国人女性人工全膝关节胫骨平台假体匹配度队列研究

Matching degree between total knee prosthesis and tibial plateau in Chinese female patients

目的探索人工全膝关节置换中胫骨平台假体不同的选择原则,对女性患者胫骨平台匹配程度的影响。方法近3年开展的连续102例女性人工全膝关节置换手术组成研究队列,使用胫骨平台前后径(anteroposteriordiameter,A/P)作为参考选择胫骨平台假体型号定义为A组,使用胫骨平台内外径(medial-lateral diameter,M/L)作为参考选择胫骨平台假体型号定义为B组。观察胫骨截骨面与假体是否匹配,覆盖面积超过75%定义为匹配,低于75%定义为不匹配。比较膝关节术前及术后3 d、7 d、3个月屈曲伸直角度及膝关节KSS评分、WOMAC评分、切口周围感染、假体周围感染、深静脉栓塞、肺栓塞、假体位置不良、脱位、假体松动发生率的差异。结果 B组假体匹配程度显著优于A组结果有统计学意义,但显著低于国外报道的匹配程度。术后7 d,A组膝关节伸直角度为(3.2±1.5)°,B组为(2.5±1.6)°,组间差异有统计学意义(P<0.05),其余观察指标差异无统计学意义(P>0.05)。未出现感染等术后并发症。结论国人膝关节解剖数据与进口假体设计基础存在差异,特别是国人胫骨平台前后径与左右径比例远低于白种人,这种差异在女性群体尤为突出。根据国人的解剖数据设计更加符合国人解剖数据的膝关节胫骨平台假体是必要的。

Objective To assess the matching degree between total knee prosthesis and the tibial plateau in Chinese female patients.Methods One hundred and two female patients undergoing knee arthroplasty from August 2014 to July 2017 were enrolled.The tibial prosthesis was applied according to the tibial antero-posterior diameter(A/P)in 66 patients(group A),and according to the tibial medial-lateral diameter(M/L)in 36 patients(group B).Legacy PS(Zimmer,USA)total knee prosthesis was used for all patients.When the prosthesis cover rate was>75%,it was referred to matching;when the rate was<75%,it was referred to mismatching.The range of motion(ROM)on 3 d,7 d and 3 month after surgery,the KSS score and the WOMAC score,infection around the prosthesis,deep vein thrombosis,pulmonary embolism,prosthetic cacothesis,dislocation,aseptic loosening were recorded and analyzed.Chi-square analysis and t test were used for statistic analysis.Results The matching rate of group B was significant higher than that of group A,but was significant lower than that reported in international literature.The extending ROM of group B(2.5°±1.6°)was significant less than that of group A(-3.2°±1.5°)(P<0.05).There was no significant difference in other indexes(P>0.05).No complications were found in both groups.Conclusion The imported prostheses are designed according to the anatomy of Caucasians,which is quite different from Chinese tibial plateau A/P diameter and M/L diameter,especially in women.The modification of prostheses according to Chinese is necessary.