采用保留后交叉韧带旋转半月板假体人工全膝关节置换治疗类风湿性关节炎的临床研究

CLINICAL RESEARCH OF POSTERIOR CRUCIATE LIGAMENT-RETAINED MOBILE-BEARING TOTAL KNEE ARTHROPLASTY IN TREATMENT OF RHEUMATOID ARTHRITIS

目的探讨采用保留后交叉韧带旋转半月板假体的人工全膝关节置换(total knee arthroplasty,TKA)治疗类风湿性关节炎(rheuma toid arthritis,RA)的疗效及常见问题的处理方法。方法回顾分析1999年2月-2005年8月行TKA的73例RA患者临床资料,其中38例采用保留后交叉韧带旋转半月板假体(A组),35例采用不保留后交叉韧带的后稳定固定平台假体(B组);并与同期采用保留后交叉韧带旋转半月板假体行TKA的70例骨性关节炎(osteoar-thritis,OA)患者(C组)比较。A组:男8例,女30例;平均年龄56.5岁;平均病程16.8年。B组:男6例,女29例;平均年龄57.3岁;平均病程17.1年。C组:男37例,女33例;平均年龄65.4岁;平均病程10.8年。A、B组一般资料比较差异无统计学意义(P>0.05),但与C组比较差异有统计学意义(P<0.05)。结果术后A、B组分别有2例(5.3%)及1例(2.9%)出现切口愈合不良,C组切口均愈合良好;A、B组发生率比较差异无统计学意义(P>0.05),与C组比较差异均有统计学意义(P<0.05)。术后患者均获随访,随访时间3.5～10.5年,平均7.6年。术后A、B、C组各1例出现深部感染,发生率比较差异无统计学意义(P>0.05)。A组术后5年出现1例(2.6%)后方不稳定,C组术后9年出现2例(2.9%),B组无后方不稳定发生;A、C组发生率比较,差异无统计学意义(P>0.05);A、C组与B组比较差异有统计学意义(P<0.05)。末次随访时,3组患者膝评分、Feller髌骨评分及膝前痛评分与术前比较,差异均有统计学意义(P<0.05);但术后组间比较差异均无统计学意义(P>0.05)。3组组内功能评分与术前比较,差异均有统计学意义(P<0.05);A、B组术前及术后功能评分与C组比较,差异均有统计学意义(P<0.05);A、B组比较差异无统计学意义(P>0.05)。结论采用保留后交叉韧带旋转半月板假体行TKA治疗RA可获得满意疗效,该型假体后方不稳定发生率低,并且在未置换髌骨的情况下前膝功能恢复较好。

Objective To analyse the results of posterior cruciate ligament-retained mobile-bearing total knee arthroplasty （TKA） in treatment of rheumatoid arthritis （RA） and to solve the problems often encountered during surgery. Methods From February 1999 to August 2005, the clinical data from 73 patients with RA undergoing TKA were analysed retrospectively. In 73 patients, 38 patients were treated with posterior cruciate ligament-retained mobile-bearing prosthesis （group A）, while 35 patients were treated with posterior stabilized fixed-bearing prosthesis （group B）. Another 70 patients with osteoarthritis （OA） treated with an posterior cruciate ligament-retained mobile-bearing prosthesis served as controls （group C）. In group A, there were 8 males and 30 females with an average age of 56.5 years and an average disease course of 16.8 years. In group B, there were 6 males and 29 females with an average age of 57.3 years and an average disease course of 17.1 years. In group C, there were 37 males and 33 females with an average age of 65.4 years and an average disease course of 10.8 years. There was no significant difference （P 〉 0.05） in general data between groups A and B, but there were significant differences （P 〈 0.05） when compared with group C. Results In groups A and B, 2 cases （5.3%） and 1 case （2.9%） had poor healing of incision, respectively; in group C, all cases had good healing of incision. There were significant differences in healing rate of incision between groups A, B and group C （P 〈 0.05）. All patients were followed up 7.6 years on average （range, 3.5-10.5 years）. Deep infection occurred in 1 case respectively in 3 groups, showing no significant difference （P 〉 0.05）. Posterior instability occurred in 1 case （2.6%） 5 years after operation in group A and 2 cases （2.9%） 9 years after operation in group C, and no posterior instability occurred in group B; showing significant differences between groups A, C and group B （P 〈 0.05）. There were significant differences （P 〈 0.05） in knee score, Feller patellar score, and anterior knee pain score between pre- and post- operative values among groups A, B, and C. There were significant differences （P 〈 0.05） in the function scores between pre- and post-operative values in 3 groups, between groups A, B and group C pre- and post-operatively. Conclusion Posterior cruciate ligament-retained mobile-bearing TKA can yield satisfactory clinical results in treatment of RA at intermediate-term follow- up. This mobile-bearing prosthesis has a low prevalence of posterior instability and a good outcome for anterior knee function without patellar resurfacing.