矢状位假体位置对PS型全膝关节置换术术后关节活动度的影响

The Effect of Sagittal Prosthesis Position on Joint Mobility after Surgery of PS-type TKA

目的对接受双侧全膝关节置换手术的患者进行自身左右侧肢体对照,评价股骨假体屈曲角、胫骨平台后倾角对术后关节活动度的影响。方法纳入行双侧初次全膝关节置换,且双膝术后屈伸功能有显著差异的患者,将双侧肢体分为功能相对较好及相对较差两组,采用t检验分析两组之间股骨假体屈曲角γ、胫骨假体后倾角δ有无差异;Pearson检验分析膝关节活动范围与γ角、δ角有无相关性。结果 31例62膝纳入研究,术后伸直功能相对较好侧平均伸膝(-0.3±0.9)°,γ角(2.8±2.2)°,另一侧平均伸膝(-4.0±2.3)°,γ角(6.1±3.4)°;屈曲功能相对较好侧平均屈膝(106.5±9.3)°,δ角(5.2±2)°,另一侧平均屈膝(99.4±8.2)°,δ角(4.2±2)°,差异均有统计学意义(P<0.001)。Pearson检验分析膝关节活动范围ROM与δ角相关(P<0.001),δ角越大,ROM越大,而与γ角无相关性(P=0.400)。结论确保恰当的胫骨后倾角度,同时避免出现股骨假体俯屈可以帮助获得满意的术后活动度,在2°~9°后倾范围内时,后倾越大,术后关节活动度越好,推荐5°后倾角。

Objective To evaluate the effect of femoral prosthesis flexion angle and tibial plateau posterior inclination on the postoperative joint mobility in patients with bilateral total knee arthroplasty. Their own left and right limbs were compared. Methods The patients who had bilateral total knee arthroplasty first time and significant difference in flexion and extension func- tion were divided into two groups ： relatively good function and relatively poor. The t-test was used to analyze the difference of femo- ral prosthesis flexion angle（γ） and tibial plateau posterior inclination（δ） between the two groups. The Pearson test was used to analyze whetherthere is correlation between knee range of motion and ＂yandB. Results 31 cases of 62 knees were included in the stud- y. The groupwith a relatively better postoperative extension function had an average extension angle of（-0. 3 ± 0. 9 ） ° ,γ angle （2. 8 ± 2. 2） °. The other grouphad an average extension angle of（ -4. 0 ± 2.3 ）° ,γ angle （ 6. 1 ± 3.4 ） °. The groupwith a relatively better postoperative flexion function had an average flexion angle of（ 106. 5 ± 9.3 ） °, Bangle （5.2 ± 2） °. The other grouphad an av- erage flexion angle of（99.4 ± 8. 2） ° ,Bangle（4. 2 ± 2） °,δThe difference was statistically significant（ P 〈 0. 001 ）. The Pearson test showed correlation between the ROM range of the knee and theBangle （P 〈 0. 001 ）. The larger theδangle,the greater the ROM, but there was no correlation with theyangle（ P = 0. 400）. Conclusion Ensuring propertibial plateau posterior inclination（B） and avoi- ding femoral prosthesis flexion can help to obtain satisfactory postoperative activity. The greater the rearward posterior, the better the degree of joint mobility in a 2°-9° backward range. 5° rear angle is recommended.