TKA术后股骨假体旋转对KSS主观评分影响的临床研究

Effect of Rotation of Femoral Component on Subjective Scores of the KSS after TKA

目的探讨全膝关节置换术中股骨假体旋转对患者膝关节评分的影响。方法对在我院行初次全膝关节置换术(PS型假体)的158位患者198例膝关节于术后5年进行随访,其中男性54例68膝,女性104例130膝。通过CT测量股骨髁扭转角(computed tomography angiography,CTA)来评价膝关节假体的旋转,同时对患者膝关节进行美国膝关节协会(knee society score,KSS)(2011版)主观功能评定。根据患者的CTA分为A组正常组(外旋3°至内旋3°),B组外旋组(外旋大于3°),C组内旋组(内旋大于3°),对A、B、C组的各项KSS得分进行统计学分析。结果三组在在功能活动评分差异有统计学意义,但在满意度评分、期望评分差异无统计学意义。在功能评分的细项中,标准活动评分、高级活动评分、自由活动评分中差异有统计学意义,但在步行及站立评分差异无统计学意义。结论全膝关节置换中股骨假体的旋转位置影响膝关节功能活动主观评分,术者应避免股骨假体旋转不良。

Objective To investigate the effect of rotational alignment of the femoral component on evaluation of outcomes using The 2011 KSS. Methods 158 patients with 198 knees（ 54 males with 68 knees,104 females with 130 knees） of primary posterior cruciate ligament-substituting（ PS） TKA were follow-up five years postoperatively. The rotational alignment of the femoral components was assessed with computed tomography（ CT） using the condylar twist angle（ CTA）,and the subjective scores of the KSS（ 2011） was evaluated. The patients were classified into three groups based on the rotational alignments of the femoral Component： Group A（ external rotation of 3°to internal rotation of 3°）,Group B（ external rotation〉 3°）,Group C（ internal rotation 〉3°）. scores of each category of The 2011 KSS were compared among the groups by statistical analysis. Results There was significant difference among groups in the category of functional activities,but no significant differences in the category of satisfactions and expectations. For each detail of the scores of functional activities,it showed significant differences among groups in the category of standard activities,advanced activities and discretionary knee activities,but showed no significant difference in the categories of walking and standing. Conclusion The internal rotation of the femoral component affects the subjective score of functional activities,Surgeons should avoid malrotation of the femoral component.