旋转铰链膝在复杂初次膝关节置换中的应用及临床疗效

doi:10.6040/j.issn.1671-7554.0.2025.1535

摘要/Abstract

摘要： 目的探讨旋转铰链型膝关节假体在复杂初次全膝关节置换术中的临床应用并评价其临床疗效。方法回顾性分析2012年4月至2024年11月北京积水潭医院矫形骨科因严重膝关节畸形或韧带功能不全而使用旋转铰链型假体行初次膝关节置换患者36例(38膝)的临床资料,其中男15例(16膝),女21例(22膝),25~78(62.1±11.4)岁。术前诊断包括严重内外翻畸形、神经性关节病和创伤后关节炎等。采用美国膝关节协会评分(Knee Society Score, KSS)评估膝关节疼痛、稳定性及功能;使用量角器测量膝关节主动活动范围(range of motion, ROM),比较患者术前及末次随访时的膝关节协会评分和膝关节活动度,记录术后并发症情况和患者满意度,采用Kaplan-Meier法计算假体生存率,以任何原因的假体翻修或有症状的影像学松动为终点事件。结果所有患者随访时间(75.8±38.1)个月。末次随访时,膝关节KSS评分由术前(26.1±12.1)分提升至(77.2±18.5)分,功能评分由(26.3±15.9)分提升至(70.5±22.6)分,活动度由(79.5±32.9)°改善至(99.6±19.4)°,差异均有统计学意义(P<0.001)。术后患者满意度为86.7%。至末次随访,共有3膝(7.9%)发生终点事件。假体5年累积生存率为94.6%(95%CI: 87.6~100)。总并发症发生率为26.3%(10/38膝),包括术中骨折、伤口延迟愈合、术后铰链柱脱出、假体松动及关节僵硬。结论旋转铰链膝应用于复查初次膝关节置换,可以显著改善患者膝关节功能,中期假体生存率满意,但其并发症发生率较高,严格选择适应证是手术成功的关键。

关键词: 关节成形术, 置换, 膝, 旋转铰链膝, 临床疗效

Abstract: Objective To investigate the clinical application of rotating hinge knee(RHK)prosthesis in complex primary total knee arthroplasty(TKA)and evaluate the clinical efficacy. Methods A retrospective analysis was conducted on 36 patients(38 knees)who underwent primary TKA using a RHK prosthesis between April 2012 and November 2024 for severe knee deformity or ligamentous insufficiency. The cohort included 15 males(16 knees)and 21 females(22 knees), with(62.1±11.4)years at surgery. Preoperative diagnoses included severe varus/valgus deformity, neuropathic arthropathy, and post-traumatic arthritis. The American Knee Society Score(KSS)was used to assess knee pain, stability and function, and the active range of motion(ROM)of the knee was measured using a gonio-meter. Preoperative and final follow-up KSS and ROM were compared. The postoperative complications and patient satisfaction were assessed. Prosthesis survival was calculated using the Kaplan-Meier method, with revision for any reason or symptomatic radiographic loosening defined as the endpoint. Results All patients were followed up for(75.8±38.1)months. At the final follow-up, significant improvements were observed: the KSS knee score increased from(26.1±12.1)to(77.2±18.5)points, the function score from(26.3±15.9)to(70.5±22.6)points, and ROM from(79.5±32.9)° to(99.6±19.4)°(P<0.001). Patient satisfaction was 86.7%. Three knees(7.9%)reached the endpoint by the final follow-up. The 5-year cumulative survival rate was 94.6%(95%CI: 87.6-100). The overall complication rate was 26.3%(10/38 knees), including intraoperative fracture, delayed wound healing, postoperative hinge post dislocation, prosthetic loosening, and joint stiffness. Conclusion The application of rotating hinge knees in complex primary TKA can significantly improve knee function and yield satisfactory mid-term prosthesis survival. However, the procedure is associated with a high complication rate. Successful outcomes depend on strict patient selection.

Key words: Arthroplasty, Replacement, Knee, Rotating hinge knee, Clinical outcome

中图分类号:

R687.4

王兴山,张浩天,张云峰,周一新. 旋转铰链膝在复杂初次膝关节置换中的应用及临床疗效[J]. 山东大学学报 (医学版), 2026, 64(4): 51-57.

WANG Xingshan, ZHANG Haotian, ZHANG Yunfeng, ZHOU Yixin. Application and clinical outcomes of rotating hinge knee prosthesis in complex primary total knee arthroplasty[J]. Journal of Shandong University (Health Sciences), 2026, 64(4): 51-57.

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