CR假体与PS假体全膝关节置换治疗膝骨性关节炎合并膝外翻畸形的疗效分析

Efficacy analysis of total knee arthroplasty with CR-prosthesis and PS-prosthesis in the treatment of knee osteoarthritis complicated with knee valgus deformity

目的 比较后交叉韧带保留型(CR)假体与后方稳定型(PS)假体行人工全膝关节置换术(TKA)治疗膝骨性关节炎合并膝外翻畸形的临床疗效。方法 回顾性分析南昌大学附属赣州医院关节外科2019年5月至2021年5月收治的60例(60膝)膝骨性关节炎合并膝外翻畸形患者资料,均为单侧置换。30例采用CR假体行TKA治疗(CR组),30例采用PS假体行TKA治疗(PS组)。比较两组患者的手术时间、术中失血量、术后引流量、术后3 d血红蛋白(Hb)下降量及深静脉血栓发生情况;比较两组患者手术前后膝外翻角;比较两组患者术后1周、1个月、3个月、6个月、1年疼痛视觉模拟评分(VAS)、膝关节活动度(ROM)、美国特种外科医院膝关节评分(HSS)。结果 60例患者均顺利完成TKA手术,所有患者随访13~28个月,平均(18.51±0.90)个月。CR组术中出血量、术后引流量、术后3 d的Hb下降量较PS组减少(P<0.05);两组手术时间相当、术后均无深静脉血栓发生,差异无统计学意义(P>0.05);两组手术前后膝外翻角的比较差异无统计学意义(P>0.05);CR组术后1周、1个月VAS评分较PS组更低(P<0.05),两组术后3个月、6月、1年VAS评分比较差异无统计学意义(P>0.05);CR组术后1周、1个月、3个月膝关节ROM和HSS评分优于PS组(P<0.05),两组术后6个月、1年膝关节ROM和HSS评分比较差异无统计学意义(P>0.05)。结论 采用CR或PS假体行TKA手术治疗膝骨性关节炎合并膝外翻畸形均可有效纠正膝关节畸形、减轻膝关节疼痛、改善膝关节活动度及功能,取得满意临床疗效;但相对PS假体,CR假体保留了后交叉韧带,减少了股骨髁部截骨量,从而减少手术出血,更好减轻早期术后疼痛,有助于TKA术后早期功能康复。

Objective To analyze the clinical efficacy of total knee arthroplasty(TKA) with posterior cruciate ligament retaining(CR) prosthesis and posterior-cruciate substituting(PS) prosthesis in the treatment of knee osteoarthritis complicated with knee valgus deformity. Methods From May 2019 to May 2021, 60 patients with knee osteoarthritis complicated with knee valgus deformity who were treated in the Affiliated Ganzhou Hospital of Nanchang University were retrospectively analyzed. They were all treated with primary unilateral TKA, 30 patients were treated with CR prosthesis(CR group) and 30 patients were treated with PS prosthesis(PS group). The operation time, intraoperative blood loss,postoperative drainage volume, the decrease of hemoglobin(Hb) on the 3rd day after operation and the occurrence of deep vein thrombosis were compared between CR and PS groups. The knee valgus angle before and after the operation was compared between the two groups;the visual analogue score(VAS) of pain, range of motion(ROM) of knee joint and hospital for special surgery knee score(HSS) were compared between the two groups at 1 week, 1 month, 3 months, 6 months and 1 year after TKA operation. Results All the 60 patients completed TKA successfully, and all patients were followed up for 13-28 months, with a mean time of(18.51±0.90) months. The intraoperative bleeding volume,postoperative drainage volume and the decrease of Hb on the 3rd day after operation in the CR group were lower than those in PS group(P<0.05). There was no significant difference in operation time and postoperative deep venous thrombosis between the CR and PS groups(P>0.05);there was no significant difference in the knee valgus angle between the CR and PS groups before and after operation(P>0.05). Compared with PS group, the VAS scores of CR group was lower at 1 week and 1 month after TKA operation(P<0.05), and there was no significant difference in VAS score at 3 months, 6 months and 1 year after operation between the CR and PS groups(P>0.05). The ROM and HSS scores of knee joint in CR group were better than those in PS group at 1 week, 1 month and 3 months after operation(P<0.05). There were no significant differences in the ROM of knee joint and the HSS scores of knee joint at 6 months and 1 year after operation between the CR and PS groups(P>0.05). Conclusion TKA with CR or PS prosthesis in the treatment of knee osteoarthritis combined with knee valgus deformity can effectively correct knee deformity, reduce knee pain, improve knee mobility and function, and achieve satisfactory clinical results. However, compared with PS prosthesis, CR prosthesis retains the posterior cruciate ligament, reduces the amount of osteotomy at the femoral condyle, thus reducing surgical bleeding, better alleviating early postoperative pain, and contributing to early functional recovery after TKA.