关节线高度变化对内轴型假体全膝关节置换术中期疗效的影响  

The impact of joint line alteration on patients underwent primary medial pivot total knee arthroplast

作　　者：史为鹏 王锴[2] 王英振[1] 李海燕[1] 张子安[1] Shi Weipeng;Wang Kai;Wang Yingzhen;Li Haiyan;Zhang Zian(Department of Joint Surgery,the Affiliated Hospital of Qingdao University,Qingdao 266000,China;Department of Joint Surgery,Peking University People's Hospital,Beijing 100044,China)

机构地区：[1]青岛大学附属医院关节外科,266000 [2]北京大学人民医院关节病诊疗中心,100044

出　　处：《中华骨科杂志》2021年第24期1744-1752,共9页Chinese Journal of Orthopaedics

摘　　要：目的探讨关节线高度变化对初次内轴型假体全膝关节置换术中期疗效的影响。方法回顾性分析2015年1至12月因膝关节骨关节炎接受初次内轴型假体全膝关节置换术且随访4年以上的患者189例(233膝),男30例(30膝)、女159例(203膝);年龄(66.42±6.12)岁(范围51~82岁)。根据手术前后关节线高度改变值(术后第2天关节线高度-术前关节线高度)以4 mm为间距将患者分为<-4 mm组、-4 mm~组、0 mm~组及>4 mm组。比较四组患者术前及术后4年膝关节屈曲活动度、膝关节学会膝关节评分系统(Knee Scoring System,KSS)、西安大略和麦克马斯特大学(Western Ontario and McMaster Universities,WOMAC)骨关节炎指数。结果术后随访(52.20±2.94)个月(范围48~59个月)。133膝(57%)术后关节线升高,100膝(43%)关节线降低。术前关节线高度为(16.56±3.54)mm(范围7.33~25.32 mm),术后4年为(17.34±2.92)mm(范围7.25~25.43 mm),关节线升高(0.78±3.17)mm(范围-6.00~9.91 mm),手术前后差异有统计学意义(t=-2.596,P=0.010)。四组患者年龄、体质指数、术前胫骨后倾角、术前股骨后髁偏心距的差异均无统计学意义(P>0.05)。术前膝关节活动度为90.45°±20.44°,术后4年增大至108.95°±12.55°(t=-22.381,P<0.001);各组活动度的差异有统计学意义(F=7.101,P<0.001),其中0 mm~组和>4 mm组高于<-4 mm组和-4 mm~组(P<0.05)。术后4年KSS临床评分及功能评分均较术前升高,WOMAC评分较术前降低(F=0.723,P<0.001;F=1.138,P<0.001;F=2.502,P<0.001),而组间差异均无统计学意义(P>0.05)。>4 mm组术后半年出现1例垫片脱出,<-4 mm组3例术后即出现屈曲时膝前区疼痛。结论使用内轴型关节假体行初次全膝关节置换可明显改变关节线位置。关节线高度改变值越大,膝关节活动度越大,但关节线高度变化值对术后中期膝关节功能无明显影响。Objective:To investigate the influence of joint line alteration on the mid-term clinical effects of primary medial pivot total knee arthroplasty(MP-TKA).Methods:Data of a total 189 patients(233 knees)with 30 males(30 knees)and 159 females(203 knees)with age 66.42±6.12,diagnosed as knee osteoarthritis and underwent primary MP-TKA from January to December 2015,were retrospectively analyzed.All cases were followed up for at least 4 years.The patients were divided into four groups according to the extent of alteration,namely<-4 mm,-4-mm,0-mm and>4 mm.Range of motion(ROM),Knee Society's Knee Scoring System(KSS),the Western Ontario and McMaster University(WOMAC)osteoarthritis index score were compared preoperatively and at 4 years postoperatively.Results:The postoperative follow-up duration was 52.20±2.94 months(48-59 months).A total of 133 knee(57%)had joint line raised and 100 cases(43%)joint line distal shifted.The overall height of joint line before surgery was 16.56±3.54 mm(7.33-25.32 mm)and 17.34±2.92 mm(7.25-25.43 mm)postoperatively.The average alteration was 0.78±3.17 mm(-6.00-9.91 mm)with statistically significant difference(t=-2.596,P=0.010).There was no statistical difference among the four groups in terms of gender,body mass index,pre-operative tibia slope and post condylar offset.The overall preoperative ROM of the all groups was 90.45°±20.44°,which increased from baseline to 108.95°±12.55°at 4 years postoperatively(t=-22.381,P<0.001).There was statistical difference in term of ROM among each group(F=7.101,P<0.001).The ROM in group 0-mm and>4 mm was significantly higher than that in group<-4 mm and-4-mm(P<0.05).The KSS function score and clinic score at 4 years postoperatively were significantly higher that those before surgery,the WOMAC score was statistically lower at 4 years postoperatively(F=0.723,P<0.001;F=1.138,P<0.001;F=2.502,P<0.001).There was no significant difference among the four groups in terms of KSS score and WOMAC(P>0.05).One case in>4 mm group had gasket prolapse at 6 month afte

关 键 词：骨关节炎 关节成形术 置换 膝 治疗结果 

分 类 号：R687.4[医药卫生—骨科学]