| Objective:To investigate the clinical effect of ACCK condylar restrictive prosthesis in complex knee joint primary arthroplasty.Methods:A total of 28 patients(35 knees)who underwent knee arthroplasty for the first time in our department from January 2013 to June 2015 were retrospectively analyzed.The mean follow-up period was 25 months(range,15-34 months).All the patients with primary knee arthroplasty were treated with ACCK condylar restrictive prosthesis.All cases were performed by a senior medical doctor who had been engaged in joint replacement for a long time.Functional exercise was performed in accordance with the unified rehabilitation program.The data were recorded,including name,gender,age,limb,varus or valgus deformity,joint activity,preliminary diagnosis and follow-up time;through the knee joint and lateral patellar axial,limb weight-bearing feature,imaging examination of knee joint prosthesis before and after surgery,postoperative femoral tibial angle;the HSS score,KSS score and clinical KSS score,VAS score of knee score,HSS score,KSS score and excellent rate of intraoperative evaluation;according to the AORI classification of tibial bone defect were classified,and give the corresponding treatment,inclusive bone defects or uncontained bone defect and prolong bar use,treatment of patella;postoperative complications.This study was to investigate the ACCK prosthesis for the soft tissue release technology still can not meet the complex primary knee replacement effect of preliminary stability;platform tibial bone defect and corresponding treatment according to the AORI classification,the stability of the prosthesis;Results:All the patients were followed up,including 12 males and 16 females with an average age of 68.9 years,with 19 left knees and 16 right knees,Varus14 knees,valgus knees,21,with an average follow-up of 25 months.According to the AORI of tibial defect type: no defect in 9 knees(6 knees metaphyseal drilling,3 knees without treatment),I degrees 13(of which 8knee bone cement,bone cement and screw in 5 knees,IIdegrees 11 knees(metal gasket filled),III degrees 2 knees(bone grafting and metal gasket);inclusive of 24 knees,11 knees uncontained;24 knees replacement of the patella,11 knees without patellar replacement;all cases were bilateral extension rod.The imaging follow-up showed that 3 knees(8.6%,2 knees anterior femoral condylar,1 knee medial tibial plateau)bone cement and bone interface of radiology radiolucent line,after repeated follow-up to determine the radiolucent zone is less than 1mm,no progressive situation.Total knee arthroplasty for femoral anatomical distal femoral shaft and individual mechanical axis angle determined by osteotomy,postoperative knee limb alignment were recovered,the clinical study of postoperative femoral tibial angle(171.50±1.54)was compared with the preoperative tibiofemoral angle(152.63±7.28)was significantly improved,the difference was statistically significant(t=14.41,P<0.05).No knee flexion disorders found after surgery,preoperative knee joint activity(65.23±16.82)degrees,after unified functional exercise of knee joint activity is(108.63±9.53)degrees,there were significant differences between the two groups of data(t=13.47,P < 0.05).The HSS score of the knee joint(87.31±4.30)was significantly higher than that of the preoperative HSS score(34.31±5.03),and the difference was statistically significant(t=46.03,P<0.05).The VAS score of knee joint was decreased from preoperative(8.03±0.56)to postoperative(2.20 ± 0.55),the difference was statistically significant(t=45.56,P < 0.05).The clinical KSS score from preoperative(25.69 ± 6.51)points to improve the postoperative(88.17±33.34),the difference was statistically significant(t=47.60,P < 0.05),preoperative KSS score(19.43 ± 8.56)points,KSSpostoperative score(89.00 ± 5.92),the two groups had statistical significance the difference(t=38.59,P < 0.05).There were no significant complications such as neurovascular injury,prosthesis loosening,joint infection,prosthesis subsidence,joint instability,patellar dislocation,periprosthetic fracture and so on.According to postoperative HSS knee evaluation standard for evaluation:excellent in 27 knees(77.14%),good in 8 knees(22.86%),the excellent rate was 100%;according to the KSS standard for evaluation evaluation: excellent in 31 cases(88.57%),good in 4 knees(11.43%),the excellent rate was 100%.Knee pain relieved after surgery,activity increased significantly,they can take care of themselves,even for mild physical labor,a small number of patients with knee joint local numbness slight pain(suffering from lumbar disc herniation),patients with high satisfaction.Conclusions:1.ACCK prosthesis used for soft tissue lysis technique can not achieve the stability of complex knee replacement,early functional recovery,clinical effect is good,satisfaction rate is high.2 The bone defects of tibial plateau were treated according to the AORI classification and the immediate and early stability was achieved.3 In the knee joint replacement based on the anatomical axis of femur and the angle of the mechanical axis to determine the characteristics of the distal femoral osteotomy,to ensure that the lower limb power line and patellar trajectory is good.4 In the knee replacement,no matter whether the patella was replaced or not,the patella was well adjusted by soft tissue during operation. |
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