全膝关节置换术后严重异位骨化及关节僵硬.docVIP

全膝关节置换术后严重异位骨化及关节僵硬 　 作者：陈百成，高石军，孙然，邵德成，王晓峰 【关键词】 全膝关节置换 　　摘 要： 　　［目的］探讨全膝关节置换术后严重异位骨化与关节僵硬的关系。［方法］对420例接受全膝关节置换术的患者随访，其中9例出现了Ⅲ级异位骨化，分别测量并记录该9例患者术后2周、12个月的疼痛评分和膝关节活动度，拍摄X线片，测量异位骨的大小。随机抽取9例无异位骨化的关节置换术后患者作为对照组，并测量疼痛评分及活动度。分别将异位骨化组和对照组的结果进行对比。［结果］关节置换术后Ⅲ级异位骨化的发病率为21％，X线片显示异位骨gt;5 cm，侵及股四头肌，引起关节疼痛。异位骨化组术后2周疼痛评分平均256分，关节最大伸直角度平均11°，最大屈曲角度1191°，与对照组比较差异均无统计学意义(Pgt;005)。异位骨化组术后12个月疼痛评分平均1556分，低于术后2周(Plt;001)，与对照组术后12个月(25分)比较有显著差异(Plt;001)。关节活动度：伸直61°，屈曲917°与术后2周和对照组术后12个月比较均有显著差异(Plt;001)。［结论］全膝关节置换术后Ⅲ级异位骨化可以导致关节疼痛和活动度受限，是术后关节僵硬的原因之一，严重影响置换术后临床效果。 　　关键词：全膝关节置换; 异位骨化; 僵硬 　　　Abstract：［Objective］To study the relation between hard heterotopic ossification after TKA and knee stiff.［Method］A total of 420 TKA patients were followed up.A total of 9 knees showed type Ⅲ heteroropic ossification .Postoperative range of motion,pain scores and X ray were obtained at 2 weeks and 12 months.Random sample of 9 knees without heteroropic ossification as control group.［Result］The rate of type Ⅲ heteroropic ossification after TKA was 2.1%,the size was larger than 5cm,the new bone invaded extensor mechanism and lead to pain in knee.Two weeks after TKA,the pain scores of HO group were 25.6,the degree of extend was 1.1°,the degree of flection was 119.1°. There were no differencets between HO group and comparison group (Pgt;0.05) .Twelve months after TKA, the pain score of HO group was 15.56,lower than 2 weeks and comparison group in 12 months (Plt;0.01).The degree of extend was 6.1°, flection was 91.7°.There was statistically significance campaired with 2 weeks and comparison group(Plt;0.01).［Conclusion］Ⅲ heteroropic ossification after TKA leads to knee pain and limit of range of motion. It is one of the reasons lead to knee stiff. 　　Key words：Total knee arthroplasty; Heterotopic ossification; Knee stiff 　　全膝关节置换术后的异位骨化日益受到学者的关注，文献报道其发病率在1％～40％之间，其中严重异位骨化的发病率约为1％左右。本篇文章Ⅲ级异位骨化对全膝关节置换术后关节活动度的影响进行探讨。 　　1 资料和方法 　　1999年1月～2005年12月间9例在本院接受全膝关节置换的患者(9例膝)出现了Ⅲ级的异位骨化。3例为男性，6例女性。平均年龄63岁(60～75岁)。平均随访时间146个月