全膝关节置换术关节后方复合松解中期随访的病例对照研究

Case control study on midterm follow up effects of the extended release of posterior clearance in total knee arthroplasty

目的 :评价全膝关节置换术中关节后方复合松解对膝关节功能中期随访的效果。方法 :观察2010年3月至2012年3月行单侧全膝关节置换的膝关节骨性关节炎患者,分为两组:试验组和对照组,各60例。其中试验组男21例,女39例,平均年龄(62.2±10.9)岁;对照组男25例,女35例,平均年龄(64.9±11.4)岁。均取膝关节前方正中切口,术中在截骨完成后,试验组进行关节后方复合松解,包括后髁的修饰性截骨和后关节囊的贴骨松解以及必要的增生物清理,释放后方空间;对照组仅行常规的后髁增生骨的清理。安装的假体均采用同品牌后稳定型假体。通过门诊回访,对比两组术后中期随访时美国膝关节协会(American Knee Society Score,KSS)评分情况,包含膝关节膝关节功能评分及临床评分,对比膝关节活动度。结果:术后门诊中期随访(中位随访时间46个月),排除失访或无效患者,最终试验组49例,对照组54例获随访。膝关节KSS功能评分:试验组91.3±3.4,优于对照组86.4±3.9;而KSS临床评分试验组86.9±4.6,与对照组85.7±5.1比较差异无统计学意义。主动屈膝活动度:试验组(133.2±5.9)°,优于对照组(126.9±7.4)°;主动伸膝活动度试验组(0.5±1.1)°,与对照组(0.3±1.2)°比较差异无统计学意义。结论:膝关节后方复合松解改善膝关节功能和屈曲活动度中期效果显著,患者获益。

Objective：To evaluate the midterm follow up results of extended release of posterior clearance in total knee arthroplasty. Methods：A total of 120 patients with knee osteoarthritis were equally randomly assigned to the experimental group and control group,and underwent unilateral TKA from March 2010 to March 2012. In experimental group,there were 21 males and 39 females with an average age of（62.2±10.9） years old. In the control group,there were 25 males and 35 females with an average age of（64.9±11.4） years old. All the patients were performed using the anterior knee approach. During operation,after osteotomy of the tibia and the femoral condyle,extended release of the posterior knee clearance were taken in experimental group,while only the clearance of osteophyte in the posterior condyle were performed in the control group. The KSS scores including knee functional score and knee clinical score,as well as the range of motion（ROM） of patients,were compared between the two groups at midterm follow up. Results：Totally 49 patients in the experimental group and 54 patients in the control group were followed up,and the median follow up time was 46 months. The knee functional score of patients in the experimental group was 91.3±3.4,which was better than 86.4±3.9 of patients in the control group; initiative ROM of flexion of patients in the experimental group was（133.2±5.9） °,which was better than（126.9 ±7.4）° of patients in the control group.There were no significant difference of knee clinical score between 86.9±4.6 of patients in the experimental group and 85.7±5.1of patients in the control group,and the initiative ROM of extension between（0.5±1.1） °and（0.3±1.2）°. Conclusion：Extended release of the posterior knee clearance contributes to the knee function and initiative flexion ROM during a midterm follow up and patients benefit.