人工膝关节置换术中应用高屈曲旋转平台与固定平台假体疗效比较
发布时间：2018-09-17 15:13
【摘要】：目的:探讨人工膝关节置换术中应用高屈曲旋转平台假体与高性能固定平台假体临床疗效。方法:回顾性研究分析自2014年1月至2014年12月在我科行全膝关节置换术患者83例(86膝),依据使用假体类型的不同将患者分为高屈曲旋转平台假体(High flexion rotating platform,RPF)组(46例,47膝)和高性能固定平台假体(High performance fixed platform,HFB)组(37例,39膝)。采集患者基本资料,包括性别、年龄、患侧、体重指数和围手术期出血量等。所有随访患者依据影像学资料应用Kellgren-Lawrence分级标准对关节炎进行影像学分级。所有患者均由一名长期从事关节置换手术的高年资医师主刀完成,两组患者假体及骨水泥均由美国强生公司Depuy提供,术后所有患者按照统一的康复方案行患肢功能锻炼。所有患者均获得随访,随访时间为2年,随访内容包括:1.美国特种外科医院膝关节评分(Hospital for special surgery knee score,HSS),参照末次随访评分计算优良率(优大于等于85分,良70~84分,中60~69分,差小于59分);2.膝关节活动度(range of motion,ROM);3.术前、术后1周、术后6个月及术后2年随访时膝关节正侧位片;4.是否有膝关节置换术后并发症发生。通过HSS评分评估患者膝关节疼痛程度及功能情况,通过影像学资料了解假体位置情况、是否有假体松动、假体下沉、骨溶解等。结果:所有患者均获得随访。其中RPF组患者46例(47膝),男6例,女40例;年龄47~82(64.2±8.6)岁;右膝28例,左膝19例;体重指数25.8±3.5kg/m~2;骨关节炎影像学分级Ⅲ级31例,Ⅳ级16例;围手术期出血量1016.7±240.1ml。HFB组患者37例(39膝),男11例,女26例;年龄52~81(64.9±8.1)岁;右膝19例,左膝20例;体重指数26.1±3.9kg/m~2;骨关节炎影像学分级Ⅲ级26例,Ⅳ级13例;围手术期出血量1012.3±297.9ml。分别将RPF组和HFB组患者年龄、患侧、性别比、体重指数、骨关节炎影像学分级、围手术期出血量进行统计学分析,差异无统计学意义(P0.05),两组资料具有可比性。所有患者术后切口均为一期愈合,无皮肤坏死、切口感染发生。至末次随访,所有患者无假体松动、假体下沉、下肢深静脉血栓形成等。所有患者无髌骨骨折、髌骨脱位及髌韧带损伤等并发症发生,但RPF组中有6例患者、HFB组中有4例患者出现关节摩擦音或关节弹响的问题,经比较两组差异无统计学意义(P0.05)。HSS评分术前RPF组为33.8±4.1分、HFB组为34.2±3.7分;末次随访RPF组为90.3±3.5分、HFB组为89.4±4.4分。两组末次随访与术前HSS评分比较差异有统计学意义(P0.001);两组末次随访HSS评分比较差异无统计学意义(P0.05)。末次随访RPF组HSS评分优39例,良5例,中3例,差0例,优良率为93.6%;HFB组HSS评分优32例,良5例,中2例,差0例,优良率为94.8%,两组优良率比较差异无统计学意义(P0.05)。膝关节活动度术前RPF组为86.0±9.4°、HFB组为84.4±9.3°;末次随访RPF组为123.8±18.4°、HFB组为110.8±9.6°。两组膝关节活动度末次随访与术前比较差异有统计学意义(P0.001);末次随访膝关节活动度两组比较差异有统计学意义(P0.001)。结论:1.RPF假体与HFB假体在临床疗效上相类似,患者满意度均较高,但RPF假体可获得较高的关节活动度,更加适用于对膝关节活动度要求较高的患者。2.RPF假体衬垫旋转作用可提供患者较佳的膝关节调节能力,上下楼梯等动作效果更佳。3.因本研究为2年的中期随访,随访时间相对较短,且样本数量少,其远期临床疗效需进一步观察。
[Abstract]:Objective: To evaluate the clinical efficacy of high flexion rotary platform prosthesis and high performance fixed platform prosthesis in total knee arthroplasty (TKA).Methods: A retrospective study was conducted in 83 patients (86 knees) who underwent total knee arthroplasty from January 2014 to December 2014. High flexion rotating platform (RPF) group (46 cases, 47 knees) and high performance fixed platform (HFB) group (37 cases, 39 knees). Basic data of patients, including sex, age, affected side, body mass index and perioperative bleeding volume, were collected. All patients were followed up according to imaging data using Kellgren-Lawrence classification. All patients were performed with a senior surgeon's knife. Prostheses and bone cement were provided by Depuy, a Johnson & Johnson Company in the United States. All patients performed functional exercises according to a unified rehabilitation program. All patients were followed up for a period of time. For 2 years, follow-up included: 1. Hospital for Special Surgery knee score (HSS), according to the final follow-up score, the excellent and good rate was calculated (excellent or equal to 85 points, good 70-84 points, middle 60-69 points, difference less than 59 points); 2. range of motion (ROM); 3. Posterior and lateral radiographs of knee joint were taken at 2-year follow-up.4.Whether complications occurred after knee replacement.The degree of pain and function of knee joint were evaluated by HSS score. (47 knees), male 6, female 40; age 47-82 (64.2 (+ 8.6) years old; right 28, left 19; body mass index 25.8 (+ 3.5 kg / M ~ 2); osteoarthritis imaging grade III 31 cases, grade IV 16 cases; perioperative blood loss 1016.7 (+ 240.1 ml). HFB group 37 cases (39 knees), male 11 cases, female 26 cases; age 52-81 (64.9 (+ 8.1) years old; right 19 cases, left 20 cases; body mass index 26.9 (+ 8.9). There were 26 cases of osteoarthritis grade III and 13 cases of osteoarthritis grade IV. The perioperative bleeding volume was 1012.3 (+ 297.9 ml). Age, sex ratio, body mass index, osteoarthritis imaging grade and perioperative bleeding volume of RPF group and HFB group were statistically analyzed. There was no significant difference between the two groups (P 0.05). At the last follow-up, no prosthesis loosening, prosthesis subsidence, deep venous thrombosis of the lower extremity, etc. No patellar fracture, patellar dislocation, patellar ligament injury and other complications occurred in all patients, but there were 6 cases in RPF group and 4 cases in HFB group. There was no significant difference between the two groups (P 0.05). HSS score was 33.8 (+ 4.1) in RPF group and 34.2 (+ 3.7) in HFB group before operation, 90.3 (+ 3.5) in RPF group and 89.4 (+ 4.4) in HFB group at the last follow-up. There was no significant difference in HSS score between the two groups (P 0.05). At the last follow-up, there were 39 excellent, 5 good, 3 middle and 0 poor HSS scores in RPF group, and the excellent and good rate was 93.6%. In HFB group, there were 32 excellent, 5 good, 2 poor, and 0 poor HSS scores, the excellent and good rate was 94.8%. There was no significant difference in the excellent and good rate between the two groups (P 0.05). There was a significant difference between the two groups in the final follow-up (P 0.001) and the preoperative (P 0.001). Conclusion: 1. RPF prosthesis and HFB prosthesis were similar in clinical efficacy and patient satisfaction. RPF prosthesis can obtain higher joint mobility, which is more suitable for patients with higher knee mobility requirements. 2. RPF prosthesis pad rotation can provide better knee adjustment ability, better up and down stairs movement effect. 3. Because this study is a two-year mid-term follow-up, follow-up time is relatively short, and sample size. The short term clinical efficacy should be further observed.
【学位授予单位】：承德医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4
本文编号：2246304
[Abstract]:Objective: To evaluate the clinical efficacy of high flexion rotary platform prosthesis and high performance fixed platform prosthesis in total knee arthroplasty (TKA).Methods: A retrospective study was conducted in 83 patients (86 knees) who underwent total knee arthroplasty from January 2014 to December 2014. High flexion rotating platform (RPF) group (46 cases, 47 knees) and high performance fixed platform (HFB) group (37 cases, 39 knees). Basic data of patients, including sex, age, affected side, body mass index and perioperative bleeding volume, were collected. All patients were followed up according to imaging data using Kellgren-Lawrence classification. All patients were performed with a senior surgeon's knife. Prostheses and bone cement were provided by Depuy, a Johnson & Johnson Company in the United States. All patients performed functional exercises according to a unified rehabilitation program. All patients were followed up for a period of time. For 2 years, follow-up included: 1. Hospital for Special Surgery knee score (HSS), according to the final follow-up score, the excellent and good rate was calculated (excellent or equal to 85 points, good 70-84 points, middle 60-69 points, difference less than 59 points); 2. range of motion (ROM); 3. Posterior and lateral radiographs of knee joint were taken at 2-year follow-up.4.Whether complications occurred after knee replacement.The degree of pain and function of knee joint were evaluated by HSS score. (47 knees), male 6, female 40; age 47-82 (64.2 (+ 8.6) years old; right 28, left 19; body mass index 25.8 (+ 3.5 kg / M ~ 2); osteoarthritis imaging grade III 31 cases, grade IV 16 cases; perioperative blood loss 1016.7 (+ 240.1 ml). HFB group 37 cases (39 knees), male 11 cases, female 26 cases; age 52-81 (64.9 (+ 8.1) years old; right 19 cases, left 20 cases; body mass index 26.9 (+ 8.9). There were 26 cases of osteoarthritis grade III and 13 cases of osteoarthritis grade IV. The perioperative bleeding volume was 1012.3 (+ 297.9 ml). Age, sex ratio, body mass index, osteoarthritis imaging grade and perioperative bleeding volume of RPF group and HFB group were statistically analyzed. There was no significant difference between the two groups (P 0.05). At the last follow-up, no prosthesis loosening, prosthesis subsidence, deep venous thrombosis of the lower extremity, etc. No patellar fracture, patellar dislocation, patellar ligament injury and other complications occurred in all patients, but there were 6 cases in RPF group and 4 cases in HFB group. There was no significant difference between the two groups (P 0.05). HSS score was 33.8 (+ 4.1) in RPF group and 34.2 (+ 3.7) in HFB group before operation, 90.3 (+ 3.5) in RPF group and 89.4 (+ 4.4) in HFB group at the last follow-up. There was no significant difference in HSS score between the two groups (P 0.05). At the last follow-up, there were 39 excellent, 5 good, 3 middle and 0 poor HSS scores in RPF group, and the excellent and good rate was 93.6%. In HFB group, there were 32 excellent, 5 good, 2 poor, and 0 poor HSS scores, the excellent and good rate was 94.8%. There was no significant difference in the excellent and good rate between the two groups (P 0.05). There was a significant difference between the two groups in the final follow-up (P 0.001) and the preoperative (P 0.001). Conclusion: 1. RPF prosthesis and HFB prosthesis were similar in clinical efficacy and patient satisfaction. RPF prosthesis can obtain higher joint mobility, which is more suitable for patients with higher knee mobility requirements. 2. RPF prosthesis pad rotation can provide better knee adjustment ability, better up and down stairs movement effect. 3. Because this study is a two-year mid-term follow-up, follow-up time is relatively short, and sample size. The short term clinical efficacy should be further observed.
【学位授予单位】：承德医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4
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