胫骨后倾角在全膝关节表面置换术中的临床应用研究

A clinical research on tibial posterior slope in the of total knee arthroplasty

[目的]探讨胫骨后倾解剖截骨技术在全膝关节表面置换术中的临床应用及术后疗效。[方法]采用前瞻性随机对照研究,选取2013年1月~2013年12月期间采用同一类型的PS假体行单侧全膝关节表面置换的患者80例。按胫骨的后倾截骨方法不同随机抽样分为两组,胫骨后倾解剖截骨组42例,常规7°~10°后倾截骨组38例。比较分析两组患者的手术情况、影像学评估及膝关节功能恢复情况。[结果]80例患者中75例获得随访,两组患者的膝关节畸形得到了矫正,疼痛及活动功能均得到明显改善。解剖组每名患者的术后胫骨后倾角相比术前变化范围较小;常规组患者的术后后倾角变化范围较大,93%集中在7°~10°之间;两组患者术后6周,3、6个月,1年随访的HSS评分,解剖组明显高于常规组,P〈0.05。[结论]全膝关节表面置换术作为一种成熟的矫形外科手术,对晚期膝骨关节炎疗效确切。使用胫骨后倾解剖截骨的方法能够使术后患者的后倾角与术前趋于一致,较常规后倾截骨能够获得更好的近期临床疗效。

[Objective] To evaluate effect of tibial osteotomy based on individual anatomical posterior slope on clinical results of total knee arthroplasty（ TKA）. [Methods] We conducted a prospective,randomized- controlled clinical trial in which 80 patients were randomized to receive unilateral TKA with tibial osteotomy on individual anatomical posterior slope（ anatomical group）,and routine osteotomy（ routine group） from Jan 2013 to Dec 2013. There were 42 patients in the anatomic group,while 38 patients in the routine group. The same type of posterior stability prosthesis was used in the both groups. Data regarding imaging and knee function were compared and analyzed between the two groups before operation and at follow up. [Results] Of the 80 patients,75 patients were followed up for more than 1 year. The patients in both groups had gotten satisfactory correction of deformities,good pain relief and significant improvement of knee function after operation. Posterior tibial slope in each patient of the anatomical group changed minimally before and after operation,whereas it changed considerably in patients of the routine group after operation,93% of them varied from 7°to 10°. The HSS scores of the anatomical group were significantly higher than those of the routine group at 6 weeks,3 months,6 months and 1 year after operation（ P 〈0. 05）. [Conclusion]Tibial osteotomy based on individual anatomical posterior slope is a feasible approach to improve clinical consequences of TKA in the short term.