线片均显示假体位置良好，无松动表现，无假体周围骨折。[结论]可旋转铰链全膝关节置换治疗晚期夏科氏膝关节病短期疗效确切，远期疗效有待进一步随访。

Abstract:

[Objective] To explore the short-term clinical outcomes of rotating hinged total knee arthroplasty (TKA) for end-stage Char- cot joint of the knee. [Methods] From January 2013 to January 2020, 11 patients with Charcot arthropathy of the knee were treated by rotat- ing hinged total knee arthroplasty. The documents regarding to perioperative period, follow-up and radiographs were summarized. [Results] All the patients had operation completed successfully without neurovascular injuries and other serious complications. All patients were fol- lowed up for 18~84 months, with an average of (38.73±13.51) months. The AKSS clinical score and functional score, as well as SF-36 score and range of motion (ROM) significantly improved at the latest follow-up compared with those before operation (P＜0.05) . Radiographically, the hip-knee-ankle (HKA) angle significantly increased, whereas the medial proximal tibial angle (MPTA) significantly decreased at the latest follow up compared with those preoperatively (P＜0.05) , however, the posterior tibial slope (PTS) remained unchanged (P＞0.05) . By the time of last follow-up, the prostheses were in good position with no loosening and no periprosthetic fractures in anyone of them. [Conclusion] The rotating hinged total knee arthroplasty does achieve sound short-term clinical outcomes for treatment of end-stage knee neuro- arthropathy, but its long-term outcome needs further follow-up.