不同K-L分级的膝骨关节炎行全膝关节置换术治疗的效果比较

Comparison of total knee arthroplasty in patients with different K-L grades of knee osteoarthritis

目的比较不同K-L分级的膝骨关节炎(KOA)行全膝关节置换术(TKA)治疗的效果。方法将108例行TKA治疗的KOA患者根据术前K-L分级不同分为K-L 2级组(29例)、K-L 3级组(47例)和K-L 4级组(32例)。记录开始下地时间、开始部分负重行走时间、开始完全负重行走时间、膝关节屈曲活动度。采用HSS评分评价膝关节功能,采用IKDC膝关节功能主观评分评价膝关节功能,采用Mar-shall评分评价韧带恢复效果。结果患者均获得6个月随访。开始下地时间、开始部分负重行走时间、开始完全负重行走时间:K-L 2级组均短于K-L 3级组、K-L 4级组(P<0.05);K-L 3级组均短于K-L 4级组(P<0.05)。术后6个月HSS评分、IKDC评分、Mar-shall评分、膝关节屈曲活动度:K-L 2级组均高(大)于K-L 3级组、K-L 4级组(P<0.05);K-L 3级组均高(大)于K-L 4级组(P<0.05)。末次随访时,患者均行走自如,膝关节无疼痛,X线片显示假体位置良好,无松动及脱位情况发生。结论TKA治疗KOA能有效改善患者膝关节功能,但术前K-L分级越高,手术效果越差。

Objective To compare the effects of total knee arthroplasty(TKA)for knee osteoarthritis(KOA)with different K-L grades.Methods The 108 patients with KOA who underwent TKA were divided into three groups according to different K-L grades:K-L grade-2 group(29 cases),K-L grade-3 group(47 cases),and K-L grade-4 group(32 cases).The time of starting to stand,start to walk time with partial weight-bearing,time to walk with full weight-bearing,and knee flexion ROM were recorded.The knee function was evaluated with HSS score,the subjective knee function was evaluated by using the IKDC score,and the recovery effect of the ligaments was assessed with Mar-shall score.Results All patients were followed up for 6 months.The time to first weight-bearing,start to walk time with partial weight-bearing,and time to walk with full weight-bearing:the data of K-L grade-2 group were all shorter than those in K-L grade-3 group and K-L grade-4 group(P<0.05),while K-L grade-3 group was shorter than K-L grade-4 group(P<0.05).HSS scores,IKDC scores,Mar-shall scores,knee flexion ROM:K-L grade-2 group was all bigger(larger)than those in K-L grade-3 group and K-L grade-4 group(P<0.05),while K-L grade-3 group was bigger(larger)than K-L grade-4 group(P<0.05).At the last follow-up,all patients walked freely,without knee pain,and X-ray showed good prosthesis position,without loosening or dislocation.Conclusions TKA treatment for KOA can effectively improve knee joint function in patients,but preoperative K-L grade is higher,the surgical outcome is worse.