膝关节置换术中股骨、胫骨假体匹配情况与功能性的相关研究

发布时间：2018-08-31 16:11

【摘要】：目的:通过临床及影像学的随访,观察膝关节置换手术股骨假体与胫骨假体匹配情况与功能性的研究,为临床提供更好的数据资料。方法:通过回顾性分析山东中医药大学第一附属医院(山东省中医院)关节骨科2013.03-2014.03月行全膝关节置换的病人30例,对其临床资料进行总结、分析,经过定期随访,根据膝关节HSS评分以评价临床效果。影像学评估通过膝关节正侧位片了解假体与骨界面是否有透光区和硬化带,同时了解假体是否有松动,以及假体与骨接触情况。手术后随访时对患者的膝关节进行评分,随访3个月。评价膝关节置换中假体匹配情况与患者功能性活动的短期临床效果,为临床供客观依据。结果:本次研究,纳入30例膝关节置换病人,30例均为初次置换,根据手术使用假体情况分为匹配组和不匹配组。匹配组15例,不匹配组15例,根据统计结果,匹配组和不匹配组受试者人口学指标和基线期的生命体征比较均无统计学差异。在手术前后,对匹配组和不匹配组入院指标进行观察,所有受试者的检查结果均为正常或异常无意义,且在治疗前后无变化。通过观察不匹配组术前术后HSS优良率,显示匹配组术后较术前受试者的情况都有明显改善,经统计分析,两组的HSS评分术前无统计学差异,术后亦无统计学差异。随访3个月时间表明股骨假体与胫骨假体不匹配并没有影响患者术后功能。X线片示膝关节假体位置满意,假体与骨界面无透光区和硬化带,假体无松动和感染的征象。术后未出现切口感染、假体周围骨折等严重并发症。患者膝关节功能明显改善,疼痛缓解彻底,稳定性和灵活性增强,步态恢复正常,生活能自理。术后患者伤口均I期愈合,无1例感染病例出现,8-10周膝关节屈伸功能恢复正常。结论:膝关节置换过程中,手术中的不同情况影响假体型号的选择,从而产生了股骨假体与胫骨假体不匹配的情况。我们的临床试验证明,假体匹配与否,对膝关节功能没有太大的影响。因此,术中可以根据需要,增加截骨量或改变截骨角度。
[Abstract]:Objective: To observe the matching between femoral prosthesis and tibial prosthesis in knee arthroplasty and to provide better data for clinic through clinical and imaging follow-up. Methods: Total knee joints were performed in the Department of Arthroplasty of the First Affiliated Hospital of Shandong University of Traditional Chinese Medicine (Shandong Hospital of Traditional Chinese Medicine) from March 2013 to March 2014. The clinical data of 30 patients were summarized and analyzed. After regular follow-up, the clinical effect was evaluated according to the HSS score of the knee joint. To evaluate the short-term clinical effect of prosthesis matching and functional activities of patients during knee replacement, and provide objective basis for clinical application. Results: 30 patients with knee replacement were included in this study, 30 of them were primary replacement, and were divided into matching group and non-matching group according to the operation conditions. Matching group: 15 cases in matching group and 15 cases in mismatching group. According to the statistical results, there was no significant difference in demographic indexes and baseline vital signs between matching group and mismatching group. There was no significant difference between the two groups in HSS score before and after operation. Follow-up for 3 months showed that there was no significant difference in HSS score between the two groups. The X-ray showed that the prosthesis was well positioned, the interface between the prosthesis and bone was free of light transmission and sclerosis, and the prosthesis was free of loosening and infection.No serious complications such as incision infection and periprosthetic fracture occurred after operation. All the wounds healed in stage I, no infection occurred, and the knee flexion and extension function returned to normal in 8-10 weeks. Conclusion: During the knee replacement, different conditions during the operation affect the choice of prosthesis type, resulting in the mismatch of femoral prosthesis and tibial prosthesis. Matching or not has little effect on knee function. Therefore, osteotomy can be increased or the angle of osteotomy can be changed according to the need.
【学位授予单位】：山东中医药大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.4

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