Objective: To investigate the clinical outcomes of total knee arthroplasty (TKA) by using the condylar constrained knee prosthesis in the treatment of destructive hemophilic arthritis.
Methods: Between September 2007 and July 2015, 8 cases (8 knees) of destructive hemophilic arthritis accepted TKA by using condylar constrained knee prosthesis. All patients were male, aged 22 to 56 years, with an average age of 35 years. The disease course of hemophilia A was 3-30 years (mean, 17.3 years). Preoperative range of motion (ROM) was (68.1±32.6)°; the flexion deformity was (14.38±16.13)°. Six patients had valgus of 7-35° (mean, 17.3°), of whom, one had fixed dislocation of patella; and one had varus of 15°. Hospital for Special Surgery (HSS) knee score was 52.5±12.9. Pre-operative X-ray film examination demonstrated narrowing of the knee gap and cystic degeneration of articular cartilage and subchondral bone.
Results: All patients achieved primary wound healing, and were followed up 1-9 years (mean, 5 years). Tense blister with common peroneal nerve damage and extension penetrating into distal tibial cortex occurred in 1 case respectively, which were cured corresponding treatment. At last follow-up, the knee ROM and the flexion deformity were significantly improved to (98.1±8.9)° and (0.63±1.77)° ( t=-2.527, P=0.036; t=2.396, P=0.047). At 2 weeks after operation and last follow-up, the HSS scores were significantly increased to 77.3±11.0 and 85.0±9.0 ( P<0.05). X-ray film showed that lower extremity alignment returned to normal in patients with varus and valgus.
Conclusion: Good curative effect can be get by using condylar constrained knee prosthesis in TKA for the treatment of destructive hemophilic arthritis.
目的: 探讨采用髁限制性假体行人工全膝关节置换术（total knee arthroplasty，TKA）治疗严重毁损性血友病性膝关节炎的临床疗效。.
方法: 2007 年 9 月—2015 年 7 月采用髁限制性假体行 TKA 治疗 8 例（8 膝）严重毁损性血友病性膝关节炎患者。患者均为男性；年龄 22～56 岁，平均 35 岁。均为甲型血友病；病程 3～30 年，平均 17.3 年。术前膝关节活动度（68.1±32.6）°；8 例均存在屈曲挛缩畸形，达（14.38±16.13）°。6 例患者合并外翻畸形，达 7～35°，平均 17.3°，其中 1 例合并固定性髌骨脱位；1 例合并内翻畸形（15°）。美国特种外科医院（HSS）评分为（52.5±12.9）分。术前X线片示膝关节间隙明显变窄，关节软骨及软骨下骨破坏囊性变。.
结果: 患者手术切口均Ⅰ期愈合。8 例术后均获随访，随访时间 1～9 年，平均 5 年。术中 1 例出现延长杆突破胫骨远端皮质，术后 1 例出现张力性水疱伴腓总神经损伤，均经相应处理后治愈。末次随访时，膝关节活动度为（98.1±8.9）°，屈曲挛缩畸形为（0.63±1.77）°，均较术前显著改善（ t=–2.527， P=0.036； t=2.396， P=0.047）。术后 2 周及末次随访时 HSS 评分分别为（77.3±11.0）、（85.0±9.0）分，与术前比较差异均有统计学意义（ P<0.05）。X 线片复查示，术前合并内、外翻畸形患者术后均恢复正常力线。.
结论: 采用髁限制性假体行 TKA 治疗严重毁损性血友病性膝关节炎，可获得良好疗效。.
Keywords: Hemophilia; condylar constrained knee prosthesis; total knee arthroplasty.