全膝关节置换术中胫骨假体旋转定位方法的比较

发布时间：2018-04-10 21:43

  本文选题：全膝关节置换术 + 胫骨假体　； 参考：《福建中医药大学》2015年硕士论文

【摘要】：目的对比全膝关节置换术中三种胫骨假体旋转定位的方法,寻求较为简便、准确的旋转定位方法,以期提高全膝关节置换术后关节稳定性、活动度及使用寿命。方法2013年3月-2014年9月,对45例膝关节骨关节炎患者行全膝关节置换术(后交叉韧带替代型骨水泥旋转人工膝关节),其中男17例,女28例,年龄55-80岁。以入院时间为前后顺序,随机抽取定位方法,分为3组,每组15病人。术中胫骨假体定位方法：A组采用胫骨结节中内1/3作为参照,B组采用ROM(Range-Of-Motio n)技术作为参照,C组采用胫骨前后轴作为参照。术前、术后评估HSS评分、髌骨评分、FTA角及Q角,术中测量三组聚乙烯假体垫片的旋转角度。计量数据以均数±标准差表示,使用SPSS17.0统计软件进行统计学分析,单因素方差分析应用于各组组内对比,组间对比则采用t检验,p值0.05则认定为有统计学意义。结果ABC三组术前HSS评分(44.3±4.0 VS 44.8±4.1 VS 44.5±3.5)分,术前髌骨评分(12.9±1.9 VS 12.6±2.1 VS 11.6±2.0)分,术前胫股角(8.9±2.7°VS 9.7±3.2°VS 9.2±3.1°),术前Q角(20.6±2.7°VS 19.8±2.4°VS 19.5±2.5°)。ABC三组术后HSS评分(86.7±3.8 VS 86.8±3.5 VS 89.4±2.3)分,术后髌骨评分(19.6±2.4 VS 19.6±1.6 VS 20.9±2.6)分,术后胫股角(6.2±1.9°VS 5.7±1.6° VS 5.8±1.5°),术后Q角(15.7±1.7°VS 14.8±1.6°VS15.5±1.8°)。组内两两比较无统计学意义(P0.05),术前与术后比较有统计学意义(P0.05)。A组患者聚乙烯半月板垫片平均内旋(10.1±2.7)°。B组患者的聚乙烯半月板垫片平均内旋(0.8±2.8)°。C组患者聚乙烯半月板垫片平均内旋(0.65±2.6)°。A与B、A与C比较有统计学意义(P0.05)；B与C比较无统计学意义(P0.05)。结论在全膝关节置换术中,采用胫骨结节中内1/3为定位方法时,与股骨假体的位置相比较,其出现胫骨假体过度外旋机会较大；当使用ROM方法时,若股骨假体位置准确且能够充分地行软组织松解,其能够获得较好的对线对位；考虑到术中定位的准确性及直观性,以胫骨前后轴轴作为胫骨假体的定位参照时,两侧假体之间能够获得较为准确的对位。
[Abstract]:Objective to compare the three rotation localization methods of tibial prosthesis in total knee arthroplasty (TKA), and to find a simple and accurate method to improve the stability, range of motion and service life of tibial prosthesis after total knee arthroplasty (TKR).Methods from March 2013 to September 2014, 45 patients with knee osteoarthritis underwent total knee arthroplasty (posterior cruciate ligament replacement bone cement rotation artificial knee arthroplasty), including 17 males and 28 females aged from 55 to 80 years.According to the time of admission before and after, the method was randomly selected and divided into 3 groups, 15 patients in each group.Intraoperative tibial prosthesis localization method: group A used 1 / 3 of tibial nodule as reference group, group B used ROM(Range-Of-Motio nn technique as reference group, group C used tibial anterior and posterior axis as reference.Before and after operation, the HSS score, patella score, and Q angle were evaluated, and the rotation angle of polyethylene prosthesis gasket was measured during operation.The measurement data were expressed as mean 卤standard deviation and were statistically analyzed by SPSS17.0 software. The single factor variance analysis was applied to the intra-group contrast and the inter-group contrast was determined to be statistically significant by using t test (0.05).缁撴灉ABC涓夌粍鏈�鍓岺SS璇勫垎(44.3卤4.0 VS 44.8卤4.1 VS 44.5卤3.5)鍒，

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