高屈曲型与标准型人工膝关节假体在全膝关节置换术后疗效的比较研究
发布时间：2018-09-19 20:13
【摘要】：目的:探讨高屈曲型和标准型两种膝关节假体术后临床疗效以及患者满意度。方法:本文采用回顾性研究,对山西医科大学第二医院骨关节科2012年3月-2014年7月行初次单侧或非同期双侧TKA的病人进行随访,共计91例患者(103膝);按植入假体类型(均为美国SmithNephew公司)分为高屈曲组(50膝)与标准组(53膝)两组,根据术前及末次随访进行系统的科学的评定指标包括:KSS评分、关节活动度及活动度增加量、术后膝关节影像学资料进行分析比较研究临床疗效;比较两组KSS评分、关节活动度和屈曲度、WOMAC评分(疼痛)、SF-36量表满意度调查,同时对两组术后并发症进行总结和研究。收集资料通过SPASS13.0统计软件进行数据处理得出统计学依据。结果:91例患者平均随访时间为15月(13月~28月),两组术后KSS评分、ROM、WOMAC评分及自我满意度均明显高于术前,术后疼痛均明显缓解。高屈曲组和标准组之间的研究中:(1)两组间末次随访KSS评分,P0.05,差异无统计学意义;末次关节活动度和最大屈曲度两组间比较,P0.05(差异无统计学意义);但是比较了术前膝关节活动度能达到110°的38膝末次随访结果,高屈曲组KSS评分高于标准组;高屈曲组18膝关节平均活动度为123.39°(0~128°)、最大屈曲度为124.66°(120~128°),标准组20膝关节活动度是115.02°(0~120°)、最大屈曲度116.12°(100~120°),这38膝中高屈曲组术后膝关节活动度、最大屈曲度和KSS评分均优于标准组;(2)两组末次随访(1年)WOMAC疼痛评分高屈曲组为1.01±1.29分,标准组为3.93±1.79分,两者比较P0.05;VAS疼痛评分中高屈曲组为2.02±1.24分,标准组为3.11±1.42分,两者比较P0.05,差异有统计学意义,即缓解疼痛方面高屈曲组优于标准组。在患者满意度方面的研究结果中,总的SF-36量表两组间比较,P0.05(差异有统计学意义),即术后高屈曲组患者自我满意度高于标准组,尤其在躯体健康部分满意度更高。(3)术后并发症标准组和高屈曲组间没有明显差异,严格控制易感因素本研究中无一感染病例,DVT的发生在高屈曲组中发生1例,标准组为2例;术后随访发现标准组有1例出现无症状性假体周围透亮X线,经后期随访并未发现给例患者出现假体松动迹象;两组间术后随访均无关节僵硬发生。结论:高屈曲型假体作为一种通过稳定假体设计来获得较大活动度以便满足不同患者的需求,在临床应用中日趋广泛。本研究中发现使用高屈曲型假体相对传统标准假体术后临床总体疗效提升,尤其是具有术前良好屈膝的关节,在术后使用高屈曲型假体可以恢复更好的屈膝功能获得更大的膝关节活动度,而且术后膝前痛发生率方面低于传统假体,高屈曲型假体术后患者满意度更高;术后并发症方面两组没有明显差异。因此,充分了解并掌握术前屈膝范围,综合评估关节功能,选择与良好屈膝相匹配的假体和术中精准的软组织平衡是手术成功的重要因素。总之对于特殊需求或者更高术后要求的患者来说高屈曲型假体也是一个不错的选择,当然高屈曲假体远期临床疗效还需长期随访进一步研究。
[Abstract]:Objective: To investigate the clinical efficacy and patient satisfaction of high flexion and standard knee prosthesis. Methods: A retrospective study was conducted in 91 patients (103 knees) who underwent primary unilateral or asynchronous bilateral TKA from March 2012 to July 2014 in the Department of Orthopaedics and Arthroplasty, Second Hospital of Shanxi Medical University. Body types (Smith Nephew, USA) were divided into two groups: high flexion group (50 knees) and standard group (53 knees). According to the preoperative and final follow-up, systematic and scientific evaluation indicators included: KSS score, joint mobility and activity increase, postoperative knee imaging data were analyzed and compared to study the clinical efficacy of the two groups. Joint mobility and flexion, WOMAC score (pain), SF-36 scale satisfaction survey, and two groups of postoperative complications were summarized and studied. Data collected by SPASS 13.0 statistical software for data processing obtained statistical basis. Results: The average follow-up time of 91 patients was 15 months (13-28 months), two groups of postoperative KSS score, ROM, WOMAC evaluation. There was no significant difference between the high flexion group and the standard group: (1) KSS score of the last follow-up between the two groups, P 0.05, there was no significant difference; there was no significant difference between the last joint mobility and maximum flexion between the two groups, P 0.05 (no significant difference); but there was no significant difference between the pre-operative knee joint viability; The final follow-up results of 38 knees with 110 degrees of motion showed that the KSS score of the high flexion group was higher than that of the standard group; the average range of motion of the 18 knees in the high flexion group was 123.39 degrees (0-128 degrees), the maximum flexion was 124.66 degrees (120-128 degrees), the 20 knees in the standard group were 115.02 degrees (0-120 degrees), and the maximum flexion was 116.12 degrees (100-120 degrees). Joint mobility, maximum flexion and KSS scores were superior to the standard group; (2) WOMAC pain score was 1.01 (+ 1.29) in the high flexion group and 3.93 (+ 1.79) in the standard group at the last follow-up (1 year), compared with P 0.05; VAS pain score was 2.02 (+ 1.24) in the high flexion group and 3.11 (+ 1.42) in the standard group, the difference was statistically significant (P 0.05). In the study of patient satisfaction, the total SF-36 scale was compared between the two groups, P 0.05 (statistically significant), that is, the self-satisfaction of the high flexion group was higher than that of the standard group, especially in the physical health part. (3) Postoperative complications standard group and high flexion group were higher than that of the standard group. (3) Postoperative complications standard group and high flexion group. There was no significant difference between the two groups. No infection was found in this study. DVT occurred in 1 case in the high flexion group and 2 in the standard group. Conclusion: High flexion prosthesis, as a kind of stable prosthesis design to obtain greater mobility to meet the needs of different patients, has been widely used in clinical application. Knee joint, the use of high-flexion prosthesis can restore better flexion function after surgery to obtain greater knee mobility, and postoperative pain rate is lower than the traditional prosthesis, high-flexion prosthesis postoperative patients satisfaction is higher; postoperative complications of the two groups are not significantly different. Therefore, fully understand and master the preoperative flexion. Knee range, comprehensive assessment of joint function, selection of prostheses matching good knee flexion, and accurate intraoperative soft tissue balance are important factors for successful surgery. Follow up study.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4
[Abstract]:Objective: To investigate the clinical efficacy and patient satisfaction of high flexion and standard knee prosthesis. Methods: A retrospective study was conducted in 91 patients (103 knees) who underwent primary unilateral or asynchronous bilateral TKA from March 2012 to July 2014 in the Department of Orthopaedics and Arthroplasty, Second Hospital of Shanxi Medical University. Body types (Smith Nephew, USA) were divided into two groups: high flexion group (50 knees) and standard group (53 knees). According to the preoperative and final follow-up, systematic and scientific evaluation indicators included: KSS score, joint mobility and activity increase, postoperative knee imaging data were analyzed and compared to study the clinical efficacy of the two groups. Joint mobility and flexion, WOMAC score (pain), SF-36 scale satisfaction survey, and two groups of postoperative complications were summarized and studied. Data collected by SPASS 13.0 statistical software for data processing obtained statistical basis. Results: The average follow-up time of 91 patients was 15 months (13-28 months), two groups of postoperative KSS score, ROM, WOMAC evaluation. There was no significant difference between the high flexion group and the standard group: (1) KSS score of the last follow-up between the two groups, P 0.05, there was no significant difference; there was no significant difference between the last joint mobility and maximum flexion between the two groups, P 0.05 (no significant difference); but there was no significant difference between the pre-operative knee joint viability; The final follow-up results of 38 knees with 110 degrees of motion showed that the KSS score of the high flexion group was higher than that of the standard group; the average range of motion of the 18 knees in the high flexion group was 123.39 degrees (0-128 degrees), the maximum flexion was 124.66 degrees (120-128 degrees), the 20 knees in the standard group were 115.02 degrees (0-120 degrees), and the maximum flexion was 116.12 degrees (100-120 degrees). Joint mobility, maximum flexion and KSS scores were superior to the standard group; (2) WOMAC pain score was 1.01 (+ 1.29) in the high flexion group and 3.93 (+ 1.79) in the standard group at the last follow-up (1 year), compared with P 0.05; VAS pain score was 2.02 (+ 1.24) in the high flexion group and 3.11 (+ 1.42) in the standard group, the difference was statistically significant (P 0.05). In the study of patient satisfaction, the total SF-36 scale was compared between the two groups, P 0.05 (statistically significant), that is, the self-satisfaction of the high flexion group was higher than that of the standard group, especially in the physical health part. (3) Postoperative complications standard group and high flexion group were higher than that of the standard group. (3) Postoperative complications standard group and high flexion group. There was no significant difference between the two groups. No infection was found in this study. DVT occurred in 1 case in the high flexion group and 2 in the standard group. Conclusion: High flexion prosthesis, as a kind of stable prosthesis design to obtain greater mobility to meet the needs of different patients, has been widely used in clinical application. Knee joint, the use of high-flexion prosthesis can restore better flexion function after surgery to obtain greater knee mobility, and postoperative pain rate is lower than the traditional prosthesis, high-flexion prosthesis postoperative patients satisfaction is higher; postoperative complications of the two groups are not significantly different. Therefore, fully understand and master the preoperative flexion. Knee range, comprehensive assessment of joint function, selection of prostheses matching good knee flexion, and accurate intraoperative soft tissue balance are important factors for successful surgery. Follow up study.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4
【参考文献】
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1 石晶磊;聂少波;蔡，
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