内翻膝关节置换中后交叉韧带保留型膝关节假体对步态、下肢静脉回流的影响

Effect of posterior cruciate ligament preserving knee prosthesis on gait and lower extremity venous return in varus knee arthroplasty

背景:内翻膝关节置换是治疗膝骨关节炎伴内翻畸形的重要方法,术中关节置换假体包括后交叉韧带保留型和后交叉替代型,目前关于2种假体的治疗效果存在一定争议。目的:探究后交叉韧带保留型膝关节假体在内翻膝关节置换中对步态、下肢静脉回流的影响。方法:回顾性分析2019年10月至2020年10月贵州省骨科医院收治的98例内翻型膝骨关节炎患者的病历资料,均行全膝关节置换治疗,根据术中膝关节假体不同分为2组(n=49),对照组采用后交叉替代型膝关节假体,试验组采用后交叉韧带保留型膝关节假体。比较两组患者手术情况、术后并发症发生率、术后住院时间、手术前后膝关节活动度、最大屈曲角度、膝关节功能、关节遗忘程度、步态参数、血浆纤维蛋白原、活化部分凝血活酶时间及D-二聚体水平。结果与结论:(1)试验组手术时间长于对照组,术中出血量、术后引流量及术后住院时间均少于对照组(P <0.05);(2)两组术后3,6,12个月膝关节活动度、最大屈曲角度均高于术前,且试验组高于对照组(P <0.001);(3)两组术后3,6,12个月步速、步幅、支撑时间百分比均高于术前,且试验组高于对照组(P <0.05);(4)两组术后3,6,12个月美国特种外科医院膝关节评分均高于术前(P <0.05),但两组间比较差异无显著性意义(P> 0.05);(5)试验组术后3,6,12个月关节遗忘程度评分均高于对照组(P <0.05);(6)试验组术后1,2周血浆纤维蛋白原、活化部分凝血活酶时间、D-二聚体水平均低于对照组(P <0.05);(7)试验组并发症总发生率(4%)低于对照组(17%)(P <0.05);(8)提示在内翻膝关节置换中采用后交叉韧带保留型膝关节假体虽然手术时间较长,但能明显减轻手术创伤,促进患者康复,且能更有效地改善患者膝关节活动度、步态及下肢静脉回流,降低术后并发症发生率。

BACKGROUND:Varus knee arthroplasty is an important treatment for osteoarthritis of the knee with varus deformity.Intraoperative joint replacement prostheses include the posterior cruciate ligament prese rving type and the posterior cruciate re placement type,and there is some controversy about the therapeutic effects of the two groups of prostheses.OBJECTIVE:To investigate the effect of posterior cruciate ligament preserving knee prosthesis on gait and lower extremity venous return in varus knee arthroplasty.METHODS:The medical records of 98 patients with varus knee osteoarthritis in Guizhou Provincial Orthopedics Hospital from October 2019 to October 2020 were retrospectively analyzed,all of whom were treated with total knee arthro plasty.According to the different intraoperative knee prostheses,they were divided into two groups(n=49).The control group used a posterior cruciate replacement knee prosthesis,and the test group used a poste rior cruciate ligament preserving knee prosthesis.The two groups were compared in terms of surgical condition,postoperative complication rate,postoperative hospital stay,preand postoperative knee range of motion,maximum flexion angle,knee function,degree of joint oblite ration,gait paramete rs,plasma fibrinoge n,activated partial thromboplastin time,and D-dimer level.RESULTS AND CONCLUSION:(1) The operation time of the test group was longer than that of the control group.The intraope rative blood loss,postoperative drainage and postoperative hospital stay were less in the test group than those of the control group(P <0.05).(2) The knee range of motion and maximum flexion angle at 3,6 and 12 months after surgery were higher than those before surgery in both groups,and above indexes in the test group were higher than those in the control group(P <0.001).(3) The percentages of gait speed,stride length,and suppo rt time were higher in both groups at 3,6,and 12 months after surgery than before surgery,and the test group was higher than the control group(P <0.05).(4) The knee joint scores of the Hospital for Special Surge ry in the two groups at 3,6,and 12 months after operation were higher than those before operation(P<0.05),but there was no significant difference between the two groups(P> 0.05).(5) The scores of degree of joint obliteration in the test group were higher than those in the control group at 3,6,and 12 months after operation(P<0.05).(6) Plasma fibrinoge n,activated partial thromboplastin time,and D-dimer levels were lower in the test group than those in the control group at 1 and 2 weeks after surgery(P <0.05).(7) The ove rall complication rate was lower in the test group(4%) than that in the control group(17%)(P <0.05).(8) It is suggested that the use of posterior cruciate ligament-preserving knee prosthesis in varus knee arthroplasty can significantly reduce surgical trauma and promote patients’ recovery,and can more effectively improve knee range of motion,gait and lower limb venous return and reduce the incidence of postope rative complications,although the operation time is longer.