间隙平衡和测量截骨技术在分期双侧全膝关节置换术中的对比研究

Comparative study of gap balancing and measured resection technique in patients receiving staged bilateral total knee arthroplasty

目的对比观察同一患者两侧膝关节使用间隙平衡(GB)和测量截骨(MR)技术行全膝关节置换术(TKA)的临床效果。方法分析2018年7月至2020年1月57例于西安交通大学附属红会医院双侧分期行TKA患者的临床资料。采用随机数字表法,在患者首次行TKA时随机采用MR或GB技术,对侧手术则用另一种技术完成。手术均由一位主任医师主刀,假体均选择同一种假体。比较两种截骨技术行TKA的手术情况、影像学资料、患者膝关节功能恢复情况以及满意度。结果57例患者其中男16例,女41例,首次手术年龄(68.5±4.6)岁(59~79岁)。随访(29.6±4.5)个月(22~39个月)。两次手术间隔(4.7±3.0)个月(0.5~12.0个月)。GB侧术后的引流量相比MR侧更少[(93.6±22.2)ml比(109.9±36.9)ml,P=0.003]。在术后1个月随访时,GB侧疼痛视觉模拟评分(VAS)低于MR侧[(3.0±0.8)分比(3.5±1.2)分],活动度较MR侧高(105.7°±8.2°比100.2°±7.5°),美国膝关节协会(KSS)评分优于MR侧[(78.5±5.4)分比(74.2±6.3)分],美国西部Ontario和McMaster大学骨关节炎指数(WOMAC)评分低于MR侧[(35.4±5.5)分比(38.0±6.3)分],差异均有统计学意义(均P<0.05)。而重复测量的方差分析显示,在VAS评分、关节活动度、KSS评分和WOMAC方面,两种技术总体差异无统计学意义(均P>0.05)。患者GB侧满意率为84.2%(48/57),MR侧为86.0%(49/57),差异无统计学意义(P=0.446)。两种技术在并发症发病率方面差异也无统计学意义(P=0.754)。结论在无明显畸形的膝关节炎患者中,使用GB和MR技术行TKA均可获得良好的膝关节功能,临床效果相似。

Objective To compare the clinical outcomes of staged total knee arthroplasty(TKA)performed on both knees in the same patient using gap balancing(GB)and measured resection(MR)techniques,respectively.Methods The clinical data of 57 patients undergoing bilateral staged TKA at the Xi′an Jiaotong University Affiliated Honghui Hospital from July 2018 to January 2020 were analyzed.Using the random number table,MR or GB technique was selected when patients underwent primary TKA,and contralateral procedure was done with another technique.The procedures were performed by one chief surgeon,and the same prosthesis was chosen for all the procedures.The two osteotomy techniques for TKA were compared in terms of surgical status,radiographic data,functional recovery and satisfaction rate.Results Total of 57 patients,including 16 males and 41 females,were included in the study with a mean age of(68.5±4.6)years(59-79 years)at primary TKA.All patients were followed up for(29.6±4.5)months(22-39 months).The interval between the two procedures was(4.7±3.0)months(0.5-12.0 months).Postoperative drainage was less in the GB side when compared with that in the MR side[(93.6±22.2)ml vs(109.9±36.9)ml,P=0.003].At the 1-month postoperative follow-up,the visual analogue scale(VAS)of pain was lower on the GB side(3.0±0.8)than on the MR side(3.5±1.2),the range of motion(ROM)was higher on the GB side(105.7°±8.2°vs 100.2°±7.5°),the Knee Society Score(KSS)was higher on the GB side(78.5±5.4 vs 74.2±6.3),and the Western Ontario and McMaster University(WOMAC)score was lower on the GB side(35.4±5.5 vs 38.0±6.3),there were significant differences in the up-mentioned indexes between the two groups(all P<0.05).However,the repeated-measures analysis of variance indicated that there was no significant difference in VAS score,ROM,KSS score and WOMAC score between the two techniques(all P>0.05).The satisfactory rate of GB technique was 84.2%(48/57),ant it was 86.0%(49/57)with MR technique(P=0.446).There was also no significant difference between the two techniques in terms of complications(P=0.754).Conclusion Both the GB and MR technique result in good knee function with similar clinical outcomes in patients receiving TKA in both knees for osteoarthritis without significant deformity.