( ) ChinJJointSurg(ElectronicEdition), February, Vol., No. Totalkneearthroplastyinrheumatoidstiforankylosed knees SUN Tie-zheng, LU Hou-shan.Arthritis

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孙铁铮吕厚山孙铁铮, 副主任医师, 副教授, 硕士研究生导师年毕业于北京大学, 获得医学博士学位, 在北京大学人民医院关节病诊疗研究中心工作 ; 年曾赴美国纽约 BethIsrael 医学中心关节病诊疗研究中心进修学习人工关节置换和关节镜技术 ; ~ 年赴美国哈佛大学麻省总医院骨科研修目前在北京大学人民医院关节病诊疗研究中心从事关节疾病的诊断和外科治疗年和

1 孙铁铮吕厚山孙铁铮, 副主任医师, 副教授, 硕士研究生导师年毕业于北京大学, 获得医学博士学位, 在北京大学人民医院关节病诊疗研究中心工作 ; 年曾赴美国纽约 BethIsrael 医学中心关节病诊疗研究中心进修学习人工关节置换和关节镜技术 ; ~ 年赴美国哈佛大学麻省总医院骨科研修目前在北京大学人民医院关节病诊疗研究中心从事关节疾病的诊断和外科治疗年和年连续获得两项国家自然科学基金课题资助, 和年分别在 JournalofArthroplasty 和 JournalOrthopedicResearch 发表论文 (RA), RA ( ) ( ),, (KSS), ( ),. ( ~ ),. ( ~ ),. ( ~ ), KSS. ( ~ ),.,,,,. ( ~ ),. ( ~ ), KSS ( ~ ),. ( ~ ),. ( ~ ), KSS. ( ~ ),. ( ~ ),,,,,, RA, ; ;, ;,, ; ; ; ;,, DOI:. /cma.j.isn. - X... : : lu [email protected]

2 ( ) ChinJJointSurg(ElectronicEdition), February, Vol., No. Totalkneearthroplastyinrheumatoidstiforankylosed knees SUN Tie-zheng, LU Hou-shan.ArthritisClinicandResearch Center, People shospitalpekinguniversity, Beijing, China Corespondingauthor:LUHou-shan, [email protected] Abstract Objective Toinvestigatetheefectsoftotalkneearthroplastyinlatephaserheumatoidarthritis(RA)withstifor ankylosedknees.methods Aretrospectivestudyoftotalkneearthroplastieswascariedoutin rheumatoidankylosedorstifknees inflexion, andthreerheumatoidankylosedkneesinextension, whichweredonebytheseniorauthorbetwen -.Results Inthegroupof patientswithankylosedkneesinflexion, folow-uptimerangedfrom oneto years(average. years).the averagepostoperativerangeofmotionwas. ( - ), scorewas. ( - )postoperative, andtheaverageextensionlagwas. ( - ).Theaverageknee. morethanthepreoperative.onepatientwithrheumatoidarthritishadasupracondylar fractureduringextension exerciseinpostoperativerehabilitation, andtwopatientshadlate-phaseinfection, whichneeded tobe revised.threepatientshadtransientpalsyofthecommonperonealnervebutrestoredtonormalstateinhalfayearafteroperation.the averagefolow-uptimeofthethreekneesankylosedinextension was. months(rangingfrom sixmonthstonineyears). Radiographsrevealed noinfection, looseningordisplacement, noheterotrophicosificationorstifness.themeanvalueofpreoperativerom was. ( - ), butpost-operativerom was ( - ), sotheoveralimprovementinrom was.. ThemeanKSSscoreimprovedfrom ( - )to. ( - )andthefunctionalscoreimprovedfrom. ( - )to. ( - ).Therewas extensionlaginoneknebecauseofpatelatendonavulsion.therewasonepatientwithskinedgenecrosis, whosewoundhadhealedatdischargebydecreasingtheexerciseintensityandfrequency.therewasanotherkneewithsuperficial woundinfectionatearly-stageaftertheoperation, whichresolvedafterdebridement, tension-decreasingsutureandsensitiveantibiotics. Conclusions AlthoughTKAinanankylosedkneedemandshightechniquesandhasahighrateofcomplications, itisreliablefor achievingpainrelief, increasingrangeofmotion, maintainingstability, andimprovingwalkingabilityinpatientswithstifand ankylosedkneesinflexionorextensionbycarefulselectionofpatients, meticuloussurgicaltechniqueandagressiverehabilitation. Keywords Arthritis, rheumatoid;knee;ankylosis;stif;arthroplasty, replacement, kne (rheumatoidarthritis, RA),,,,,,,, ( ),,,,,,,,, [ ] ~,,,,, RA,,,. ( ~ ) (StrykerScorpio

3 , DepuyPFC ), ( PCA ) ( ),,,,,, ;,,,,,,,,,,,, X,,,,,,,,,,,,,,,,,,,,,,, ~,,,,,,,,,,,,,,,,,,,,,

4 ( ) ChinJJointSurg(ElectronicEdition), February, Vol., No.,,,,,,,,,, ;,, ;,,,,,, (CPM),,,,,,,,,, Ⅲ,,,,, CPM, ( ~ ), ; Ⅳ,, ( ),,,,,, (KSS) ; X (,, ) ( ),, m,. ( ~ ),. ( ~ ),. ( ~ ), KSS. ( ~ ),.,,, ;,,,,,,,,,, ;,, ;,

5 ,. ( ~ ), X,,, KSS ( ~ ),. ( ~ ),. ( ~ ),, ;KSS. ( ~ ),. ( ~ ),,,, RA, RA,,, RA ( ),,,,,,,,,,,,,,,,, RA,,, [ ], [ ],,,,,,,, [ ],, V-Y, V-Y,,,, [ ],,,, [ ], Garvin [ ],,,,,,

6 ( ) ChinJJointSurg(ElectronicEdition), February, Vol., No.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ~,,,,, [ ],,,,, RA,, RA.,, RA,,,,, RA,,,,,,,,,,, [ ] KimYH, Kim JS, ChoSH.Totalkneereplacementafterspontaneousoseousankylosisandtakedownofformalkneefusion.J Arthroplasty,, ( ): -. [ ] SculcoTP.Managementofthestifkne. Calaghan J, RosenbergAG, Rubash HE, etaleds.theadultknee. Philadelphia, PA:LippincotWiliams Wilkins,, -. [ ] BradleyGW, FreemanMA, AlbrektssonBE.Totalprostheticreplacementofankylosedknees.JArthroplasty,, ( ):

7 -. [ ] RajgopalA, AhujaN, DolaiB.Totalkneearthroplastyinstifandankylosedknees.JArthroplasty,, ( ): -. [ ] TrousdaleRT, HansenAD, RandJA, etal.v-y quadricepsplastyintotalknearthroplasty.clinorthop, ( ): -. [ ] WhitesideLA.Exposureindificulttotalkneearthroplastyusingtibialtubercleosteotomy.ClinOrthop, ( ): -. [ ] GarvinKL, ScuderiG, InsalJN.Evolutionofthequadricepssnip.ClinOrthop, ( ): -. [ ] KimYH, ChoSH, Kim JS.Totalknearthroplastyinbonyankylosisingrossflexion.JBoneJointSurgBr,, ( ): -. ( : - - ) 孙铁铮, 吕厚山. 晚期类风湿关节炎合并膝关节强直或僵直畸形行人工膝关节置换术 [ J/CD]. 中华关节外科杂志 : 电子版,, ( ): -.

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