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題 名 | Patellar Dislocation after Total Knee Arthroplasty=經全膝人工關節成形術後引起之髕骨脫臼 |
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作 者 | 王世典; 許弘昌; 吳濬哲; 陳天雄; 羅惠熙; 楊大中; | 書刊名 | 中華醫學雜誌 |
卷 期 | 57:5 1996.05[民85.05] |
頁 次 | 頁348-354 |
分類號 | 416.26 |
關鍵詞 | 髕骨脫臼; 近端重整術; 錯位骨材修正術; 全膝人工關節成形術; Patellar dislocation; Proximal realignment; Revision; Total knee arthroplasty; TKA; |
語 文 | 英文(English) |
中文摘要 | 背景 由骨引起之問題,在現今全膝人工關節成形術中,是一個引起 骨材無菌性衰竭的重要原因。全膝人工關節成形術後所引起之骨脫臼並不常見, 但可造成膝部下適之症狀。 方法 自1984年7月至1992年7月,本院施行1100例全膝人工關節成形術。 於追蹤檢查中,我們發現11例因全膝人工關節成形術後引起之骨脫臼。這些病 人中,9例於本院接受手術,另2例則由他院轉至本院。所有的病人均接受手 術治療.其中6例只接受股四頭肌近端電整術,2例接受錯位骨材修正術,2例 接受近端及遠端重整術,1例接受骨韌帶移轉術。 結果 經平均21.8個月的追蹤檢查,只發生一例因外傷引起之術後重脫臼,平 均膝功能量表為90.5分,其手術結果令人滿意。 結論 在我們的病例報告中,造成骨脫臼最常兒的原因為手術技術的錯誤。在 骨材位置不正的情況下,骨材重整術是必需的。在股四頭肌不平衡的情況下, 我們建議使用股四頭肌近端重整術,遠端重整術(骨韌帶移轉術)只在近端電 整術失敗,而無法保持骨正確的軌跡時,才建議使用,但手術時需非常小心, 以避免嚴重的併發症。 |
英文摘要 | Background.Patellar problem is an important cause of nonseptic failure of the current condylar design of total knee arthroplasties. Patellar dislocation after total knee arthroplasty is infrequent but can cause disabling symptoms. Methods. From March, '84 to July, '92, 1652 total knee arthroplasties were performed at this Hospital. Of these 1100 knees in 978 patients were available to be followed up regularly at the Outpatient Department. Eleven cases of patellar dislocation after total knee arthroplasty were encountered during follow-up. Among these patients, nine patients had received operation at this Hospital; the other two patients had been referred here by the other hospitals. All 11 patients had been treated with surgical methods: proximal realignment of the quadriceps alone in 6 knees, lateral retinacular release combined with revision of the malaligned components in 2 knees, combined proximal and distal realignment in 2 knees and patellar tendon transfer in 1 knee. Results. After an average follow-up of 21.8 months, from April, '84 to April, '93, there was one redislocation, unfortunately caused by trauma. Using the average knee rating scale of the Hospital for Special Surgery, New York, USA, the results of 90.5 were satisfactory and encouraging. Conclusions.Patellar dislocation after total knee arthroplasty can cause disabling symptoms, including pain, weakness, limited range of motion, extension lag and difficulty when climbing up or down stairs. The cause of patellar dislocation after total knee arthroplasty was error in surgical technique in this series. Revision of the component should be performed in those with malaligned component. Proximal realignment is recommended in those with quadriceps imbalance. Distal realignment is recommended only when proximal realignment alone has failed to restore proper patellar tracking, this should be carried out with great caution due to the potential for serious complications. |
本系統中英文摘要資訊取自各篇刊載內容。