CR假体与固定平台型假体人工膝关节置换术治疗膝骨关节炎的近期疗效对比研究以及全膝关节置换术后的社区康复

发布时间：2018-03-13 04:32

本文选题：膝关节成形术　切入点：旋转平台　出处：《安徽医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的对比研究保留后交叉韧带旋转平台型假体(Cruciate Retaining,CR)与后稳定型固定平台假体(Posterior Stable,PS)全膝关节置换术(Total Knee Arthroplasty,TKA)治疗膝骨关节炎的近期临床疗效,并观察社区康复对全膝关节置换术后功能恢复的影响。方法选取2011年1月至2011年10月因膝关节骨关节炎入住我科行TKA患者108例。其中56例采用保留后交叉韧带旋转平台假体(A组),52例采用固定平台型假体(B组)。比较两组患者末次随访时膝关节活动度及膝关节HSS评分。A组中有18例患者出院后进行社区康复,与A组余下未进行社区康复的病例对比研究,比较术后三个月、半年以及一年时膝关节HSS疼痛评分和患者满意度。结果A、B两组间病例资料(年龄、BMI以及性别分布)、临床资料(HSS评分、关节活动度)差异无统计学意义。108例TKA患者均恢复满意,且均获得2年以上随访。患者术后膝关节疼痛、功能和活动度方面均有明显改善。HSS评分A组术前为41.00±4.34分提高到术后2年时86.50±7.57分(P=0.00),B组术前为43.85±3.26分提高到术后2年时85.69±8.34分(P=0.00),两组术后2年时HSS评分差异无统计学意义(P=0.43)。膝关节活动度A组术前为61.93±18.22度提高到术后2年时122.17±3.92度(P=0.00),B组术前为62.75±10.06度提高到术后2年时120.33±4.15度(P=0.00),两组术后2年时关节活动度差异无统计学意义(P=0.57)。无一例出现感染、松动及异响。A组出院后进行社区康复的患者在术后三个月和半年时膝关节HSS疼痛评分和患者满意度明显优于未进行社区康复的患者,术后一年时差异无统计学意义。结论近期随访结果表明,采用保留后交叉韧带旋转平台型假体以及固定平台型假体TKA治疗膝关节骨关节炎疗效良好,虽然旋转平台膝关节假体理论上可以降低聚乙烯磨损和改善关节运动等优势,但本研究中旋转平台的理论优势并未得到体现。TKA术后社区康复有助于减轻患者早期疼痛,提高患者满意度。
[Abstract]:Objective to compare the clinical effects of total Knee arthroplasty (TKAA) and total Knee arthroplasty (TKAA) in the treatment of knee osteoarthritis. The effects of community rehabilitation on functional recovery after total knee arthroplasty were observed. Methods from January 2011 to October 2011, 108 patients with TKA were admitted to our department of knee osteoarthritis, 56 of whom were treated with posterior cruciate ligament rotation. Group A (52 cases) were treated with fixed platform prosthesis (group B). The range of motion of knee joint and the HSS score of knee joint were compared between the two groups at the last follow-up. 18 patients in group A were treated with community rehabilitation after discharge from hospital. Three months after operation, a comparative study was conducted with the remaining patients in group A who did not undergo community-based rehabilitation. Results there was no significant difference in HSS score and patient satisfaction between group A and B (age and sex distribution, clinical data and joint mobility). There was no significant difference between group A and group B in terms of HSS pain score and patient satisfaction at six months and one year. All patients were followed up for more than 2 years. Significant improvement in function and activity. HSS score: 41.00 卤4.34 before operation in group A to 86.50 卤7.57 before operation in group B: 43.85 卤3.26 before operation to 85.69 卤8.34 at 2 years after operation. There is no significant difference in HSS score between the two groups at 2 years after operation. The range of motion of knee joint in group A was increased from 61.93 卤18.22 degrees before operation to 122.17 卤3.92 degrees before operation to 122.75 卤10.06 degrees before operation to 120.33 卤4.15 degrees of motion in group B, and there was no significant difference between the two groups at 2 years after operation (P = 0.57). The scores of HSS pain and satisfaction of patients in group A of loosening and abnormal noise after discharge from hospital were significantly better than those of patients without community rehabilitation at 3 months and 6 months after operation. There was no significant difference at one year after operation. Conclusion the recent follow-up results showed that the treatment of knee osteoarthritis by using the rotatory platform prosthesis of posterior cruciate ligament and the fixed platform prosthesis TKA had a good effect on knee osteoarthritis. Although rotary platform knee prosthesis can theoretically reduce polyethylene wear and improve joint movement, the theoretical advantage of rotary platform in this study has not been demonstrated that community rehabilitation after .TKA can alleviate early pain in patients. Improve patient satisfaction.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.4

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