MB/CR假体与FB/PS假体全膝关节置换术早期疗效观察

Early clinical observation of TKA with MB/CR or FB/PS prosthesis

目的比较后交叉韧带保留活动平台(MB/CR)假体与后交叉韧带稳定固定平台(FB/PS)假体全膝关节置换术(TKA)早期疗效的差异。方法将2008年10月至2013年8月北京市通州区新华医院收治的56例TKA患者随机分为A组和B组,A组采用MB/CR假体(n=30),B组采用FB/PS假体(n=26)。记录术后引流血量,检测术前及术后3 d两组患者血红蛋白水平,根据美国膝关节学会评分(KSS)评定术后2周膝关节功能改善情况。结果 A、B两组术后引流血量分别为(450±158)、(605±132)m L,两组比较,差异有统计学意义(P<0.05)。两组术后血红蛋白水平均低于术前,KSS则较术前有显著改善(P<0.05)。A组患者术后3 d血红蛋白含量高于B组,术后2周膝关节活动度弱于B组,两组比较,差异有统计学意义(P<0.05);但两组术后2周KSS临床评分和功能评分比较,差异无统计学意义(P>0.05)。结论 MB/CR与FB/PS两类假体TKA术后早期临床疗效均满意,但前者围术期出血量更少,术后早期血红蛋白水平更高,而后者术后早期有更好的关节活动度。提示临床上应根据患者病情、意愿以及术者理念和手术操作的娴熟程度来选择TKA假体。

Objective To compare the differences of early clinical effects between mobile-bearing/posterior cruciate retaining（MB/CR） prosthesis and fixed bearing/posterior cruciate stabilizing（FB/PS） prosthesis for the patients who underwent total knee arthroplasty（TKA）. Methods Total of 56 TKA patients treated from October2008 to August 2013 in Tongzhou Xinhua Hospital were randomly divided into two groups, in which A group using MB/CR prosthesis（n = 30）, and B group using FB/PS prosthesis（n = 26）. The postoperative drainage blood volume was recorded, and the levels of hemoglobin of TKA patients in two groups at preoperation and 3days after surgery were examined, also, the improvement of knee joint function 2 weeks after surgery was evaluated by American Knee Society score（KSS）. Results Postoperative drainage blood volume in A group and B group was（450 ± 158）,（605 ± 132） m L respectively, the difference between two groups had statistical significance（P〈0.05）. Postoperative hemoglobin levels in two groups were lower than the preoperative ones,while the postoperative KSS were all improved（P〈0.05）. In A group, hemoglobin levels 3 days after the operation were higher than those in B group, but the range of motion（ROM） of knee joint 2 weeks after surgery was lower than that in B group, the differences between two groups showed statistical significance（P〈0.05）.As for KSS clinical and functional scores 2 weeks postoperatively, there were no statistical differences between 2groups（P〈0.05）. Conclusions Both types of MB/CR and FB/PS prosthesis could obtain satisfactory early effects after TKA. Perioperative estimate blood loss and postoperative hemoglobin levels in TKA with MB/CR prosthesis are better than FB/PS prosthesis, while patients who underwent FB/PS prosthesis could achieve better ROM of knee joint. As a result, the choice of TKA prosthesis type should be based on patient conditions and preference, as well as surgeon＇s recognition and proficiency.