国产生物型全膝关节置换的初始稳定性观察及临床探索  

Initial stability observation and clinical exploration of domestic cementless total knee prosthesis

作　　者：宋晓兰 孙永强[1] 刘国杰 阎亮 李帅垒 叶晔[1] SONG Xiao-lan;SUN Yong-qiang;LIU Guo-jie;YAN Liang;LI Shuai-lei;YE Ye(Department of Orthopaedics,Henan Luoyang Orthropedic Hospital.Zhengzhou,Henan,450016,China)

机构地区：[1]河南省洛阳正骨医院,郑州450016

出　　处：《中国骨与关节杂志》2023年第2期123-130,共8页Chinese Journal of Bone and Joint

基　　金：河南省中医药科学研究专项(编号:2019ZYZD01)。

摘　　要：目的观察国产生物型全膝关节置换[(非骨水泥固定)(total knee arthroplasty,TKA)]术后早期的临床结果和放射影像,分析其初始稳定性。方法回顾性分析2021年12月至2022年3月,我院收治的29例膝关节,均采用国产生物型TKA治疗,分别观察术后6周、3个月的美国膝关节协会膝评分(Knee Society Objective Score,KSOS)、美国膝关节协会功能评分(Knee Society Function Score,KSFS)、关节活动度(range of motion,ROM)、数字模拟疼痛评分(numerical rating scale,NRS)较术前的变化,并观察可能的并发症发生情况。术后第2天、6周、3个月给予放射平片观察术后假体位置是否发生变化、是否透亮线出现。术后3个月借助SPECT/CT、薄层(0.6 mm)减伪影CT分析骨整合状态。统计学分析临床数据变化观察术后早期效果再结合实验室力学测试结果初步分析初始稳定性。结果29例(29膝)均采用国产生物型全膝关节假体(雅博尼西医疗科技,苏州)行TKA,均于术后第7天出院,其中19例行后交叉韧带保留(cruciateretaining,CR)型TKA,8例行后交叉韧带切除超吻合(ultra-congruent,UC)型TKA,2例行后稳定(posterior stabilized,PS)型TKA;KSOS评分:术前(65.72±9.47),术后末次随访时(90.31±3.36),(P=0);KSFS评分:术前(34.41±13.05),术后末次随访时(75.14±6.09),(P=0);NRS评分:术前(6.97±1.18)术后末次随访时(3.00±0.96),(P=0);ROM:术前(91.14±8.43)°术后末次随访时(118.21±4.99)°,(P=0);所有膝关节无明显感染迹象,无血栓栓塞类并发症出现,放射平片无1例出现明显假体松动移位、透亮线、关节不稳;薄层(0.6 mm)减伪影CT结合SPECT/CT显示骨-假体界面结合紧密,局部可见松质骨长入假体内面涂层孔隙中,界面骨转换强度活跃。结论国产生物型TKA术后初期临床结果很好,假体初始稳定性可靠,术后3个月界面出现有效骨长入。Objective To observe the early clinical results and radiographic images of domestic cementless total knee arthroplasty,and to analyze its initial stability.Methods A retrospective analysis was performed on 29 cases admitted to our hospital from December 2021 to March 2022.All were treated with domestic cementless total knee arthroplasty.The American Knee Society Objective Score(KSOS),Knee Society Function Score(KSFS),Range of Motion(ROM),Numerical Rating Scale(NRS)and possible complications were observed 6 weeks and 3 months after surgery.On the second day,6 weeks and 3 months after the operation,plain radiographs were taken to observe prosthesis dislocation and bright lines.SPECT/CT and thin layer(0.6 mm)subtraction CT were used to analyze the status of bone integration 3 months postoperatively.Statistical analysis and laboratory mechanical tests were applied to observe initial stability.Results A total of 29 patients(29 knees)underwent TKA with domestic cementless total knee prosthesis(Yabonisi Medical Technology,Suzhou).All were discharged 7 days postoperatively.Among them,19 patients underwent cruciate-retaining(CR)TKA,8 patients underwent ultra-congruent(UC)TKA,and 2 patients underwent posterior stabilized(PS)TKA.At the last follow-up,the KSOS and KSFS scores of all knees increased from(65.72±9.47)and(34.41±13.05)to(90.31±3.36)and(75.14±6.09),respectively(P=0,P=0).NRS pain score decreased from(6.97±1.18)to(3.00±0.96)(P=0).ROM improved from preoperative(91.14±8.43)to(118.21±4.99)(P=0).No obvious signs of infection,thromboembolic complication,prosthesis loosening,prosthesis displacement,radiolucent line,or joint instability were observed.Thin layer(0.6 mm)subtraction CT combined with SPECT/CT showed a tight bone-prosthesis interface with locally observed cancellous bone growing into the surface coating of the prosthesis and an active bone conversion intensity at the interface.Conclusions The early clinical results of domestic cementless total knee arthroplasty are good.The initial stability of the pros

关 键 词：关节成形术 置换 膝 人工膝关节 生物假体 后交叉韧带 膝关节 

分 类 号：R687.4[医药卫生—骨科学]