全膝关节置换后冠状位股骨-胫骨机械轴偏移与早期关节功能恢复的关系  

Relationship between tibio-femoral mechanical axis deviation on coronal plane and early joint function recovery after total knee arthroplasty

作　　者：米尔阿里木•木尔提扎 艾尼瓦尔江•达毛拉 蔺海山 王利[1] Mieralimu•Muertizha;Ainiwaerjiang•Damaola;Lin Haishan;Wang Li(Department of Orthopedics,Joint and Geriatric Osteopathy,People’s Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830001,Xinjiang Uygur Autonomous Region,China)

机构地区：[1]新疆维吾尔自治区人民医院骨科中心关节老年病区,新疆维吾尔自治区乌鲁木齐市830001

出　　处：《中国组织工程研究》2021年第21期3300-3304,共5页Chinese Journal of Tissue Engineering Research

基　　金：新疆维吾尔自治区人民医院院内课题项目(20190406),项目名称:下肢负重全长拼接X片中肢体旋转误差对评估TKA术后下肢力线的影响研究,项目负责人:米尔阿里木·木尔提扎。

摘　　要：背景:人工全膝关节置换是终晚期膝关节病最有效的诊疗手段,但术后下肢冠状位力线偏移中立位程度对临床预后的影响目前存在较大争议。目的:探讨人工全膝关节置换术后冠状位上股骨-胫骨机械轴偏移中立位程度对患者关节功能及临床预后的影响。方法:纳入2015年1月至2017年12月新疆维吾尔自治区人民医院收治的原发性膝骨关节炎患者60例,年龄(66.8±5.0)岁,均接受单侧人工膝关节置换治疗,术后随访拍摄下肢全长拼接片,测量股骨-胫骨机械轴。根据末次随访股骨-胫骨机械轴将患者分为中立位组(0°≤夹角≤3°,n=25)、轻度偏移组(夹角3°-6°,n=21)、重度偏移组(夹角>6°,n=14)。同时比较末次随访时3组间的牛津膝关节功能评分OKS、目测类比评分与SF-12健康调查问卷评分。试验获得且得到医院伦理委员会批准。结果与结论:①3组患者随访过程中均未出现切口愈合问题、深静脉血栓、假体周围感染、假体松动等并发症;②术后末次随访时,3组间OKS评分、目测类比评分比较差异均无显著性意义(P>0.05),重度偏移组SF-12健康调查问卷评分低于其他两组(P<0.05);③结果表明,当人工全膝关节置换术后股骨-胫骨机械轴偏离下肢力线中心3°-6°时,对患者术后功能及生活质量无明显影响;当偏离下肢力线中心6°以上时,对患者术后生活质量可能有相应的影响。BACKGROUND:Total knee arthroplasty is the most effective treatment method for the end-stage knee diseases.However,the influence of the neutral alignment of lower limb on coronal plane on the clinical outcomes after surgery is still controversial.OBJECTIVE:To investigate the effect of tibio-femoral mechanical axis deviation degree on coronal plane on the joint function and clinical outcomes after total knee arthroplasty.METHODS:Sixty patients with primary knee osteoarthritis aged(66.8±5.0)years from the People’s Hospital of Xinjiang Uygur Autonomous Region from January 2015 to December 2017 who underwent unilateral total knee a rthroplasty were retrospectively analyzed.At the last follow-u p,full-length radiographs were taken and tibio-femoral mechanical axis values were measured.The patients were divided into three groups:neutral position group(0°≤included angle≤3°,n=25),mild deviation group(3°-6°,n=21),and severe deviation group(included angle>6°,n=14)according to the tibio-femoral mechanical axis during the last follow-up.OKS,visual analogue scale score,and SF-12 health questionnaire scores were also compared among the three groups at the last follow-up.The trial was approved by the hospital ethics committee.RESULTS AND CONCLUSION:(1)There were no incision healing problems,deep vein thrombosis,pe riprosthesis infection,prosthesis loosening,or other complications during the follow-up in the three groups.(2)There was no significant difference in OKS and visual analogue scale scores among the three groups(P>0.05).The SF-12 health questionnaire scores of severe deviation group were lower than those of the other two groups(P<0.05).(3)The results showed that when the tibio-femoral mechanical axis deviated from the center of the line of lower limbs by 3°-6°after total knee arthroplasty,was no significant influence on the postoperative function and quality of life of the patients.Deviation from the center of the line of lower limbs by more than 6°may have a corresponding impact on the postoperative clini

关 键 词：骨 假体 骨性关节炎 人工膝关节置换 胫股机械轴 下肢力线 

分 类 号：R459.9[医药卫生—治疗学] R319[医药卫生—临床医学]