全膝关节置换中采用测量截骨与间隙平衡技术的对比分析

Measuring osteotomy versus gap balance in total knee arthroplasty

背景:全膝关节置换多用来治疗膝骨关节病变,术中截骨方法主要有测量截骨技术与间隙平衡技术,通过合理截骨能确保假体植入的稳定性,提升预后效果。目的:对全膝关节置换患者采用测量截骨与间隙平衡技术的临床疗效指标进行统计分析。方法:76例原发性骨关节炎病例资料收集时间为2015年5月至2016年10月,按手术方法分为对照组与试验组,每组均38例,其中对照组术中采用测量截骨技术,试验组采用间隙平衡技术,对两组术中指标及置换后1年的预后效果进行比较分析。结果与结论:置换后3 d,采用间隙平衡技术的试验组股骨远端截骨量明显多于采用测量截骨技术的对照组,聚乙烯衬垫厚度大于对照组(P <0.05)。置换后3 d,试验组较对照组膝关节稳定性及屈膝90°股胫角改善更佳(P <0.05);置换后3 d,对照组与试验组下肢力量与小腿解剖轴线夹角的优良率分别为47%及61%(P>0.05)。随访期间两组均未见假体松动病例,其他不良反应亦无比较差异(P> 0.05)。随访1年后试验组目测类比评分、WOMAC疼痛评分显著降低,KSS功能明显提高(P <0.05)。结果证实,间隙平衡技术用于全膝关节置换患者时,临床症状指标及预后改善较测量截骨组更加明显。

BACKGROUND: Total knee arthroplasty is often used to treat knee joint diseases. The intraoperative osteotomy mainly measures osteotomy and gap balance technology, which can ensure the stability of prosthesis implantation and improve the prognosis by reasonable osteotomy. OBJECTIVE: To statistically analyze the clinical efficacy of the osteotomy and gap balance technique in patients undergoing total knee arthroplasty. METHODS: Data of 76 cases of primary osteoarthritis from May 2015 to October 2016 were collected. The patients were divided into control and trial groups(n=38/group). The control group used the measurement osteotomy technique, and the trial group used the gap balance technique to compare the surgical indexes and prognostic effects at 1 year postoperatively. RESULTS AND CONCLUSION: The femoral distal osteotomy and thickness of polyethylene liner in the trial group were significantly higher than those in the control group at postoperative 3 days(P < 0.05). Compared with the control group, the knee joint stability and knee flexion 90° femoral angle were improved better in the trial group(P < 0.05). The excellent and good rate of the lower limb strength and the anatomical axis of the lower leg in the control and trial groups was 47% and 61%, respectively(P > 0.05). There was no case of loosening of the prosthesis in the two groups during the follow-up, and there were no significant differences in other complications(P > 0.05). After 1 year of follow-up, the Visual Analogue Scale and Western Ontario and Mc Master Universities Osteoarthritis Index pain scores in the trial group were significantly decreased, and the Knee Society Score function was significantly improved(P < 0.05). These results imply that the gap balance technique used in total knee arthroplasty, can significantly improve the clinical symptoms and prognosis.