全膝关节置换术后关节线上移对临床功能和运动学参数的影响  

Effect of joint line elevation after total knee arthroplasty on clinical outcomes and kinematics

作　　者：及松洁[1] 姜旭[1] 王广志[2] 丁晖 周一新[1] JI Song-jie;JIANG Xu;WANG Guang-zhi;DING Hui;ZHOU Yi-xin(Dept.of Adult Joint Reconstruction Surgery,Beijing Jishuitan Hospital,Beijing 100035;Dept.of Biomedical Engineering,Tsinghua University,Beijing,100084)

机构地区：[1]北京积水潭医院矫形骨科,北京100035 [2]清华大学生物医学工程系,北京100084

出　　处：《基础医学与临床》2018年第11期1526-1531,共6页Basic and Clinical Medicine

基　　金：国家自然科学基金(81472189)

摘　　要：目的探讨关节线上移对后稳定假体和后交叉韧带保留假体的全膝关节置换(TKA)患者的临床功能和运动学参数的影响。方法收集北京积水潭院2013年1月至2015年12月使用GⅡ行全膝关节置换术的病例,符合标准的纳入研究,共57膝。按手术假体分为后稳定假体(PS)组和交叉韧带保留假体(CR)组。随访1年,临床功能使用美国膝关节协会(AKS)评分、AKS功能评分和Feller髌骨评分进行评定。用透视技术采集患者的运动学数据,并用2D-3D的注册匹配技术将假体的数字模型还原在影像学动态数据上进行测量。分析患者屈伸活动时股骨内髁、股骨外髁在胫骨平台上的运动,以及股骨胫骨之间的相对旋转。结果 PS组术后的AKS评分(P<0. 05)、AKS功能评分(P<0. 05)、Feller髌骨评分(P<0. 01)和术后活动度(P<0. 01)均比CR组好。PS组股骨内髁的移动是(4. 9±3. 0) mm,外髁的移动是(12. 8±3. 3) mm,股胫关节旋转12. 9°±4. 5°; CR组股骨内髁的移动是(4. 3±3. 5) mm,外髁的移动是(7. 9±4. 2) mm,股胫关节旋转6. 7°±5. 9°。PS组更接近生理。结论关节线(JL)上移对CR假体的不良影响比PS假体大,在关节线上移的病例中尽量选择PS假体。Objective To evaluate the clinical and kinematic results of TKAs with posterior-stabilized(PS)or cruciate-retaining(CR)prosthesis in which the JL was elevated postoperatively.Methods Patients who underwent total knee arthroplasty between January 2013 and December 2015 were collected.The patients were divided into two groups based on the prosthesis they received(PS or CR).Clinical results were evaluated by AKS knee score、AKS function score and Feller score.In vivo kinematic analysis after TKA was performed and a previously validated three-dimensional(3D)to two-dimensional(2D)image registration technique was used to obtain the kinematic data.Anteroposterior translation of the medial and lateral femoral condyles,and axial rotation relative to the tibial plateau,were analyzed.Results Following up results showed differences in the AKS knee scores,AKS function scores,Feller scores and postoperative ROMs between the PS and CR group.In the PS group,the magnitudes of AP translation for the medial and lateral condyle were(4.9±3.0)mm and(12.8±3.3)mm,respectively.Axial rotation of the tibial component relative to the femoral component was 12.9°±4.5°.In the CR group,the magnitudes of AP translation for the medial and lateral condyle were(4.3±3.5)mm and(7.9±4.2)mm respectively.Axial rotation was 6.7°±5.9°.There were statistically different between PS group and CR group in kinematics post-operatively.Conclusions Postoperative JL elevation has been linked to more adverse events.

关 键 词：运动学 全膝关节置换术 后交叉韧带保留 后稳定 透视分析 

分 类 号：R687.42[医药卫生—骨科学]