全膝人工关节股骨假体屈曲对疗效的影响:1年随访结果(英文)

Effect of femoral component flexion in total knee arthroplasty One-year follow-up results

背景:对于全膝人工关节置换术的股骨假体屈曲问题,多数人认为不能或不太影响膝关节术后功能,仅仅是术后X射线片令人不甚满意,因此尚未引起人们足够的重视。目的:回顾分析78例123膝全膝人工关节置换术股骨假体屈曲对随访疗效的影响。设计:分组对比观察。单位:中国中医科学院望京医院骨关节一科。对象:选择2001-10/2004-06在中国中医科学院望京医院关节一科行全膝人工关节置换者78例123膝,其中发生股骨假体不同程度屈曲15例17膝(13.8%),男5例,女10例,年龄47～81岁;未发生屈曲63例106膝(86.2%),男22例,女41例,年龄47～79岁。方法:回顾性分析方法比较股骨假体屈曲组和非屈曲组手术前后HSS(HSS knee rating score)评分、膝关节活动范围和屈曲挛缩畸形,并测量屈曲角和屈曲距离,探讨股骨假体屈曲对置换效果的影响。主要观察指标:①股骨假体屈曲的测量结果。②患者膝关节HSS评分和活动度。③患者屈曲挛缩畸形例数及角度。④不良事件及副反应。结果:患者均获随访1年以上。①17膝股骨假体屈曲角为7°～19°,平均为11.3°;股骨假体屈曲距离为2～4mm,平均为2.6mm。②术前屈曲组与非屈曲组患者HSS评分和膝关节活动范围差异均无显著性(P>0.05),但术后屈曲组低于非屈曲组(P≤0.01);术后均高于术前(P=0.02或P<0.01)。③屈曲组术后屈曲挛缩例数和角度多于和大于非屈曲组(P<0.01),两组术后屈曲挛缩均有改善(屈曲组P<0.05,非屈曲组P<0.01)。④非屈曲组并发右股深静脉血栓1例,骨化性肌炎1例;屈曲组并发髌骨假体撞击征1膝。结论:本组资料证明,股骨假体屈曲对全膝人工关节置换效果的影响是增加术后膝关节屈曲挛缩的发生率,造成伸膝功能障碍。

BACKGROUND： The majority of pcople do not believe that the femoral component flexion in total knee arthroplasty affect or affect little postoperative function and it is the only that the radiographic films is not satisfactory, So it has not caused people＇s enough attention. But the femoral component flexion affects the results of total knee arthroplasty obviously. OBJECTIVE： To investigate the curative effects of femoral component installed in the position of flexion during the operative procedure of total knee arthroplasty （123 knees） on the follow up results in 78 patients. DESIGN： Grouping contrast observation. SETTING： First Department of Bone and Joint, Wangjing Hospital of China Academy of Traditional Chinese Medicine. PARTICIPANTS： 123 knees （78 patients） were given total knee arthroplasty in the First Department of Bone and Joint, Wangjing Hospital of China Academy of Traditional Chinese Medicine from October 2001 to June 2004. Seventeen （13.8%, 15 patients） knees were found with femoral component flexion （FCF）, in which there were 5 male cases and 10 female cases, aged from 47 to 81 years old. 106 （63 patients） knees were found without FCF, in which there were 22 male cases and 41 female cases, aged from 47 to 79 years old. METHODS： Total knee arthroplasties about their HSS rating scores, ranges of motion and flexion contractures were compared in the two groups before operation and after operation, and the degrees of the FCF angle and the distances of femoral component flexion were measured. MAIN OUTCOME MEASURES： （1） Femoral prosthesis flexion measurement; （2） HSS scores and activity; （3） femoral prosthesis flexion angle and distance buckling; （4） adverse events and side effects. RESULTS： Follow up lasted for one year above. （1） The degrees of flexion of femoral components were from 7° to 19° （average 11.3° ） and the distance of flexion was from 2 mm to 4 mm （average 2.6 mm ） in those 17 knees of total knee arthroplasty. （2） Differences in HSS rating scores and range of motion were not statistically significant （P 〉 0.05） before operations between the group of femoral component flexion and the group of femoral component plane. However, after operations the above aspects in the group of femoral component flexion were less than that in the group of femoral component plane significantly （P = 0.01, P 〈 0.01）, and were statistically significant （P = 0.02, P 〈 0.01） between post-operations and pre-operations in HSS rating scores and range of motion respectively in the two groups. （3） The statistic differences in cases and angles of flexion contractures of postperations between the group of femoral component flexion and the group of femoral component plane were significant （P 〈 0.01）, the situation in the group of femoral component flexion were more bad than that in the group of femoral component plane, but were all improved significantly in cases and angles of flexion contractures after operations in the two groups （P 〈 0.05, P 〈 0.01）, （4） There was one case with the right deep venous thrombosis and one case with myositis ossifican in non-FCF group, and there was one case in FCF group with impingement sign between patellar and component. CONCLUSION： The findings show that femoral component flexion will increase the incidence of knee flexion contracture and result in knee extension dysfunction after total knee arthroplasty surgery.