同期双侧全膝关节置换中髌骨置换与不置换的自身对照研究
发布时间：2018-11-22 18:06
【摘要】：目的比较同期行双侧全膝关节表面置换(total knee arthroplasty,TKA)治疗膝关节骨性关节炎(osteoarthritis,OA)时,髌骨置换与不置换的早期临床疗效。方法随机选择2015年2月至2015年12月青岛大学附属医院关节外科收治的,因膝OA入院拟行同期双侧全膝关节表面置换的患者40例(80膝)。将80膝按照随机数字表法随机分为两组,置换组40膝(左侧21膝,右侧19膝),术中行髌骨置换,对照组40膝(左侧19膝,右侧21膝),术中不置换髌骨。所有患者均使用Micro Port公司Advance内轴型全膝关节表面置换系统,手术均由同一高年资医师主刀完成。观察并记录两组手术时间、失血量、术前及术后3个月、6个月、9个月及12个月时美国膝关节协会评分(American Knee Society Score,KSS-clinical score;KSS-function score)、髌骨Feller评分、膝关节活动度、膝前痛发生率、患者满意度等指标,通过术前及术后X线片测量髌骨倾斜角、髌骨适合角、髌韧带比值等进行影像学评价。均采用双盲的方式进行数据收集和分析。结果髌骨置换组和非置换组术后的KSS临床评分和功能评分、髌骨Feller评分均较术前明显提高,两组患者术后均获得了良好的活动能力和膝关节功能。两组患者术后3个月、6个月、9个月、12个月的KSS膝关节临床评分均无统计学差异(P0.05),但术后9个月、12个月的KSS功能评分差异有统计学意义,置换组评分高于对照组(P0.05)。两组患者术后6个月、9个月、12个月的髌骨Feller评分差异有统计学意义,置换组优于对照组(P0.05)。两组患者术后6个月、9个月、12个月的膝前痛发生率差异有统计学意义,非置换组膝前痛发生率高于置换组(P0.05)。两组患者术后影像学相关指标比较无统计学差异(P0.05),髌骨倾斜角及髌骨适合角等均较术前改善,两组均无获得性低位髌骨。两组患者术后12个月的满意度差异有统计学意义,置换组高于对照组(P0.05)。两组患者术中失血量无统计学差异,但置换组的手术时间高于对照组,差异有统计学意义(P0.05)。两组患者均无髌骨骨折、坏死,假体松动等并发症发生。结论应用全膝关节表面置换术治疗膝关节骨性关节炎,可以显著改善患者的膝关节功能。置换髌骨可以提高患者术后满意度和膝关节功能评分,降低术后膝前痛发生率,髌骨置换与不置换的术中失血量及影像学评价无统计学差异,但置换组的手术时间高于非置换组。
[Abstract]:Objective to compare the early clinical effects of bilateral total knee surface replacement (total knee arthroplasty,TKA) in the treatment of knee osteoarthritis (osteoarthritis,OA). Methods from February 2015 to December 2015, 40 patients (80 knees) with bilateral total knee arthroplasty due to knee OA were randomly selected. 80 knees were randomly divided into two groups: 40 knees (left 21 knees, right 19 knees) in the replacement group, 40 knees in the control group (19 knees on the left and 21 knees in the right). All patients were treated with Micro Port Advance internal axial total knee arthroplasty system. The operation was performed by the same senior surgeon. To observe and record the time of operation, blood loss, preoperative and postoperative 3 months, 6 months, 9 months and 12 months after the American knee Association score (American Knee Society Score,KSS-clinical score; KSS-function score), patellar Feller score, knee motion, incidence of anterior knee pain, and patient satisfaction were evaluated by radiographs before and after radiography. Patellar angle, patellar suitable angle and patellar ligament ratio were measured before and after operation. The data were collected and analyzed in a double blind way. Results the KSS clinical score and functional score and patellar Feller score were significantly improved in the patellar replacement group and the non-replacement group. The patients in both groups obtained good motor ability and knee joint function after operation. There was no significant difference in the clinical score of KSS knee joint between the two groups at 3 months, 6 months, 9 months and 12 months after operation (P0.05), but there was a significant difference in KSS functional score between the two groups at 9 months and 12 months after operation. The score of replacement group was higher than that of control group (P0.05). The patella Feller scores of the two groups were significantly different 6 months, 9 months and 12 months after operation, and the replacement group was better than the control group (P0.05). The incidence of anterior knee pain in the non-replacement group was higher than that in the replacement group (P0.05). There was no significant difference between the two groups in imaging parameters (P0.05). Patellar angle and patellar angle were improved compared with those before operation. There was no acquired low patella in both groups. Two groups of patients 12 months after the satisfaction of the difference was statistically significant, the replacement group was higher than the control group (P0.05). There was no significant difference in intraoperative blood loss between the two groups, but the operative time in the replacement group was higher than that in the control group (P0.05). There were no complications such as patellar fracture, necrosis and loosening of prosthesis in both groups. Conclusion Total knee joint surface replacement can significantly improve knee joint function in patients with knee osteoarthritis. Patellar replacement can improve the postoperative satisfaction and knee function score, and reduce the incidence of anterior knee pain. There is no significant difference in blood loss and imaging evaluation between patellar replacement and non-replacement. But the operative time in the replacement group was higher than that in the non-replacement group.
【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
本文编号：2350155
[Abstract]:Objective to compare the early clinical effects of bilateral total knee surface replacement (total knee arthroplasty,TKA) in the treatment of knee osteoarthritis (osteoarthritis,OA). Methods from February 2015 to December 2015, 40 patients (80 knees) with bilateral total knee arthroplasty due to knee OA were randomly selected. 80 knees were randomly divided into two groups: 40 knees (left 21 knees, right 19 knees) in the replacement group, 40 knees in the control group (19 knees on the left and 21 knees in the right). All patients were treated with Micro Port Advance internal axial total knee arthroplasty system. The operation was performed by the same senior surgeon. To observe and record the time of operation, blood loss, preoperative and postoperative 3 months, 6 months, 9 months and 12 months after the American knee Association score (American Knee Society Score,KSS-clinical score; KSS-function score), patellar Feller score, knee motion, incidence of anterior knee pain, and patient satisfaction were evaluated by radiographs before and after radiography. Patellar angle, patellar suitable angle and patellar ligament ratio were measured before and after operation. The data were collected and analyzed in a double blind way. Results the KSS clinical score and functional score and patellar Feller score were significantly improved in the patellar replacement group and the non-replacement group. The patients in both groups obtained good motor ability and knee joint function after operation. There was no significant difference in the clinical score of KSS knee joint between the two groups at 3 months, 6 months, 9 months and 12 months after operation (P0.05), but there was a significant difference in KSS functional score between the two groups at 9 months and 12 months after operation. The score of replacement group was higher than that of control group (P0.05). The patella Feller scores of the two groups were significantly different 6 months, 9 months and 12 months after operation, and the replacement group was better than the control group (P0.05). The incidence of anterior knee pain in the non-replacement group was higher than that in the replacement group (P0.05). There was no significant difference between the two groups in imaging parameters (P0.05). Patellar angle and patellar angle were improved compared with those before operation. There was no acquired low patella in both groups. Two groups of patients 12 months after the satisfaction of the difference was statistically significant, the replacement group was higher than the control group (P0.05). There was no significant difference in intraoperative blood loss between the two groups, but the operative time in the replacement group was higher than that in the control group (P0.05). There were no complications such as patellar fracture, necrosis and loosening of prosthesis in both groups. Conclusion Total knee joint surface replacement can significantly improve knee joint function in patients with knee osteoarthritis. Patellar replacement can improve the postoperative satisfaction and knee function score, and reduce the incidence of anterior knee pain. There is no significant difference in blood loss and imaging evaluation between patellar replacement and non-replacement. But the operative time in the replacement group was higher than that in the non-replacement group.
【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
【参考文献】
相关期刊论文 前2条
1 张启栋;郭万首;张倩;刘朝晖;程立明;李子荣;;膝关节置换术中髌骨置换与非髌骨置换比较的Meta分析[J];中国矫形外科杂志;2010年01期
2 黄志峰;翁习生;邱贵兴;金今;林进;杨新宇;;髌骨置换与否对全膝关节置换效果的影响[J];实用骨科杂志;2007年08期
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