高屈曲型与普通屈曲型膝关节假体在初次全膝关节置换术后的早期临床疗效的对照研究

发布时间：2018-06-11 16:48

本文选题：高屈曲度型 + 普通屈曲度型　；参考：《大连医科大学》2017年硕士论文

【摘要】：背景:人工膝关节置换术(TKA Total Knee Arthroplasty)的日益成熟,使之成为治疗各种终末期膝关节疾病的治疗手段,且取得了确切的临床疗效。同时,随着我国老龄化进程的加剧,生活水平的日益提高,人们对自己的生活质量也更加注重,加之人工关节的逐渐普及,人工膝关节置换术被人们逐渐接受的同时,也对术后的期望,也不在仅仅局限于单纯地解决疼痛,更期望着有个更加舒适的术后体验,满足日常生活的需求的同时,满足一些特殊的生活需求,如蹲、跪等,这不仅仅给术者提出了更高的要求,对膝关节假体也是一个极大的考验,因为常规普通的膝关节假体,从原始设计上,对假体的屈曲角度的设计大约为120度,从设计根源上就不能满足要求,因而假体设计者们,通过原假体在临床过程中出现的众多问题,以及大量的生物力学实验,设计出新型的高屈曲度型膝关节假体,使假体在屈曲155度时仍不会出现常规假体的所面临的的点面接触、磨损加重等不利因素,但其临床实际疗效却仍存在争议[1]。目的:探讨对比高屈曲度型膝关节假体(NexGex.LPS-Flex ZIMMER)与普通屈曲型度膝关节假体(Vanguard PS Biomet)初次人工全膝关节置换术后早期的临床疗效的差异性。方法:回顾性分析2014.09-2016.06大连医科大学附属第二医院关节外科患者中行初次人工全膝关节置换术患者,其中将选择高屈曲度膝关节假体37例51膝(11男12膝,26女39膝)分为A组,选择普通屈曲度膝关节假体38人52膝(5男6膝,33女46膝)为B组。运用SPSS20.0统计学软件对比分析两组患者手术时间、术中出血量、置换前后膝关节活动度(ROM)、置换前后股骨后髁偏心距(PCO),置换前及术后1月、6月及最后一次后KSS评分[2](美国膝关节协会评分Knee society Score of American,期中包括临床评分及功能评分),及常见的临床并发症。结果与结论:两组患者总计73例患者均得到了术后随访,随访患者术中术后除了5例切口延迟愈合,1例腓总神经损伤,2例术后疼痛、功能欠佳,但均未发生感染、假体周围骨折、僵硬等重大并发症。两组患者手术时间、术后PCO均无显著性差异(P0.05),术中术后输血无统计学差异(P0.05);术中失血两组之间有统计学差异(P0.05),B组患者出血量较A组患者少,两组患者膝关节活动度、KSS评分中临床评分、功能评分术后与术前有显著性差异(P0.05),而同时期中两组患者之间术后膝关节活动度、KSS评分中临床评分、功能评分均有显著性差异(P0.05),A组膝关节活动度及KSS评分均优于B,提示:使用不同假体的人工膝关节置换术,对患者术后都有显著效果,都能改善患者的膝关节功能,改善生活质量;两组患者术中时间无统计学差异,但使用普通屈曲度型膝关节假体的患者术中出血少于高屈曲度型膝关节假体;但使用高屈曲度型膝关节假体有更好的膝关节屈曲度,术后的整体膝关节功能优于普通屈曲度型膝关节假体。
[Abstract]:Background: with the increasing maturity of TKA Total knee arthroplasty (TKA Total knee arthroplasty), it has become a method for the treatment of various end-stage knee diseases, and has achieved a definite clinical effect. At the same time, with the aggravation of aging process and the improvement of living standard in our country, people pay more attention to their quality of life, and with the popularization of artificial joints, artificial knee arthroplasty is gradually accepted by people. Also, the expectation for the operation is not only to solve the pain simply, but also to have a more comfortable experience after the operation, to meet the needs of daily life, and to meet some special needs of life, such as squatting, kneeling, etc. This is not only a higher request for the operator, but also a great test for the knee joint prosthesis, because the conventional knee joint prosthesis, in terms of its original design, is designed at a flexion angle of about 120 degrees. The root causes of the design can not meet the requirements, so the prosthesis designers design a new type of high flexion knee joint prosthesis through many problems in the clinical process and a large number of biomechanical experiments. The point and surface contact and wear aggravation of conventional prosthesis can not occur when the prosthesis is flexion 155 degree, but the clinical effect is still controversial [1]. Objective: to compare the clinical effects of high flexion type knee prosthesis NexGex.LPS-Flex ZIMMER-Vanguard PS Biomet in the early stage of total knee arthroplasty. Methods: the primary total knee arthroplasty was performed in the second affiliated Hospital of Dalian Medical University from April to June 2014.The patients were divided into two groups: group A, with 37 cases with high flexion degree knee prosthesis, 51 knees, 11 men, 12 knees, 26 knees, and 39 knees. In group B, 52 knees of 38 patients with common flexion degree and 5 men and 6 knees with 33 knees and 46 knees were selected as group B. SPSS 20.0 statistical software was used to compare the operation time and intraoperative bleeding volume between the two groups. Knee motion before and after arthroplasty, posterior femoral condylar eccentricity before and after replacement, KSs score before and after replacement [2] (American knee Association score, score of knee society score of American, mid-term including clinical score and functional score) And common clinical complications. Results and conclusion: a total of 73 patients in both groups were followed up after operation. In addition to 5 cases of delayed wound healing and 1 case of common peroneal nerve injury, 2 cases suffered from postoperative pain. Periprosthetic fracture, stiffness and other major complications. There was no significant difference in the operation time and PCO between the two groups (P 0.05), and there was no significant difference in blood transfusion between the two groups (P 0.05), but there was no significant difference between the two groups in blood loss during operation (P 0.05) and the amount of blood loss in group B was less than that in group A (P 0.05). There was a significant difference in the clinical score and functional score between the two groups in the KSS score of the knee joint motion and the clinical score in the KSS score of the knee joint motion after operation between the two groups at the same time, and there was a significant difference between the two groups before and after the operation (P < 0.05). There were significant differences in functional scores. The range of knee motion and KSS score of group A were better than that of group B. It was suggested that artificial knee arthroplasty with different prostheses had significant effect on patients after operation and could improve the function of knee joint of patients. There was no significant difference in intraoperative time between the two groups, but the intraoperative bleeding of patients with common flexion type knee prosthesis was less than that of high flexion type knee prosthesis. But the knee joint prosthesis with high flexion degree has better flexion degree, and the global knee joint function is better than that of the common flexion knee joint prosthesis.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4

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