摘要
[目的]比较膝周围骨折内固定后创伤性关节炎一期与二期全膝置换(total knee arthroplasty,TKA)的临床结果。[方法]回顾性分析2020年1月—2022年12月本院膝周围骨折内固定后创伤性关节炎行TKA的40例患者的临床资料。依据医患沟通结果,20例取出内固定同时行TKA(一期组),另外20例一期手术取内固定物,3~6个月后二期手术TKA(二期组)。比较两组围手术期、随访和影像结果。[结果]所有患者均顺利完成TKA术,无严重并发症。一期组总手术时间[min,(80.8±3.1)vs(71.1±2.9),P<0.001]、总切口长度[cm,(19.8±0.8)vs(14.2±0.8),P<0.001]、总术中失血量[mL,(56.7±2.9)vs(42.0±1.9),P<0.001]、总术后引流量[mL,(55.4±4.0)vs(40.6±5.1),P<0.001]均显著大于二期TKA组,一期组总住院时间显著短于二期组[d,(12.7±1.3)vs(17.2±1.2),P<0.001]。平均随访时间(35.0±9.4)个月,随着时间的推移,两组的VAS和WOMAC评分显著减少(P<0.05),而膝关节伸屈ROM,HSS和KSS评分显著增加(P<0.05);相应时间点,两组上述指标的差异均无统计学意义(P>0.05)。影像方面,随着时间的推移,两组下肢HKA明显减少(P<0.05),而mLDFA及mMPTA则显著增加(P<0.05),相应时间点两组间影像测量指标的差异均无统计学意义(P>0.05)。[结论]一期或二期TKA治疗膝周围骨折内固定后创伤性关节炎的临床效果相当,但一期TKA住院总时间短,且不需二次手术。
[Objective]To compare the clinical outcomes of one-stage versus two-stage total knee arthroplasty(TKA)for traumatic ar⁃thritis after internal fixation of fractures around the knee.[Methods]A retrospective study was conducted on 40 patients who underwent TKA for traumatic arthritis after internal fixation of fractures in our hospital from January 2020 to December 2022.According to doctor-pa⁃tient communication,20 patients underwent TKA simultaneously with internal fixation removal(the one-stage group),while the other 20 pa⁃tients underwent internal fixation removal in the first stage and TKA in the second stage 3 to 6 months later(the two-stage group).Perioper⁃ative,follow-up,and imaging data were compared between the two groups.[Results]All the patients had TKA completed successfully with⁃out severe complications.The one-stage group proved significantly greater than the two-stage TKA group in terms of total operation time[min,(80.8±3.1)vs(71.1±2.9),P<0.001],total incision length[cm,(19.8±0.8)vs(14.2±0.8),P<0.001],total intraoperative blood loss[mL,(56.7±2.9)vs(42.0±1.9),P<0.001],and total postoperative drainage volume[mL,(55.4±4.0)vs(40.6±5.1),P<0.001],whereas the one-stage group had significantly shorter hospital stay than the two-stage group[days,(12.7±1.3)vs(17.2±1.2),P<0.001].As time went during follow-up period lasted for(34.95±9.40)months in a mean,the VAS and WOMAC scores significantly decreased(P<0.05),while the knee flexion-extension ROM,HSS,and KSS scores in both groups significantly increased(P<0.05),which were not statistically significantly dif⁃ferent between the two groups at any time points accordingly(P>0.05).Regarding imaging,the HKA of the lower extremities significantly decreased(P<0.05),while the mLDFA and mMPTA significantly increased in both groups over time(P<0.05),regardless of no statistically significant differences between the two groups at any corresponding time points(P>0.05).[Conclusion]The one-stage and two-stage TKA for traumatic arthritis after internal fixation of fractures around the knee are comparable in clinical outcome.However,the one-stage TKA has a shorter total hospital stay and does not require a second operation.
作者
崔锁明
祁伟
陈燕
吴燕
徐正
文志
凌冬冬
王焱
顾永福
CUI Suo-ming;QI Wei;CHEN Yan;WU Yan;XU Zheng;WEN Zhi;LING Dong-dong;WANG Yan;GU Yong-fu(Department of Orthopaedics,Zhenjiang 359 Hospital,Zhenjiang 212001,Jiangsu,China)
出处
《中国矫形外科杂志》
北大核心
2026年第4期331-336,共6页
Orthopedic Journal of China
关键词
膝周围骨折内固定
膝关节创伤后骨关节炎
全膝关节置换
临床结果
internal fixation of fractures around the knee
traumatic knee osteoarthritis
total knee arthroplasty
clinical outcomes
