内轴型（MP）与后稳定型（PS）膝关节假体置换术后中期效果对比研究

发布时间：2018-05-03 15:55

本文选题：全膝关节置换术 + MP膝关节系统　；参考：《青岛大学》2017年硕士论文

【摘要】：目的对比内轴型膝关节假体(Medial pivot,MP)与经典后稳定膝关假体(Posterior Cruciate-Stabilizing,PS)系统在中国人群中全膝关节置换(Total Knee Arthroplasty TKA)术后中期效果、满意度及相关并发症的发生率,系统评价内轴型膝关节假体的应用效果。方法选取2010-2011年间由同一医师实施内轴型膝关节假体(Wright公司MP膝关节)与经典后稳定膝关假体系统(Zimmer公司PS膝关节)单侧置换术后患者各60人进行随访,采集患者术后最新的HSS活动疼痛评分、HSS静息疼痛评分、HSS活动度评分、HSS肌力评分、HSS屈曲畸形评分、HSS功能评分,HSS稳定性评分与我院已存档的该患者术前HSS评分计算差值,对两种假体的各项指标的改善程度,进行统计学分析,评价两种假体在中国人群的应用效果,同时利用WOMAC(The Western Ontario and Mc Master Universities)评分系统对患者术后满意度进行评价,对比两种假体置换后中期效果、满意度及相关并发症的发生率。结果1.实际到访101人,其中Wright组49人,Zimmer组52人,未到访病人中死亡1例,为Zimmer组患者,死于术后2年,死因系内科系统疾病(心梗诱发多器官功能衰竭),余未述明显不适;2.两组患者术前在年龄、体重、HSS各项评分等指标无明显统计学差异(P0.05)、两组随访年限无显著统计学差异(P0.05);3.两组患者术后5年的HSS活动疼痛评分、HSS静息疼痛评分、HSS活动度评分、HSS肌力评分、HSS屈曲畸形评分、HSS功能评分等与术前评分差值对比均无明显统计学差异(P0.05);4.术后满意度无显著统计学差异(P0.05);5.术后五年随访两组均未出现翻修、感染等情况;6.Wright组有1例疼痛不适患者。结论1.内轴型膝关节假体与经典后稳定膝关假体中期随访在疗效、满意度、假体松动率、翻修率、感染率无显著差异,两者在置换术后均能取得了良好的康复效果;2.在实际操作过程中内轴型膝关节假体系统通过球面设计实现了膝关节的稳定,较后稳定型假体中央立柱结构更为稳定,髁间截骨明显少于后者,操作方便,同时可大幅度降低后期翻修所致骨缺损量,减少因骨缺损所致翻修难度,对于翻修较为有利;3.疼痛不适患者考虑为过度劳累所致;4.内轴型膝关节系统的垫片磨损寿命,远期翻修率尚需长期随访。
[Abstract]:Objective to compare the efficacy, satisfaction and incidence of complications between medial pivot and posterior stable knee arthroplasty (MPP) and postoperatively stabilized knee arthroplasty (PSS) system in Chinese population after total knee arthroplasty (TKR) total Knee Arthroplasty TKA). The application effect of internal axial knee joint prosthesis was systematically evaluated. Methods A total of 60 patients were followed up from 2010 to 2011 after unilateral arthroplasty with internal axial knee prosthesis (MP) and classic posterior stable knee closure prosthesis (Zimmer PS). The latest postoperative HSS activity pain score (HSS) resting pain score (HSS) activity score (HSS) muscle strength score (HSS) flexion deformity score (HSS) function score and HSS stability score (HSS stability score) were collected and compared with the preoperative HSS score of the patient who had been archived in our hospital. The improvement degree of each index of the two kinds of prosthesis was analyzed statistically, the application effect of the two kinds of prostheses in Chinese population was evaluated, and the satisfaction degree of the patients after operation was evaluated by using WOMAC(The Western Ontario and Mc Master Universities) scoring system. The mid-term effect, satisfaction, and incidence of related complications were compared between the two prosthesis replacements. Result 1. There were 49 patients in Wright group and 52 patients in Zimmer group. One patient in Zimmer group died 2 years after operation. The cause of death was a disease of internal medicine system (MI induced multiple organ failure, the rest of which was obviously unwell). There was no significant difference in age, weight and HSS scores between the two groups before operation (P 0.05), and there was no significant difference in the follow-up years between the two groups (P 0.05). There was no significant difference between the HSS activity pain score and the rest pain score and the muscle strength score, the flexion deformity score, the functional score and the preoperative score difference between the two groups. There was no significant difference in postoperative satisfaction (P 0.05). There was no revision and infection in both groups. 6. There was one case of pain and discomfort in Wright group. Conclusion 1. There was no significant difference in efficacy, satisfaction, prosthesis loosening rate, revision rate and infection rate between the internal axis knee joint prosthesis and the classic posterior stable knee closure prosthesis. In the process of practical operation, the internal axial knee joint prosthesis system realizes the stability of the knee joint by spherical design, which is more stable than the central column structure of the posterior stable prosthesis, and the intercondylar osteotomy is obviously less than the latter, and the operation is convenient. At the same time, it can greatly reduce the amount of bone defects caused by later revision and reduce the difficulty of revision caused by bone defects, which is more favorable for revision. Patients with pain and discomfort are considered to be overworked and overworked. Long-term follow-up is needed for the wear life and long-term revision rate of the internal shaft knee joint system.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4

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