单半径假体对全膝关节置换术后伸膝装置功能的影响

Comparison of therapeutic effects of total knee arthroplasty with single radius prosthesis and multi radius prosthesis

目的探讨单半径全膝关节假体全膝关节置换术(TKA)对患者伸膝装置功能改善的影响以及临床疗效。方法采用回顾性队列研究方法。纳入同济大学附属东方医院关节外科2012年6月—2015年1月收治的60例中、重膝骨关节炎患者的临床资料,其中女50例、男10例,年龄53~79岁。60例患者均行TKA治疗,其中使用单半径假体(Triathlon假体)30例(30膝)为观察组,使用多半径假体(Nexgen假体)30例为对照组。通过比较两组患者术前与术后3个月通髁线至髌骨中心距离的增加值,评估伸膝装置功能;在术后6周、3个月、6个月、1年、2年,通过比较两组患者美国膝关节协会评分(AKSS)和膝关节伸直后段(屈曲前段)疼痛发生率,评价手术疗效。结果两组患者手术均顺利完成;术后随访3~5(4.2±1.2)年,均无感染、深静脉血栓、假体松动及假体周围骨折等并发症发生。观察组术后3个月通髁线至髌骨中心距离较术前增加(3.30±4.08)mm、对照组增加(1.58±2.64)mm,术后6周、3个月、6个月、1年、2年各时间点观察组AKSS评分均高于对照组,差异均有统计学意义(P值均<0.05),膝关节伸直后段(屈曲前段)膝前痛发生率均较对照组有下降趋势,但差异均无统计学意义(P值均>0.05)。结论单半径膝关节假体TKA治疗中、重度骨关节炎近期临床疗效可靠,术后伸膝装置功能改善,建议临床推广应用。

Objective To investigate therapeutic effects of total knee arthroplasty (TKA) with single radius prosthesis (SRP), especially knee extension device. Methods The retrospective cohort study was conducted. From June 2012 to January 2015, clinical data of 60 cases of moderate or severe knee osteoarthritis in the department of joint surgery of Dongfang Hospital Affiliated to Tongji University were collected, all of whom were treated with total knee replacement. Among the 60 cases, 50 were females and 10 were males, aged 53-79 years. Thirty patients (30 knees) who underwent TKA with single radius prosthesis were enrolled in experiment group, and another thirty patients in control group received TKA with multi radius prosthesis (MRP). Knee extension device function, American Knee Society score (AKSS) and knee pain were compared before and after operation. Results No complications occurred in both groups postoperatively. All patients were followed up for 3-5 years, with an average of (4.2±1.2) years. The increase of the distance between Blumensaat's line and patellar center in experiment group (3.30±4.08) mm was significantly higher than that in control group (1.58±2.64)mm(P<0.05). AKSS score (6 weeks, 3 months, 6 months, 1 year and 2 years postoperatively) of experiment were higher than that of control group(all P values<0.05). Incidence rate of pain in frontal knee of experiment group had a decreasing trend after operation (all P values>0.05). Conclusions The single radius prosthesis has an obvious improvement in the function of the knee extension after operation, the AKSS score, and the flexion muscle strength than multi radius prosthesis.