标准型和形态特异型假体全膝关节置换术早期临床疗效比较分析

Compared analysis of early clinical results of standard and morphological type-specific prosthesis in total knee arthroplasty

目的通过对美国膝关节协会评分(KSS)、关节活动度(ROM)的分析,探讨全膝关节置换术中使用标准型和形态特异型假体的早期临床结果差异。方法以2012年2月至2012年8月接受美国Wright医疗技术公司Advance系列膝关节假体置换术的39例(45膝)骨关节炎患者为研究对象,其中男性5例(6膝),女性34例(39膝)。根据术中使用假体的设计类型分为两组:19例(21膝)接受形态特异型假体(Stature假体组),20例(24膝)接受标准型假体(MP假体组)。假体类型选择依据:如果术中股骨髁远端或滑车区域出现假体突出,选用形态特异型假体,否则选用标准型假体。结果总体样本中Stature假体使用率为46.7%(21膝∶45膝)。Stature假体组和MP假体组平均随访时间分别为7.4个月和6.7个月,均未出现膝前疼痛、关节感染、下肢深静脉血栓、假体周围骨折等并发症。末次随访时,两组KSS分别为平均176.9±12.64分和174.4±13.87分,ROM分别为平均122.9°±10.30°和119.7°±7.60°;KSS平均改善值分别为98.60±24.98分和95.47±22.85分,ROM平均改善值分别为14.74°±10.18°和12.62°±9.57°,组间均无显著性差异(P>0.05)。结论与标准MP假体相比,Stature假体有助于提高骨骼-假体匹配性及改善假体边缘突出现象,尤其是在中国女性患者,但并未提供更好的临床结果。

Objective To study the differences of early clinical results after total knee arthroplasty （TKA） using standard and morphological type-specific femoral component by analyzing the Knee Society Score （KSS） and range of motion （ROM）. Methods From February 2012 to August 2012, 39 patients with knee osteoarthritis （45 knees） received TKA using Advance knee system of Wright medical technology company were selected for the study. There were 5 males （6 knees） and 34 females （39 knees）. The subjects were divided into two groups according to the component design type used： the first group included 19 cases （21 knees） who used morphological type-specific components, and the second group included 20 cases （24 knees） who used standard components. Basis for the selection of component type： the morphological component was selected when component overhang occured at the zone of distal femoral condyle or trochlea during TKA, otherwise the standard component was selected. Results The general utilization ratio of morphological component was 46. 7% （2l knees in 45 knees）. The mean duration of follow-up of first group and second group were 7. 4 months and 6. 7 months respectively, no any anterior knee pain, joint infection, deep vein thrombosis and periprosthetic fracture was occurred in either group. At the last follow-up, the mean KSS score of the two groups were 176. 9 ± 12. 64 points and 174. 4 ± 13. 87 points respectively, and the mean ROM were 122.9° ± 10.30° and 119.7°± 7.60° respectively. The mean improved KSS score of the two groups were 98.60 ± 24. 98 points and 95.47 ± 22.85 points respectively, and the mean improved ROM were 14. 74° ± 10. 18° and 12. 62° ± 9. 57° respectively, showing no significant differences between the two groups （P〉0. 05）. Conclusion Morphological type-specific femoral component could improve the bone-component matching and component overhang, especially in Chinese female patients, but it did not provide better clinical results compared with the standard component.