间隙平衡与测量截骨技术在全膝关节置换的比较

Gap balancing technique versus measured osteotomy in total knee arthroplasty

[目的]对比研究全膝关节置换术(TKA)中采用间隙平衡截骨与测量截骨技术的临床疗效。[方法]回顾分析本院2010年1月~2016年1月接收的78例接受单侧TKA的患者资料。按医患沟通的结果采用两种手术技术,39例采用间隙平衡技术TKA,39例行测量截骨技术TKA。比较分析两组患者的围手术期、随访和影像资料。[结果]两组患者均顺利完成手术,术中均无血管、神经损伤等严重并发症。两组患者在手术时间、切口长度、术中出血量、术后引流量和患者术后下地时间的差异均无统计学意义(P<0.05)。78例患者均获得2年以上的随访。随访过程中,间隙平衡组1例出现膝前痛,2例出现髌骨弹响;测量截骨组2例出现膝前痛,1例出现伸膝延滞,1例出现关节内粘连;经相应处理均无严重不良后果。随时间推移,两组患者HSS评分显著增加(P<0.05)。术前两组间HSS评分的差异无统计学意义(P>0.05);但是,术后3个月、术后1年和术后2年时,间隙平衡组的HSS评分显著高于测量截骨组(P<0.05)。影像方面,随时间推移两组患者下肢力线与小腿解剖轴线的夹角显著减少(P<0.05)。术前两组患者下肢力线与小腿解剖轴线的夹角差异无统计学意义(P>0.05);术后3 d、1年、2年间隙平衡组下肢力线与小腿解剖轴线的夹角皆显著小于测量截骨组(P<0.05)。[结论]全膝关节置换术中应用间隙平衡截骨相比测量截骨可获得更好的下肢力线,并可以明显改善患者的膝关节功能和主动感受。

[Objective]To compare the clinical outcomes of gap balancing technique versus measured osteotomy for total knee arthroplasty(TKA).[Methods]A retrospective study was conducted on 78 patients who received unilateral TKA from Jan uary 2010 to January 2016.Based on patient-doctor communication,39 patients had TKA performed with gap balancing tech nique(the GB group),while the remaining 39 patients underwent TKA with measured resection technique(the MR group).The perioperative,follow-up and radiographic data were compared between the two groups.[Results]The patients in both groups re ceived successful operations without grim complications,such as neurovascular injuries,and with no significant differences re garding to operation time,intraoperative blood loss,postoperative drainage volume and time returned to ambulation between them(P>0.05).All patients were followed up for more than 2 years.In term of late complications,the GB group had 1 case of anterior knee pain and 2 of patellar clicking,whereas the MR group got 2 cases of anterior knee pain,1 of knee extension defi cient and 1 of intraarticular fibrosis,nevertheless no serious consequences induced by these complications.The HHS score sig nificantly increased over time in both groups(P<0.05).Despite of no a significant difference in HHS score between them before operation,the GB group proved statistically superior to the MR group at 3 months,1 and 2 years postoperatively(P<0.05).With respect of radiographic assessment,the angle between the lower limb alignment and tibial anatomic axis significantly decreased postoperatively in both groups compared with those before operation(P<0.05).Regardless of no a statistically significant differ ence in the angle between the lower limb alignment and tibial anatomic axis between the two groups before operation,the GB group proved significantly superior to the MR group regarding the angle at 3 days,1 and 2 years postoperatively(P<0.05).[Con clusion]The gap balancing technique does achieved better alignment and functional recovery than the measured resection tech nique in total knee arthroplasty.