后交叉韧带保留型和后稳定型全膝关节置换术后早期临床疗效比较  

Comparison of early clinical results between posterior cruciate-retaining arthroplasty and posterior stabilized total knee arthroplasty

作　　者：林宏生[1] 查振刚[1] 沈伟哉[2] 姚平[2] 王国普[1] 吴昊[1] 刘宁[1] Axel Ekkernkamp 

机构地区：[1]暨南大学附属第一医院骨科,广州510630 [2]暨南大学医学院 [3]德国Unfallkrankenhaus Bedin创伤与重建外科

出　　处：《中华创伤骨科杂志》2007年第5期427-430,共4页Chinese Journal of Orthopaedic Trauma

摘　　要：目的评价后交叉韧带保留（PCR）型和后稳定（PS）型全膝关节置换（TKA）的早期临床疗效，探讨两种不同假体置换术的临床相关问题。方法回顾2000年4月～2005年10月139例（166膝）初次行TKA的患者资料，比较PCR型（PCR组）58例（69膝）和PS型（PS组）81例（97膝）的早期疗效，结合文献分析两种不同假体的优缺点及相关技术问题。结果术后随访1年，患者对手术的满意率PCR组为94.2％，PS组为93．8％，两组比较差异无统计学意义（P〉0．05）。HSS评分PCR组平均为93．9分，PS组平均为94．3分，两组比较差异无统计学意义（P〉0．05）。膝关节活动度PCR组平均为105．8°，PS组平均为107．4°，两组比较差异无统计学意义（P〉0．05）。患者主诉患膝有轻微疼痛者，PCR组有7膝（占10．1％），PS组有10膝（占10，3％），均不需特殊治疗。有明显髌骨弹响征者PCR组2例，PS组4例，但对功能活动无影响。结论PCR型或PS型TKA后早期随访疗效满意；对膝关节畸形较轻，术中探查后交叉韧带结构完整者，可考虑采用PCR型假体，但应松解PCR，原则上宁松勿紧；对于PS型假体，手术技术要求相对较低，容易掌握，临床适用范围更广。Objective To compare posterior cruciate-retaining （PCR） total knee arthroplasty （TKA） and posterior stabilized （PS） TKA with respect to their early clinical results and correlative techniques. Methods The data of 139 cases （166 knees） treated with primary TKA from April, 2000 to October, 2005 were reviewed. The early clinical results of 58 cases （69 knees） treated with PCR TKA were compared with those of 81 cases （97 knees） treated with PS TKA. The advantages and disadvantage as well as techniques of the 2 types of TKA were analyzed in the reference to related literature. Results In PCR group, early deep venous thrombosis （DVT） occurred in 2 patients but was cured after thrombolysis treatment. One patient had urinary infection at 3 weeks postoperatively and was cured within 2 weeks. One patient developed late knee infection at 14 months postoperatively, and the infection recurred in spite of 2 debridements. The patient had to receive arthrodesis of the knee after the prosthesis inside was taken out. In PS group, articular swelling and hydrarthrosis appeared in 1 case at 4 weeks postoperatively, who recovered well after open debridement and local administration of antibiotics. Three patients had early DVT which was cured by thrombolysis treatment. Lung infection appeared in 1 patient at 1 week postoperatively and was healed within 2 weeks. At one-year follow-up, the satisfaction rate of patients was 94.2% in PCR group and 93.8% in PS group, without statistically significant differences （ P 〉 0. 05 ）. The postoperative mean HSS score was 93.9 in PCR group and 94.3 in PS group, without statistically significant differences （ P 〉 0.05） . The mean range of motion was 105.8° in PCR group, and 107.4° in PS group, without significant differences （ P 〉 0. 05） . Seven cases in PCR group and 10 cases in PS group complained of slight knee pain which did not require a treatment. Two cases in PCR group and 4 cases in PS group had the patellar click sign which did not affect the k

关 键 词：关节成形术 置换 膝 假体安装 假体置入 

分 类 号：R686[医药卫生—骨科学]