内轴型膝关节假体置换保留后交叉韧带型假体与切除后交叉韧带型假体的早中期疗效

Early and intermediate clinical effects of cruciate-retain and cruciate-substitute medial pivot knee prosthesis

目的探讨在行内轴型高屈曲度人工膝关节假体置换,保留后交叉韧带型(cruciate retain,CR)假体与不保留交叉韧带型(cruciate substitute,CS)假体的早中期疗效。方法调取我院就诊的重度骨关节炎患者采用上述两种内轴型膝关节假体进行初次人工膝关节置换的资料。以2013年1月至2015年1月,在我院行内轴型高屈曲度人工膝关节假体置换,其中CR组171例,CS组200例。对比两组患者术后3个月、6个月、1年、2年、3年、5年的KSS评分、膝关节最大屈曲度和生理机能、生理职能、躯体疼痛、一般健康状况、精力、社会功能、情感职能、精神健康等指标。结果两组患者KSS评分,CR组:术后3个月(89.61±0.91)、6个月(88.68±0.95)、1年(87.61±1.09)、2年(89.38±0.97)、3年(88.18±0.89)、5年(89.63±0.89)高于术前(50.72±1.55)(P<0.05);CS组:3个月(87.63±0.93)、6个月(89.48±1.12)、1年(89.68±0.99)、2年(88.48±0.96)、3年(91.61±0.95)、5年(90.61±0.94)高于术前(51.54±1.48)(P<0.05)。膝关节最大屈曲度CR组:术后3个月(100.4±11.4)、6个月(115.2±21.5)、1年(117.6±11.7)、>1年(118.2±11.2)高于术前(70.6±12.7)(P<0.05);CS组:术后3个月(100.6±11.3)、6个月(101.4±15.3)、1年(121.1±12.3)、>1年(121.3±12.4)高于术前(74.8±12.8)(P<0.05)。两组患者的生理机能、生理职能、躯体疼痛、一般健康状况、精力、社会功能、情感职能、精神健康8个指标同组术前、术后相同时间点比较(P<0.05);两组患者组间及组内术后各时间点各项评分,差异无统计学意义(P>0.05)。结论对于重度膝关节骨关节炎患者,术后早期两种假体在一定程度上纠正膝关节畸形、提高屈曲度,有较高的满意度。然而,比较两组假体置换术后,早期效果、关节活动度的改善及患者主观满意度差异无统计学意义。

Objective To investigate the early and intermediate effects of cruciate-retain（ CR） and cruciatesubstitute（ CS） medial pivot knee prosthesis. Methods From January 2013 to January 2015, the data of patients with severe osteoarthritis who underwent primary total knee arthroplasty with the above two kinds of prosthesis were analyzed retrospectively. All patients were divided into the cruciate-retain（ CR） group（ n = 171） and cruciatesubstitute（ CS） group（ n = 200）. KSS, SF-36 health survey, maximum knee flexion were compared between the 2 groups 3 months, 6 months, 1 year, 2 years, 3 years, and 5 years postoperatively. Results KSS（ CR）： 3 months（ 89.61 ± 0.91）, 6 months（ 88.68 ± 0.95）, 1 year（ 87.61 ± 1.09）, 2 years（ 89.38 ± 0.97）, 3 years（ 88.18 ± 0.89）, 5 years（ 89.63 ± 0.89）, significantly improved than that before the operation（ 50.72 ± 1.55）（ P 0.05）; KSS（ CS）： 3 months（ 87.63 ± 0.93）, 6 months（ 89.48 ± 1.12）, 1 year（ 89.68 ± 0.99）, 2 years（ 88.48 ± 0.96）, 3 years（ 91.61 ± 0.95）, 5 years（ 90.61 ± 0.94）, significantly improved than that before the operation（ 51.54 ± 1.48）（ P 0.05）. Maximum knee flexion（ CR）： 3 months（ 100.4 ± 11.4）, 6 months（ 115.2 ± 21.5）, 1 year（ 117.6 ± 11.7）, 1 year（ 118.2 ± 11.2）, significantly improved than that before the operation（ 70.6 ± 12.7）（ P 0.05）; maximum knee flexion（ CS）： 3 months（ 100.6 ± 11.3）, 6 months（ 101.4 ± 15.3）, 1 year（ 121.1 ± 12.3）, 1 year（ 121.3 ± 12.4）, significantly improved than that before the operation（ 74.8 ± 12.8）（ P 0.05）. Physical function, physical role, pain, general health, energy, social function, emotional function, and mental health were compared with the data at the same time points before and after surgery（ P 0.05）, and different time points within and between the 2 groups（ P 0.05）. Conclusions Early effects of CR and CS are both good in the treatment of severe knee arthritis, which can correct the deformity and improve the knee flexion to some extent. However, no significant differences are found in the improvement of knee ROM and patients＇ satisfaction.