应用旋转平台人工全膝关节置换术的初步报告

Preliminary report of application of mobile bearing total knee replacement

目的探讨旋转平台人工全膝关节置换术的临床效果。方法对49例患者行70膝的Sigma旋转平台人工全膝关节置换术，其中21例为双侧膝关节置换。男7例，女42例；年龄38—78岁，平均63岁。术前诊断膝骨关节炎42例，类风湿关节炎7例。采用正中切口髌旁内侧入路、后稳定型假体，所有膝关节都未进行髌骨置换，但对髌骨进行去神经化和修复术。结果本组随访时间6—22个月，平均12．7个月，共70膝。影像学显示均无松动，无髌骨脱位。对膝关节临床评定采用美国膝关节学会评分（KSS评分），术前膝评分49分（35—70分），膝功能评分40分（30—60分），术后最后一次随访膝评分为96分（83—100分）；功能评分为95分（65—100分），没有旋转平台的旋出，没有翻修或者感染的发生。结论旋转平台人工全膝关节置换术在运动学分析和实验室磨损试验的数据上有潜在的优势，尤其是在年轻的活动能力强的患者，近期随访获得了满意的疗效，远期的疗效还需进一步随访。

Objective To discuss clinical results of mobile bearing total knee replacement. Methods Forty-nine patients （70 knees besides 21 bilateral knees） including 7 males and 42 females at age range of 38-78 years （mean 63 years） were treated with total knee replacement by using Sigma mobile bearing knee system. Primary diagnosis showed osteoarthritis in 42 patients and rheumatoid arthritis in 7 patients. By midline incision and side-patella approach, posterior stabilized prosthesis was performed in every patient, with denervation and plasty of patella instead of patella replacements. Results The patients （ with 70 knees） were followed up for mean 12.7 months （ 6-22 months）. Image analysis showed no prosthesis loosening or patella dislocation. Preoperative knee score and knee function score were 49 points （35-70 points） and 40 points （30-60 points） respectively and those at final follow-up were 96 points （83-100 points） and 95 points （65-100 points） respectively. No rotation plate dislocation, revision or infection occurred. Conclusions The mobile bearing total knee replacement has potential advantages in kinematic analysis and wearing experiment. Short term follow-up shows good clinical results especially in young and active patients but remote effect still needs further follow up studies.