Background::Total knee arthroplasty (TKA) can reduce severe joint pain and improve functional disability in hemophilia. However, the long-term outcomes have rarely been reported in China. Therefore, this study aimed to evaluate the long-term outcomes and complications of TKA in Chinese patients with hemophilic arthropathy.Methods::We retrospectively reviewed patients with hemophilia who underwent TKA between 2003 and 2020, with at least 10 years of follow-up. The clinical results, patellar scores, patients’ overall satisfaction ratings, and radiological findings were evaluated. Revision surgery for implants during the follow-up period was recorded.Results::Twenty-six patients with 36 TKAs were successfully followed up for an average of 12.4 years. Their Hospital for Special Surgery Knee Score improved from an average of 45.8 to 85.9. The average flexion contracture statistically significantly decreased from 18.1° to 4.2°. The range of motion (ROM) improved from 60.6° to 84.8°. All the patients accepted patelloplasty, and the patients’ patellar score improved from 7.8 preoperatively to 24.9 at the last follow-up. There was no statistically significant difference in clinical outcomes between the unilateral and bilateral procedures, except for a better ROM at follow-up in the unilateral group. Mild and enduring anterior knee pain was reported in seven knees (19%). The annual bleeding event was 2.7 times/year at the last follow-up. A total of 25 patients with 35 TKAs were satisfied with the procedure (97%). Revision surgery was performed in seven knees, with 10- and 15-year prosthesis survival rates of 85.8% and 75.7%, respectively.Conclusions::TKA is an effective procedure for patients with end-stage hemophilic arthropathy, which relieves pain, improves knee functions, decreases flexion contracture, and provides a high rate of satisfaction after more than ten years of follow-up.

目的:探讨全膝关节置换术(TKA)中髌骨成形联合软骨面切除成形对早期功能及膝前痛的影响。方法:采用前瞻性对照研究方法，选取2021年2月—2022年4月山东省邹城市人民医院收治的100例膝关节骨性关节炎(KOA)行TKA治疗的患者，采用随机数字表法将其分为两组：联合组和对照组，每组各50例。联合组患者TKA术中行髌骨成形联合软骨面切除成形术，对照组患者TKA术中仅行髌骨成形术。记录两组术前骨关节炎Kellgren-Lawrance(K-L)分级、关节活动度(ROM)、手术时间、血红蛋白比术前下降值，术后1、3、6、12个月采用美国特种外科医院膝关节功能评分(HSS)测评膝关节功能，采用视觉模拟评分(VAS)评价患者爬楼梯时的膝前痛症状，采用Feller评分系统评估髌股关节恢复情况。计量资料以均数±标准差( ± s)表示，组间比较采用 t检验；计数资料组间比较采用 χ2检验。 结果:两组患者术前K-L分级、ROM比较，差异均无统计学意义( P>0.05)；联合组患者的手术时间长于对照组[(71.49±9.34) min比(66.27±8.22) min]，差异具有统计学意义( P<0.05)；两组患者的血红蛋白比术前下降值差异无统计学意义( P>0.05)；术后3、6、12个月，联合组患者的HSS评分高于对照组[术后3个月：(76.93±8.26)分比(71.74±7.84)分，术后6个月：(85.72±6.27)分比(81.47±6.19)分，术后12个月：(88.64±5.27)分比(85.72±4.85)分]，差异均具有统计学意义( P<0.05)；术后1、3、6、12个月，联合组患者膝前痛VAS评分低于对照组[术后1个月：(2.54±0.48)分比(2.77±0.63)分，术后3个月：(2.02±0.53)分比(2.58±0.45)分，术后6个月：(1.32±0.35)分比(1.97±0.38)，术后12个月：(1.14±0.33)分比(1.75±0.35)分]，差异均具有统计学意义( P <0.05)；联合组患者术后3、6、12个月膝前痛发生率低于对照组[术后3个月：20.0%比38.0%，术后6个月：14.0%比32.0%，术后12个月：10.0%比28.0%]，差异均具有统计学意义( P <0.05)；术后3、6、12个月，联合组患者髌骨Feller评分高于对照组[术后3个月：(18.63±3.52)分比(15.36±3.28)分，术后6个月：(22.27±3.18)分比(19.63±3.48)分，术后12个月：(25.82±3.27)分比(22.47±3.47)分]，差异均具有统计学意义( P <0.05)。 结论:TKA术中行髌骨成形联合软骨面切除成形可有效预防术后膝前痛的发生，改善治疗效果。

[目的]比较初次人工全膝关节置换术(total knee arthroplasty,TKA)是否髌骨置换的早期临床疗效.[方法]回顾分析2018年2月—2020年12月本科室收治的45例(52膝)初次TKA治疗晚期骨关节炎患者的临床资料,根据医患沟通结果,24例(28膝)行髌骨置换,21例(24膝)未行髌骨置换.比较两组围手术期与随访结果.[结果]两组患者均顺利完成手术,两组手术时间、术中出血量、切口长度和术后下地时间的差异均无统计学意义(P＞0.05).两组患者均获得3个月以上随访,与术前相比,末次随访时两组患者的VAS和KSS评分均显著改善,末次随访时,两组间VAS评分[(1.6±1.0)vs(1.8±0.9),P=0.781]、KSS评分[(86.3±7.9)vs(84.6±7.9),P=0.865]的差异均无统计学意义(P＞0.05).[结论]初次TKA术是否行髌骨置换的早期疗效无明显差异.

在30例伸直型膝关节僵硬松解手术中，对股四头肌成形术作了部分改良，对存在股直肌挛缩和髌股关节严重骨性改变的病例，分别进行股直肌腱延长和髌骨成形。一年以上随访23例，屈膝功能由术前平均31°增至116.7°，伸膝功能恢复正常。作者认为本术式的改良提高了松解效果，股直肌腱延长和髌骨成形会使伸膝功能减弱，但可通过肌力锻炼得到代偿。