活动平台与固定平台假体行人工全膝关节置换术十年疗效的比较研究

Effectiveness comparison of mobile-bearing and fixed-bearing prostheses in total knee arthroplasty for ten years follow-up

目的比较活动平台与固定平台假体行人工全膝关节置换术(total knee arthroplasty,TKA)的10年疗效,为临床选择TKA假体提供参考。方法回顾分析2002年1月—2005年12月符合选择标准的113例初次行TKA的膝关节骨关节炎患者临床资料,其中47例采用活动平台假体(A组),66例采用固定平台假体(B组)。两组患者年龄、性别、体质量指数、膝关节内翻和屈曲畸形以及术前膝关节活动度、美国膝关节学会评分系统(KSS)评分、美国西部Ontario与Mc Master大学骨关节炎指数评分(WOMAC)等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。结果 A、B组手术时间分别为(88.1±6.5)、(90.3±7.2)min,比较差异无统计学意义(t=1.666,P=0.099)。术后两组患者切口均Ⅰ期愈合,无切口感染及下肢深静脉血栓形成等术后早期并发症发生。两组患者均获随访,A组随访时间10.2~12.3年,平均10.8年;B组随访时间10.2~12.6年,平均11.3年。A、B组分别有3例和4例行假体翻修,假体存活率分别为93.6%和93.9%,比较差异均无统计学意义(χ~2=0.005,P=0.944)。两组患者术后各时间点膝关节活动度、KSS评分及WOMAC评分均较术前显著改善(P<0.05)。B组术后6周膝关节活动度和KSS评分优于A组(P<0.05),术后1、3、10年两组比较差异无统计学意义(P>0.05)。术后6周及1、3年两组WOMAC评分比较差异均无统计学意义(P>0.05),但术后10年A组WOMAC评分优于B组,差异有统计学意义(t=2.086,P=0.037)。术后10年A、B组KSS评分优良率分别为87.2%和84.8%,比较差异无统计学意义(χ~2=0.018,P=0.893)。结论采用活动平台和固定平台假体行TKA均能获得优良的中远期疗效,采用固定平台假体手术操作相对简便,早期康复效果更佳;活动平台假体可提供更好的远期WOMAC评分满意度,但要求更高的手术技巧和软组织平衡技术。

Objective To compare the clinical results of mobile-bearing and fixed-bearing prostheses in total knee arthroplasty （TKA） during 10 years follow-up so as to provide a reference for clinical selection of TKA prosthesis. Methods Between January 2002 and December 2005, 113 patients with osteoarthritis of the knee joint underwent primary TKA, and the clinical data were retrospectively analyzed. Mobile-bearing prosthesis was used in 47 cases （group A） and fixed-bearing prosthesis in 66 cases （group B）. There was no significant difference in age, gender, body mass index, varus and flexion deformity of the knee, range of motion （ROM） of the knee, knee society score （KSS）, and Western Ontario and McMaster University Osteoarthritis Index （WOMAC） between 2 groups before operation （P〉0.05）, so the data were comparable. Results The operation time of groups A and B was （88.1±6.5） and （90.3±7.2） minutes respectively, showing no significant difference （t=1.666, P=0.099）. The wounds healed by first intention in all patients of both groups, and no postoperative early complications of incision infection and deep venous thrombosis occurred. The follow-up time was 10.2-12.3 years （mean, 10.8 years） in group A, and was 10.2-12.6 years （mean, 11.3 years） in group B.Revision was performed in 3 cases of group A and 4 cases of group B; the survival rates of prosthesis were 93.6% and 93.9% in groups A and B respectively, showing no significant difference （h3=0.005, P=0.944）. The postoperative knee ROM, KSS score, and WOMAC score were significantly improved when compared with preoperative ones （P〈0.05）. The knee ROM and KSS score of group B were significantly better than those of group A at 6 weeks after operation （P〈0.05）, but no significant difference was found between 2 groups at 1, 3, and 10 years after operation （P〉0.05）. The WOMAC score of group A was significantly better than that of group B at 10 years after operation （t=2.086, P=0.037）, but no significant difference was shown at 6 weeks, 1 year, and 3 years after operation （P〉0.05）. At 10 years after operation, the excellent and good rate of KSS score was 87.2% in group A and was 84.8% in group B, showing no significant difference （X2=0.018, P=0.893）. Conclusion Good medium- and long-term clinical results can be achieved in TKA with both mobile-bearing and fixed-bearing prostheses. The TKA with fixed-bearing prosthesis is relatively simple with better early effectiveness of rehabilitation; and the TKA with mobile-bearing prosthesis could provide better long-term degree of satisfaction in WOMAC score, but a higher surgical skill and soft tissue balance techniques are needed.