前参考法与后参考法对全膝关节置换术后股骨影像学参数以及膝关节功能的影响  

Effects of anterior versus posterior reference methods on femoral imaging parameters and knee function after total knee arthroplasty

作　　者：何兵[1] 石建伟[1] 张永辉[1] 徐静宜[1] 董敏[1] 张怡 王宇涵 王浩然 王齐超[1] HE Bing;SHI Jianwei;ZHANG Yonghui;XU Jingyi;DONG Min;ZHANG Yi;WANG Yuhan;WANG Haoran;WANG Qichao(Articular Surgery,Luohe Central Hospital,Luohe,Henan 462000,China)

机构地区：[1]漯河市中心医院关节外科,河南462000

出　　处：《中国骨与关节损伤杂志》2024年第2期133-138,共6页Chinese Journal of Bone and Joint Injury

基　　金：河南省重点研发与推广专项(科技攻关、软科学研究)项目(202102310813)。

摘　　要：目的观察全膝关节置换术中股骨端截骨采用前参考法与后参考法对患者术后股骨影像学参数以及膝关节功能的影响。方法回顾性分析自2016-03—2021-06采用全膝关节置换术治疗的103例膝关节骨性关节炎,根据全膝关节置换术采用不同股骨远端截骨方法进行分组,AR组47例采用前参考法,PR组56例采用后参考法。比较两组术后膝关节前髁notching深度、Tayside分级、股骨后髁偏心距、股骨远端前后径、股骨后髁偏移率、膝关节临床KSS评分、膝关节功能KSS评分、WOMAC评分、膝关节活动度。结果103例均获得随访,随访时间12.0~75.0个月,平均33.1个月。AR组前髁notching深度、股骨后髁偏心距、股骨后髁偏移率均小于PR组,差异有统计学意义(P<0.05)。AR组Tayside分级情况优于PR组,差异有统计学意义(P<0.05)。AR组与PR组术后1年、末次随访时膝关节临床KSS评分、膝关节功能KSS评分、WOMAC评分比较差异均无统计学意义(P>0.05)。AR组术后1年及末次随访时膝关节活动度均大于PR组,差异有统计学意义(P<0.05)。结论全膝关节置换术中采用前参考法在股骨前髁骨量保留和恢复髌股关节对合关系方面更有优势,而后参考法在股骨后髁的骨量保留和恢复关节线方面更有优势,同时前参考法在术后早期有着更大的膝关节活动度。Objective To observe effect of femoral osteotomy using anterior versus posterior reference method in total knee ar⁃throplasty on patients'postoperative femoral imaging parameters and knee function.Methods One hurdred and three cases of knee osteoarthritis treated with total knee arthroplasty from March 2016 to June 2021 were retrospectively analyzed,which were grouped according to different distal femoral osteotomy methods for total knee arthroplasty,47 cases in the AR group using the anterior reference method and 56 cases in the PR group using the posterior reference method.Postoperative anterior condylar notching depth of the knee,tayside grading,posterior condyle offset,anteroposterior diameter of the distal femur,femoral antero⁃posterior,posterior condyle offset rate,clinical KSS score,functional KSS score,WOMAC score,and knee range of motion were compared between the two groups.Results Follow-up was obtained in 103 cases,and the follow-up time ranged from 12.0 to 75.0 months,with a mean of 75.0 months.The anterior condylar notching depth,posterior condyle offset,and posterior condyle offset rate of the AR group were less than those of the PR group,and the difference was statistically significant(P<0.05).The Tayside grading in AR group was higher than that in the PR group,and the difference was statistically significant(P<0.05).The differences between the AR group and the PR group were not statistically significant in the knee clinical KSS scores,knee func⁃tion KSS scores,and WOMAC scores at 1 year postoperatively and at the last follow-up(P>0.05).Knee range of motion in the AR group was higher than that in the PR group at 1 year after surgery and at the last follow-up,and the difference was statisti⁃cally significant(P<0.05).Conclusion The anterior reference method in total knee arthroplasty is superior in terms of preserv⁃ing bone volume in the anterior femoral condyle and restoring patellofemoral alignment,whereas the posterior reference method is superior in terms of preserving bone volume in th

关 键 词：全膝关节置换术 前参考法 后参考法 Notching深度 Tayside分级 股骨后髁偏心距 股骨后髁偏移率 膝关节活动范围 

分 类 号：R687.4[医药卫生—骨科学]