活动平台与固定平台假体行人工全膝关节置换术十年疗效的比较研究

发布时间：2018-08-23 21:30

【摘要】：目的比较活动平台与固定平台假体行人工全膝关节置换术(total knee arthroplasty,TKA)的10年疗效,为临床选择TKA假体提供参考。方法回顾分析2002年1月—2005年12月符合选择标准的113例初次行TKA的膝关节骨关节炎患者临床资料,其中47例采用活动平台假体(A组),66例采用固定平台假体(B组)。两组患者年龄、性别、体质量指数、膝关节内翻和屈曲畸形以及术前膝关节活动度、美国膝关节学会评分系统(KSS)评分、美国西部Ontario与Mc Master大学骨关节炎指数评分(WOMAC)等一般资料比较,差异均无统计学意义(P0.05),具有可比性。结果 A、B组手术时间分别为(88.1±6.5)、(90.3±7.2)min,比较差异无统计学意义(t=1.666,P=0.099)。术后两组患者切口均Ⅰ期愈合,无切口感染及下肢深静脉血栓形成等术后早期并发症发生。两组患者均获随访,A组随访时间10.2~12.3年,平均10.8年;B组随访时间10.2~12.6年,平均11.3年。A、B组分别有3例和4例行假体翻修,假体存活率分别为93.6%和93.9%,比较差异均无统计学意义(χ~2=0.005,P=0.944)。两组患者术后各时间点膝关节活动度、KSS评分及WOMAC评分均较术前显著改善(P0.05)。B组术后6周膝关节活动度和KSS评分优于A组(P0.05),术后1、3、10年两组比较差异无统计学意义(P0.05)。术后6周及1、3年两组WOMAC评分比较差异均无统计学意义(P0.05),但术后10年A组WOMAC评分优于B组,差异有统计学意义(t=2.086,P=0.037)。术后10年A、B组KSS评分优良率分别为87.2%和84.8%,比较差异无统计学意义(χ~2=0.018,P=0.893)。结论采用活动平台和固定平台假体行TKA均能获得优良的中远期疗效,采用固定平台假体手术操作相对简便,早期康复效果更佳;活动平台假体可提供更好的远期WOMAC评分满意度,但要求更高的手术技巧和软组织平衡技术。
[Abstract]:Objective to compare the 10-year efficacy of total knee arthroplasty (total knee arthroplasty,TKA) with active platform and fixed platform prosthesis in order to provide reference for clinical selection of TKA prosthesis. Methods Clinical data of 113 patients with knee osteoarthritis who met the selection criteria from January 2002 to December 2005 were retrospectively analyzed. Among them, 47 cases were treated with active platform prosthesis (group A) and 66 cases with fixed platform prosthesis (group B). Age, sex, body mass index (BMI), varus and flexion deformity of knee joint and preoperative knee motion, (KSS) score of the American Society of knee Association (AKS) were used in both groups. There were no significant differences between Ontario and Mc Master University osteoarthritis index scores (WOMAC) and other general data (P0.05). Results the time of operation in group A was (88.1 卤6.5), (, 90.3 卤7.2) min,. There was no significant difference between group A and group B (t = 1.666), (, P < 0.099). There was no incision infection and deep vein thrombosis in both groups. The mean follow-up time of group B was 10.2 ~ 12.6 years (mean 10.2 ~ 12.6 years), and the average of 11.3 years and 4 cases of prosthetic revision in group A were 93.6% and 93.9%, respectively. There was no significant difference between the two groups (蠂 2 0.005 P 0.944). KSS and WOMAC scores were significantly improved at each time point after operation in both groups (P0.05). Group B was superior to group A in knee motion and KSS score at 6 weeks after operation (P0.05), and there was no significant difference between the two groups in 10 years (P0.05). There was no significant difference in WOMAC score between the two groups at 6 weeks and 1 and 3 years after operation (P0.05), but the WOMAC score of group A was better than that of group B 10 years after operation (t0. 086%, P < 0. 037). The excellent and good rates of KSS score in group A were 87.2% and 84.8% respectively 10 years after operation, and there was no significant difference between them (蠂 2 / 0. 018 / P = 0. 893). Conclusion both active platform and fixed platform prosthesis can obtain good medium- and long-term curative effect, the operation of fixed platform prosthesis is relatively simple and the effect of early rehabilitation is better, the active platform prosthesis can provide better satisfaction with long-term WOMAC score. But higher surgical skills and soft tissue balance techniques are required.
【作者单位】：青岛大学附属医院关节外科;
【基金】：国家自然科学基金资助项目(81672197)~~
【分类号】：R687.4

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