内轴型与后稳定型假体对膝关节置换术后快速康复的影响  

A retrospective comparison of effect of medial pivot prosthesis and posterior-stabilized prosthesis on enhanced recovery after surgery of total knee arthroplasty

作　　者：陈均源[1] 佘国荣[1] 甘文奕 刘文凭 刘宁[1] 查振刚[1] CHEN Junyuan;SHE Guorong;GAN Wenyi;LIU Wenping;LIU Ning;ZHA Zhen gang(Center for Joint Surgery and Sport Medicine,the First Affiliated Hospital of Jinan University,Guangzhou 510630,China)

机构地区：[1]暨南大学附属第一医院骨关节与运动医学中心

出　　处：《暨南大学学报（自然科学与医学版）》2019年第6期494-500,共7页Journal of Jinan University(Natural Science & Medicine Edition)

基　　金：国家自然科学基金项目(81672224)

摘　　要：目的:对比内轴型(MP)假体与后稳定型(PS)假体对膝关节置换术后快速康复的影响,以期更深入了解MP假体的临床效果.方法:回顾性分析2017年9月至2018年3月在我院行单侧全膝关节置换术(TKA)的122例患者资料,根据术中使用的假体类型分为MP组(58例)和PS组(64例).比较两组患者手术前后VAS疼痛评分、HSS评分、FJS-12评分、关节活动度及围手术期并发症发生率,并调查两组患者总体满意度.结果:与手术前比较,两组手术后1周、3月及6月的VAS疼痛评分均明显降低,具有统计学差异(P<0.05),两组手术后1周、3月及6月HSS评分均明显升高,具有统计学差异(P<0.05).两组手术后1周、3月及6月VAS疼痛评分和HSS评分之间无统计学差异(P>0.05).两组患者手术后1周膝关节活动度均大于90°,早期关节活动度恢复满意,而后关节活动度进一步增大.两组手术后1周、3月及6月膝关节活动度之间无统计学差异(P>0.05).末次随访FJS-12评分中“上下楼梯”及“从坐着站起来”两项得分,MP组得分明显高于PS组,具有统计学差异(P<0.05),但两组FJS-12总分之间无统计学差异(P>0.05).两组患者围手术期并发症发生率及输血率均较低,无统计学差异(P>0.05).两组患者总体满意度之间无统计学差异(P>0.05).结论:MP假体和PS假体全膝关节置换术后均可实现快速康复,术后患者功能恢复良好,且围手术期并发症发生率较低.两组患者总体满意度相当,但MP组患者术后上下楼梯及从坐着站起来的感受更为自然.Objective:In order to have a better understanding of the clinical effects of using medial-pivot(MP)prostheses in total knee arthroplasty(TKA),we compared the effect of medial pivot(MP)prosthesis and posterior-stabilized(PS)prosthesis on the enhanced recovery after surgery(ERAS)of TKA.Methods:This study was a retrospective comparison between 2 groups of patients having unilateral TKA(58 MP-TKA vs 64 PS-TKA)from Sep 2017 to Mar 2018.The main factors were compared in 2 groups,including Visual Analogue Scale(VAS)pain score,HSS score,FJS-12,range of motion(ROM)and incidence of perioperative complications,as well as overall satisfaction.Results:The VAS score was significantly lower at 1 week,3 months and 6 months postoperation than preoperation in two groups(P<0.05).The HSS score was significant higher at 1 week,3 months and 6 months postoperation than preoperation in two groups(P<0.05).In two groups,the range of motion of knee joint was more than 90°at 1 week after operation.The recovery of ROM was satisfactory at the early stage,and the ROM increased further with time.There was no statistical difference in VAS,HSS and ROM between two groups in 1 week,3 months and 6 months postoperatively(P>0.05).In the last follow-up,the MP group scored higer on two items,“Climbing stairs”and“Standing from low sitting position”,in the FJS-12 score,although there was no statistical difference in FJS-12 total score between the two groups.No significant difference in perioperative complication incidence and blood transfusion rate,and patient-reported satisfaction were observed between the 2 groups(P>0.05).Conclusion:Both MP prostheses and PS prostheses can help to achieve ERAS after TKA.The joint function of patients recovered well,and the incidence of perioperative complications were low.It is more natural for MP prostheses patients to walk stairs and stand up,but no significant difference in patient-reported satisfaction were observed between MP prostheses and PS prostheses.

关 键 词：全膝关节置换术 内轴型 后稳定型 快速康复 骨关节炎 

分 类 号：R687.4[医药卫生—骨科学]