固定平台后稳定型假体与旋转高屈曲型假体治疗膝骨性关节炎的早期疗效比较

A comparison of the short-term effects of fixed platform versus rotating high-flexion prosthesis for the patients with osteoarthritis of knee

目的评价人工全膝关节置换(total knee replacement,TKR)中使用固定平台后稳定型假体与旋转高屈曲型假体治疗骨性关节炎的早期临床疗效。方法对我院2007年1月—2009年12月收治的68例骨关节炎患者施行TKR手术,其中应用固定平台后稳定型假体32例38膝,旋转高屈曲型假体36例44膝,通过测量手术前及末次随访时的膝关节活动度和美国特种外科医院膝关节评分(hospital for special knee surgery score,HSS)对两种假体置换方式的临床疗效进行比较。结果 68例患者获随访3～26个月,平均19个月。根据HSS评分标准,末次随访时优47例(69.1%),良17例(25.0%),可4例(5.9%),总优良率94.1%。两组之间术前活动度以及术前、末次随访时HSS的差异无统计学意义(P>0.05),而旋转高屈曲型假体组在末次随访活动度方面较固定平台后稳定型假体组为高(P<0.05)。结论高屈曲度人工膝关节假体在运动学上有潜在的优势,有助于改善关节功能,减轻接触应力和假体磨损;固定平台后稳定型假体手术方式简单、疗效肯定、术后并发症少,对不需要从事高屈曲活动、经济较为困难以及高龄患者是一种可供选择的假体。

Objective To compare the preliminary clinical outcome between fixed platform and rotating high-flexion prosthesis following total knee replacement （TKR）. Methods From January 2007 to December 2009, 68 patients with osteoarthritis of knee underwent TKR. Thirty two patients （38 knees） received fixed bearing prosthesis, while 36 patients 44 knees received rotating high-flexion prosthesis. Knee joint range of motion （ROM） and the hospital for special knee surgery score （HSS） were measured preoperatively and at the last follow-up to compare the clinical effects of two prosthesis replacement methods. Results All patients were followed up for 3-26 months with an average of 22 months. According to HSS, the result was excellent in 47 cases, good in 17 cases and fair in 4 cases with the total excellent and good rate of 94.1%. Preoperative ROM of knee joint as well as preoperative HSS and HSS at the last follow-up had no statistical differences between two prosthesis groups. However, rotating high-flexion prosthesis group had increased ROM of knee at the last follow-up （P 0.05）. Conclusions Rotating high-flexion prosthesis has potential kinematic advantages for improving joint function and relieving contact stress and prosthesis wearing; fixed platform prosthesis is suitable for elderly patients, or patients withfinancial restrictions or those who don＇t perform high-flexion activities. 【