运动学对线与机械对线全膝关节置换早期临床结果比较

Early clinical outcomes comparison of kinematic and mechanical alignments in total knee arthroplasty

目的:探讨并对比分析应用专用工具的运动学对线全膝关节置换和机械对线全膝关节置换的早期临床结果。方法:回顾性分析2019年3月至2021年3月间,在首都医科大学附属北京朝阳医院因膝骨关节炎行单侧全膝关节置换术,术后随访时间大于3个月且随访资料完整的患者,排除类风湿性关节炎等炎性关节病、髌股关节严重对位不良以及既往有膝关节侧副韧带或后交叉韧带损伤的患者;按对线方法分为专用工具运动学对线全膝关节置换(KA-TKA)组和机械对线全膝关节置换(MA-TKA)组,记录手术前后髋-膝-踝(HKA)角度,术前及术后3个月的膝关节临床评分(KS-C)和膝关节功能评分(KS-F),术后3个月的遗忘关节评分(FJS),采用独立样本t检验行统计学分析。结果:共有162例患者纳入研究,其中KA-TKA组82例,MA-TKA组80例。两组患者术后HKA差异无统计学意义(P>0.05);术后3个月KA-TKA组患者的KS-C评分(t=2.259)、KS-F评分(t=1.994)和FJS评分(t=2.945)均高于MA-TKA组,两组间差异有统计学意义(均为P<0.05)。结论:KA-TKA与MA-TKA相比,术后下肢力线相似,具有更好的临床评分表现和更高的膝关节功能表现,以及更高的FJS评分。

Objective To explore and compare the early clinical results between kinematic alignment using special tools and mechanical alignment in total knee arthroplasty.Methods A retrospective analysis was performed on patients who underwent unilateral total knee arthroplasty due to knee osteoarthritis with a follow-up time of more than three months and complete follow-up data,in Beijing Chaoyang Hospital,Capital Medical University from March 2019 to March 2021.The patients with inflammatory arthropathy such as rheumatoid arthritis,severe misalignment of patellofemoral joint,and previous knee collateral ligament or posterior cruciate ligament injury were excluded.According to alignment method,patients were divided into special tools kinematically aligned total knee arthroplasty(KA-TKA)group and mechanically aligned total knee arthroplasty(MA-TKA)group.The hip-knee-ankle(HKA)angle before and after the surgery,the knee joint clinical score(KS-C),the knee joint functional score(KS-F)before and three months after the surgery were recorded,as well as the postoperative forgotten joint score(FJS).Independent sample t test was used to compare the data.Results A total of 162 patients were enrolled,including 82 in the KA-TKA group and 80 in the MA-TKA group.There was no statistically significant difference in the postoperative HKA angle between the two groups(P>0.05).Three months after the surgery,the KS-C score(t=2.259),KS-F score(t=1.994)and FJS score(t=2.945)in the KA-TKA group were higher than those in the MA-TKA group,the differences between the two groups were statistically significant(all P<0.05).Conclusion KA-TKA has similar postoperative lower limb alignment,better clinical performance and higher knee function,and a higher FJS compared with MA-TKA.