固定平台全膝关节置换术后10年以上临床随访研究

Fixed bearing total knee arthroplasty： a more than 10 years follow-up

目的总结固定平台全膝关节置换的长期临床疗效，分析随访10年以上患者的假体生存情况及相关影响因素。方法1993年6月至2002年5月期间施行全膝关节置换手术285例，其中226例患者（246例膝）纳入研究，男47例，女179例；年龄（62．2±9．4）岁（32-78岁）。其中类风湿关节炎36例43膝，骨关节炎188例201膝。统计假体生存时间10年以上者的膝关节HSS评分、活动度及术后影像学改变，分析假体生存情况及影响假体生存的因素。结果160例（177膝）随访10年以上，术后平均随访11.9年（10～18年），总的10年假体生存率为93．6％，15年假体生存率为92．8％。后十字韧带保留假体与后稳定型假体长期生存率的差异无统计‘学意义。髌骨置换与不置换、类风湿关节炎与骨关冉炎患者假体牛存率的差异无统计学意义。术前膝关节HSS评分平均为（56．58±11．05）分，末次随访为（92．29±10．95）分；术前膝关节活动度平均为84．8°±24．0°，末次随访为99．7°±17．6°，膝关节伸直迟滞由术前平均8．4°±9．1°改善为0．5°±2°。翻修手术15例，原因为感染10例、无菌松动3例、关节僵硬l例、髌骨原因1例。结论固定平台全膝关节置换可获得满意的长期临床疗效，10年假体生存率可达90％以L。是否保留后十字韧带、是否行髌骨置换、类风湿关节炎与骨关节炎患者长期假体生存率的差异无统计学意义。

Objective To evaluate the long-term clinical outcomes and survivorship of fixed bearingtotal knee arthroplasty （TKA） and the risk factor for failure. Methods Between June 1993 and April 2002, 285 Chinese patients accepted TKA with cemented fixed bearing platform in our center, and 226 patients （246 knees） were successfully followed up. The age was （62.2±9.4） years at index operation. The survivorship of TKA and the related impact factor were analyzed. The hospital for special surgery （HSS） knee score, range of motion （ROM） and radiological results were studied at the final follow-up. Results One hundred and sixty patients （177 knees） were followed up longer than 10 years. Survival rate was 93.6%±1.7% at 10 years, 92.8%±1.8% at 15 years, with reoperation of the implant as the endpoint. Main reasons for failure were infection and aseptic loosening. There were no statistically difference in survival rate between posterior cruciate ligament retaining and posterior stabilizing group, patellar resurfacing and non-resurfacing, rheumatic arthritis （RA） and osteoarthritis （OA） patients. Meanwhile, RA patients had lower longterm survivorship compared with OA patients. HSS knee score of 96 of the knees increased from 56.58±11.05 preoperatively to 92.29±10.95 postoperatively, and ROM increased from 84.8°±24.0°preoperatively to 99.7°±17.6°postoperatively. Totally, 15 knees underwent revision surgery with the relating reason of infection for 10 knees, aseptic loosening for 3, and stiffness for 1 knee. Conclusion Fixed bearing TKA can fulfill satisfactory long-term clinical results, with more than 90% of 10-year survival rate. The strategy for posterior cruciate ligament, patellar and preoperative diagnosis has no statistically impact on the long-term survivorship.