两种关节假体在双膝置换术后中期步态分析  

Gait difference of two different prostheses in mid-term follow-up following bilateral knee replacements

作　　者：高兴华[1] 刘永轶[1] 陈霖[1] 陈祥 林泽枫 Gao Xinghua;Liu Yongyi;Chen Lin;Chen Xiang;Lin Zefeng(Department of Orthopaedics,Guangzhou First People s Hospital,South China University of Technology,Guangzhou 510180,China;Guangdong Key Lab of Orthopedic Technology and Implant Materials,General Hospital of Southern Theater Command of PLA,Guangzhou 510010,China)

机构地区：[1]广州市第一人民医院关节外科,华南理工大学,510180 [2]广东省骨科矫形技术及植入材料重点实验室,解放军南部战区总医院,广州510010

出　　处：《中华关节外科杂志（电子版）》2022年第3期287-294,共8页Chinese Journal of Joint Surgery(Electronic Edition)

摘　　要：目的:评价后稳定型假体(PS)/后交叉韧带保留型假体(CR)在双侧膝关节置换术后中期的三维运动步态特征。方法:病例组纳入广州市第一人民医院双侧膝关节置换术后约5年的膝骨关节炎患者,Kellgren-Lawrence分级为Ⅲ级或Ⅳ级,排除单侧膝关节置换、身体质量指数>30 kg/m2等的患者。根据假体类型不同分为两组:后稳定型假体(PS)组和保留后交叉韧带型假体(CR)组,各30人,共60例,120膝。对照组选取同龄健康老年人,共15人,30膝。随访膝关节协会评分(KSS评分)、视觉模拟评分法(VAS评分)及西大略湖和麦克马斯特大学膝关节评分(WOMAC评分)。运用Opti-Knee膝关节三维运动系统测试步态,选取支撑相(初、中、末期)及摆动相的相关数据分析。所有数据采用单因素方差分析,组间两两比较采用Bonferroni检验。结果:KSS评分、VAS评分三组间差异无统计学意义(均为P>0.05)。WOMAC评分三组比较差异有统计学意义(F=5.491,P<0.05),其中PS组高于对照组(P<0.05)。支撑相初期,内外移三组比较差异有统计学意义(F=84.720,P<0.05),CR组与对照组、PS组比较,CR组大于其它两组,差异均有统计学意义(均为P<0.05);支撑相中期,伸展角三组比较差异有统计学意义(F=7.779,P<0.05),PS组小于对照组(P<0.05);支撑相末期,伸展角及内外移三组比较差异有统计学意义(F=5.836、3.185,均为P<0.05)。PS组比对照组小,且差异均有统计学意义(P<0.05)。摆动相时,内旋角、屈曲角、胫骨外移三组比较差异有统计学意义(F=10.93、9.089、4.645,均为P<0.05),CR组内旋角小于对照组(P<0.05),CR组屈曲角比PS组大(P<0.05);胫骨外移PS组明显小于对照组(P<0.05)。结论:在双侧TKA术后PS假体与CR假体患者的中期步态结果中许多指标仍不如同龄健康人,其中CR假体患者三维运动步态结果比PS假体患者更接近同龄成年人。Objective To evaluate and compare the three-dimensional gait parameters of posterior stabilized prosthesis(PS)/cruciate retention ligament(CR)prosthesis after bilateral knee replacement.Methods All the patients after bilateral knee replacement in Guangzhou First People's Hospital for about five years were followed up,and the Kellgren-Lawrence classification was HI to IV grade.The patients of unilateral knee replacement and body mass index over 30 kg/m2 and so on were excluded.According to the different types of implant,the patients were divided into two groups,the posterior stabilized prosthesis(PS)group and the cruciate retention ligament(CR)group,30 cases in each group.The control group were 15 healthy adults of the same age(30 knees).Knee Society score(KSS),visual analogue scale(VAS)and the Western Ontario and Mcmaster Universities(WOMAC)osteoarthritis index were evaluated.The gait was recorded and analyzed by the Opti-Knee three-dimensional motion analysis system.The parameters were recorded in supporting phase and swing phase.The repeated measurement AN OVA was used for comparison,and Bonferroni test was used for comparison between two groups.Results There was no significant difference in KSS,VAS in PS group,CR group and control group(both P>0.05).The differences of WOMAC score among the three groups were statistically significant(F-5.491,P<0.05),and the PS group was higher than the control group(P<0.05).At initial stage of the supporting phase,the differences of the medial and lateral displacements were statistically significant among the three groups(F=84.720,P<0.05);the data of the CR group were larger than the other groups(both P<0.05).During the middle supporting phase,the extension angles were different among the three groups(F=7.779,P<0.05);the data of the PS group were smaller than the control group(P<0.05).At the end of the supporting phase,the extension angles and medial/lateral displacements were different among the three groups(F=5.836,3.185,both P<0.05);the data of the PS group were smaller than

关 键 词：关节成形术 置换 膝 人工膝关节 假体和植入物 步态 

分 类 号：R687.4[医药卫生—骨科学]