中长期随访全膝关节置换后膝关节韧带松弛度对患者满意度的影响  

Effect of knee ligamentous laxity on patient satisfaction after total knee arthroplasty:a medium to long-term follow-up

作　　者：夏培格 殷力[1] 王海涛[1] 张翼[1] 乔仁秋 孔智恒 赵洪波 石翔宇 Xia Peige;Yin Li;Wang Haitao;Zhang Yi;Qiao Renqiu;Kong Zhiheng;Zhao Hongbo;Shi Xiangyu(Department of Orthopedics,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,Henan Province,China)

机构地区：[1]郑州大学第一附属医院骨科,河南省郑州市450000

出　　处：《中国组织工程研究》2022年第15期2323-2329,共7页Chinese Journal of Tissue Engineering Research

基　　金：河南省高校重点科研项目(20A310022),项目负责人:殷力

摘　　要：背景:全膝关节置换的成功需要在术中选取适宜的软组织松弛度,但不同患者术后的软组织变化情况不同。目的:探究全膝关节置换后中长期随访中膝关节软组织松弛度对患者满意度的影响,初步检验以长度测量膝关节软组织松弛度的效能。方法:选择在郑州大学第一附属医院行全膝关节置换且获得术后5-10年随访的患者107例,拍摄应力位X射线片,以不同方法测量双侧膝关节冠状位松弛度。①方法A:以内外翻应力试验中膝关节内外侧开口距离变化值之和表示膝关节松弛度,A1组(≥0 mm且≤5 mm,n=23),A2组(>5 mm且≤7 mm,n=38),A3组(>7 mm且≤9 mm,n=24),A4组(>9 mm,n=22);②方法B:以内外翻应力试验中膝关节内外翻角度之和表示膝关节松弛度,B1组(≥0°且≤4°,n=20),B2组(>4°且≤6°,n=31),B3组(>6°且≤9°,n=23),B4组(>9°,n=33);③方法C:求出方法A中双膝关节间松弛度的差值来表示双膝关节间松弛度差异,C1组(≤-5 mm,n=22),C2组(>-5 mm且≤-1 mm,n=33),C3组(>-1 mm且≤1 mm,n=32),C4组(>1 mm,n=20);④方法D:求出方法B中双膝关节间松弛度的差值来表示双膝关节间松弛度差异,D1组(≤-3°,n=27),D2组(>-3°且≤0°,n=33),D3组(>0°且≤3.5°,n=27),D4组(>3.5°,n=20)。根据OKS评分及改良Lysholm评分评估膝关节功能,找出患者满意度最高的软组织松弛度范围。通过比较A、B两种方法的灵敏度和特异度得出在此次随访中测量效能更好的测量方法,通过分析C、D两种方法的结果解释双膝关节间松弛度差异对患者满意度的影响。结果与结论:①方法A中各组间OKS评分、改良Lysholm评分比较差异均有显著性意义(P<0.05),功能最佳的范围是5-9 mm;方法B中各组间OKS评分、改良Lysholm评分比较差异均有显著性意义(P<0.05),功能最佳的范围为4°-9°;方法C中各组间OKS评分、改良Lysholm评分比较差异无显著性意义(P>0.05);方法D中各组间OKS评分、改良Lysholm评分比较差异BACKGROUND:Appropriate soft tissue laxity is required for a successful total knee arthroplasty;however,different patients present with different soft tissue changes after surgery.OBJECTIVE:To investigate the effect of knee ligamentous laxity on patient satisfaction during medium and long-term follow-up after total knee arthroplasty,and to preliminarily test the effectiveness of measuring knee ligamentous laxity based on length measurement.METHODS:A total of 107 patients who underwent total knee arthroplasty in the First Affiliated Hospital of Zhengzhou University and had been followed up for 5-10 years after surgery were selected.Stress X-rays were taken in each patient,and the coronal laxity of the bilateral knee joints was measured by different methods.Method A:The knee joint laxity was expressed by the sum of the changes in the distance between the medial and lateral openings of the knee joint in the varus and valgus stress test:A1 group(≥0 mm and≤5 mm,n=23),A2 group(>5 mm and≤7 mm,n=38),A3 group(>7mm and≤9 mm,n=24),and A4 group(>9 mm,n=22).Method B:The knee joint laxity was expressed by the sum of the knee joint varus and valgus angles in the varus and valgus stress test:B1 group(≥0°and≤4°,n=20),B2 group(>4°and≤6°,n=31),B3 group(>6°and≤9°,n=23),and B4 group(>9°,n=33).Method C:The difference in laxity between the knee joints described in Method A was calculated to indicate the difference in laxity between the bilateral knee joints:C1 group(≤-5 mm,n=22),C2 group(>-5 mm and≤-1 mm,n=33),C3 group(>-1 mm and≤1 mm,n=32),and C4 group(>1 mm,n=20).Method D:The difference in the laxity between the knee joints in Method B was calculated to indicate the difference in laxity between the knee joints:D1 group(≤-3°,n=27),D2 group(>-3°and≤0°,n=33),D3 group(>0°and≤3.5°,n=27),and D4 group(>3.5°,n=20).The Oxford knee score and the modified Lysholm score were used for knee function assessment,to find out the soft tissue laxity range with the highest patient satisfaction.By comparing the sen

关 键 词：骨性关节炎 全膝关节置换 膝关节韧带松弛度 软组织平衡 膝关节功能评分 满意度 假体置入 骨科植入物 

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