Mid-term outcomes of a kinematically designed cruciate retaining total knee arthroplasty

BACKGROUND Advances in implant material and design have allowed for improvements in total knee arthroplasty(TKA)outcomes.A cruciate retaining(CR)TKA provides the least constraint of TKA designs by preserving the native posterior cruciate ligament.Limited research exists that has examined clinical outcomes or patient reported outcome measures(PROMs)of a large cohort of patients undergoing a CR TKA utilizing a kinematically designed implant.It was hypothesized that the studied CR Knee System would demonstrate favorable outcomes and a clinically significant improvement in pain and functional scores.AIM To assess both short-term and mid-term clinical outcomes and PROMs of a novel CR TKA design.METHODS A retrospective,multi-surgeon study identified 255 knees undergoing a TKA utilizing a kinematically designed CR Knee System(JOURNEY™II CR;Smith and Nephew,Inc.,Memphis,TN)at an urban,academic medical institution between March 2015 and July 2021 with a minimum of two-years of clinical follow-up with an orthopedic surgeon.Patient demographics,surgical information,clinical outcomes,and PROMs data were collected via query of electronic medical records.The PROMs collected in the present study included the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement(KOOS JR)and Patient-Reported Outcomes Measurement Information System(PROMIS■)scores.The significance of improvements in mean PROM scores from preoperative scores to scores collected at six months and two-years postoperatively was analyzed using Independent Samples t-tests.RESULTS Of the 255 patients,65.5%were female,43.8%were White,and patients had an average age of 60.6 years.Primary osteoarthritis(96.9%)was the most common primary diagnosis.The mean surgical time was 105.3 minutes and mean length of stay was 2.1 d with most patients discharged home(92.5%).There were 18 emergency department(ED)visits within 90 d of surgery resulting in a 90 d ED visit rate of 7.1%,including a 2.4%orthopedic-related ED visit rate and a 4.7%non-orthopedic-related ED visit rate.There were three(1.2%)hospital readmissions within 90 d postoperatively.With a mean time to latest follow-up of 3.3 years,four patients(1.6%)required revision,two for arthrofibrosis,one for aseptic femoral loosening,and one for peri-prosthetic joint infection.There were significant improvements in KOOS JR,PROMIS Pain Intensity,PROMIS Pain Interference,PROMIS Mobility,and PROMIS Physical Health from preoperative scores to six month and two-year postoperative scores.CONCLUSION The evaluated implant is an effective,novel design offering excellent outcomes and low complication rates.At a mean follow up of 3.3 years,four patients required revisions,three aseptic and one septic,resulting in an overall implant survival rate of 98.4%and an aseptic survival rate of 98.8%.The results of our study demonstrate the utility of this kinematically designed implant in the setting of primary TKA.

Reliability of preoperative measurement with standardized templating in Total Knee Arthroplasty

AIM: To investigate the correlation between preoperative measurement in total knee arthroplasty and the prosthetic size implanted. METHODS: A prospective double-blind study of 50 arthroplasties was performed. Firstly, the reliability and correspondence between the size of said measurement and the actual implant utilized was determined. Secondly, the existing correlation between the intra- and interobserver determinations with the intraclass correlation coefficient was analyzed. RESULTS: An overall correspondence of 54%, improving up to 92% when the measured size admitted a difference of one size, was found. Good intra- and interobserver reliability with an intraclass correlation coefficient greater than 0.90(P < 0.001) was also discovered. CONCLUSION: Agreement between the preoperative measurement with standardized acetate templates and the prosthetic size implanted can be considered satisfactory. We thus conclude it is a reproducible technique.

Radiographic Measurement of Femoral Lateral Bowing and Distal Femoral Condyle Resection Thickness： Variances and Effects on Total Knee Arthroplasty Planning

Background：Accurate evaluation of the plain radiography of lower limb is critical for preoperative planning of total knee arthroplasty （TKA）. We aimed to investigate the effect of femoral lateral bowing and rotation on the radiographic measurements of distal femoral condyle resection thickness （DRT） and the distal femoral resection valgus angle （FVA）. Methods： We analyzed 246 three-dimensional femoral models generated from computed tomography images of 123 patients, acquiring projected contours in seven positions – 20° and 10° internal rotation; 0° rotation; 10°, 20°, 30°, and 40° external rotation – for each model. Medial and lateral condyle DRTs, femoral shaft lateral bowing angle （FBA）, and distal FVA were determined for each position. Linear mixed effect model was used to determine the effect of degree of femur rotation on repeated measurements of DRT or FVA. Results： FBA significantly affected the FVA and DRT （Pearson＇s R = 0.767 and -0.408, respectively; P 〈 0.000）. Samples were divided into three groups according to the FBA measured in neutral position： FBA 〈0°： DRT 3.75 ± 1.30 mm, FVA 4.53° ± 1.27°; FBA 〉0° but 〈3°： DRT 3.39 ± 1.31 mm, FVA 5.92° ± 1.31°; FBA 〉3°： DRT 2.22 ± 1.31 mm, FVA 7.37° ± 1.31°. From simulated 20° internal rotation to 40° external rotation in each femoral model, the average variation ranges of radiographically measured DRT, FVA, and FBA were 0.50 ± 0.28 mm, 2.93° ± 0.96°, and 10.33° ± 1.90°, respectively, with no significant differences among the FBA groups. The degree of femoral rotation significantly affected the FVA （F = 62.148, P 〈 0.000）, whereas there was no effect on condyle resection thickness （F = 0.4705, P = 0.494）. Conclusions： Axial femoral rotation has less effect on radiographic measurements of differences in the DRT than on those of the distal FVA.

Comparison of clinical outcomes between total hip replacement and total knee replacement

BACKGROUND Total hip replacements(THR)and total knee replacements(TKR)are effective treatments for severe osteoarthritis(OA).Some studies suggest clinical outcomes following THR are superior to TKR,the reason for which remains unknown.This study compares clinical outcomes between THR and TKR.AIM To compare the clinic outcomes of THR anad TKR using a comprehensive range of patient reported outcome measures(PROMs).METHODS A prospective longitudinal observational study of patients with OA undergoing THR and TKR were evaluated using a comprehensive range of generic and joint specific PROMs pre-and post-operatively.RESULTS A total of 131 patients were included in the study which comprised the THR group(68 patients)and the TKR group(63 patients).Both groups demonstrated significant post-operative improvements in all PROM scores(P<0.001).There were no significant differences in post-operative PROM scores between the two groups:Hip and Knee Osteoarthritis Outcome scores(P=0.140),Western Ontario and McMaster Universities Osteoarthritis Index pain(P=0.297)stiffness(P=0.309)and function(P=0.945),Oxford Hip and Knee Score(P=0.076),EuroQol-5D index(P=0.386)and Short-Form 12-item survey physical component score(P=0.106).Subgroup analyses showed no significant difference(P>0.05)between cruciate retaining and posterior stabilised prostheses in the TKR group and no significant difference(P>0.05)between cemented and uncemented fixation in the THR group.Obese patients had poorer outcomes following TKR but did not significantly influence the outcome following THR.CONCLUSION Contrary to some literature,THR and TKR are equally efficacious in alleviating the pain and disability of OA when assessed using a comprehensive range of PROMs.The varying knee prosthesis types and hip fixation techniques did not significantly influence clinical outcome.Obesity had a greater influence on the outcome following TKR than that of THR.

Is clinically measured knee range of motion after total knee arthroplasty‘good enough?’:A feasibility study using wearable inertial measurement units to compare knee range of motion captured during physical therapy versus at home

Total knee arthroplasty is highly successful,in part due to range of motion(RoM)recovery.This is typically estimated goniometrically/visually by physical therapists(PTs)in the clinic,which is imprecise.Accordingly,a validated inertial measurement unit(IMU)method for capturing knee RoM was deployed assessing postoperative RoM both in and outside of the clinical setting.The study's objectives were to evaluate the feasibility of continuously capturing knee RoM pre-/post-op via IMUs,dividing data into PT/non-PT portions of each day,and comparing PT/non-PT metrics.We hypothesized IMU-based clinical knee RoM would differ from IMU-based knee RoM captured outside clinical settings.10 patients(3 M,69±13 years)completed informed consent documents following ethics board approval.A validated IMU method captured long duration(8–12 h/day,~50 days)knee RoM pre-/post-op.Post-op metrics were subdivided(PT versus non-PT).Clinical RoM and patient reported outcome measures were also captured.Compliance and clinical disruption were evaluated.ANOVA compared post-op PT and non-PT means and change scores.Maximum flexion during PT was less than outside PT.PT stance/swing RoM and activity level were greater than outside PT.No temporal variable differences were found PT versus non-PT.IMU RoM measurements capture richer information than clinical measures.Maximum PT flexion was likely less than non-PT due to the exercises completed(i.e.high passive RoM vs.low RoM gait).PT gait flexion likely exceed non-PT because of‘white coat effects’wherein patients are closely monitored clinically.This implies data captured clinically represents optimum performance whereas data captured non-clinically represents realistic performance.

间隙平衡器下平衡技术与测量截骨技术在全膝关节置换中的应用

背景:目前测量截骨技术和间隙平衡技术是全膝关节置换术中最常用的技术,各有优缺点:间隙平衡技术通过调整截骨角度可以减少对软组织的松解,得到更平衡的屈伸间隙,临床效果更优,但缺乏工具的间隙平衡技术,易受术者手术经验及主观判断影响,存在更多的误差;测量截骨法学习曲线短,但依赖解剖标志,容易定位不准而出现多种并发症。近年来,许多器械公司相继研发并推出了间隙平衡工具以期提高手术质量,但目前关于该工具的相关报道仍较少。目的:对比结合间隙平衡器的间隙平衡技术与传统测量截骨应用于全膝关节置换的临床疗效,以探究间隙平衡器在全膝关节置换过程中的应用价值。方法:收集85例全膝关节置换患者的病历资料,根据手术方式分为2组,A组44例采用结合间隙平衡器的间隙平衡技术进行全膝关节置换;B组41例采用测量截骨技术进行全膝关节置换。比较两组患者手术时间、美国膝关节协会评分、膝关节活动度、下肢力线改变及术后并发症的发生情况,以评估结合间隙平衡器的间隙平衡技术在全膝关节置换中的应用效果。结果与结论:①85例患者均获得随访;②两组术后膝关节活动度均较术前提高(P<0.05),且A组较B组改善更明显(P<0.05);③两组术后美国膝关节协会评分均较术前提高(P<0.05),且术后2周、术后1,3个月和末次随访时,A组美国膝关节协会评分高于B组同期(P<0.05);④手术时间A组较B组稍短,但差异无显著性意义(P>0.05);⑤术后两组下肢力线均较其术前改善,但两组差异无显著性意义(P>0.05);⑥术后A组并发症发生率(2%)较B组(7%)低,但两组差异无显著性意义(P>0.05);⑦提示相较于测量截骨技术,结合间隙平衡器的间隙平衡技术可提高临床效果,改善膝关节功能及活动度。

A gyroscope-based system for intraoperative measurement of tibia coronal plane alignment in total knee arthroplasty

Coronal plane alignment in total knee arthroplasty(TKA)is an important predictor of clinical outcomes including patient satisfaction and device longevity.Radiography and computer assisted navigation are the two primary technologies currently available to surgeons for intraoperative assessment of alignment;however,neither is particularly well-suited for use in this increasingly high volume procedure.Herein we propose a novel gyroscopebased instrument for intraoperative validation of tibia coronal plane alignment,and provide initial analytical and experimental performance assessments.The gyroscope-based alignment estimate is derived from simplified joint geometry and verified experimentally using a custom tibial trial insert containing a consumer-grade inertial measurement unit(IMU).Average accuracy of the gyroscope-based tibia coronal angle estimate was found to be within
1in mechanical leg jig and cadaver testing.These results indicate that the proposed gyroscope-based method shows promise for low cost,accurate intraoperative validation of limb alignment in TKA patients.Integrating IMU technology into the TKA surgical workflow via low-cost instrumentation will enable surgeons to easily validate implant alignment in real time,thereby reducing cost,operating room time,and future revision burden.

全膝关节置换术后深静脉血栓形成机制、危险因素及预防研究进展

全膝关节置换术(TKA)是目前终末期膝骨关节病治疗的最有效方法。深静脉血栓(DVT)是手术后患者恢复期最常见并发症类型之一,栓子脱落后可形成肺栓塞,严重危及患者生命安全。因此,预防术后DVT形成在TKA围手术期至关重要。现就引发TKA术后DVT形成的机制、危险因素及其预防措施进行总结,为TKA术后DVT的预防提供参考。

Comparison of clinical outcomes among total knee arthroplasties using posterior-stabilized,cruciate-retaining,bi-cruciate substituting,bi-cruciate retaining designs:a systematic review and network meta-analysis

Background:Despite the advent of innovative knee prosthesis design,a consistent first-option knee implant design in total knee arthroplasty(TKA)remained unsettled.This study aimed to compare the clinical effects among posterior-stabilized(PS),cruciate-retaining(CR),bi-cruciate substituting(BCS),and bi-cruciate retaining designs for primary TKA.Methods:Electronic databases were systematically searched to identify eligible randomized controlled trials(RCTs)and cohort studies from inception up to July 30,2021.The primary outcomes were the range of knee motion(ROM),and the secondary outcomes were the patient-reported outcome measures(PROMs)and complication and revision rates.Confidence in evidence was assessed using Confidence in Network Meta-Analysis.The Bayesian network meta-analysis was performed for synthesis.Results:A total of 15 RCTs and 18 cohort studies involving 3520 knees were included.The heterogeneity and inconsistency were acceptable.There was a significant difference in ROM at the early follow-up when PS was compared with CR(mean difference[MD]=3.17,95%confidence interval[CI]0.07,7.18)and BCS was compared with CR(MD=9.69,95%CI 2.18,17.51).But at the long-term follow-up,there was no significant difference in ROM in any one knee implant compared with the others.No significant increase was found in the PROMs and complication and revision rates at the final follow-up time.Conclusions:At early follow-up after TKA,PS and BCS knee implants significantly outperform the CR knee implant in ROM.But in the long run,the available evidence suggests different knee prostheses could make no difference in clinical outcomes after TKA with extended follow-up.

患者报告结局评估量表在全膝关节置换术中应用的研究进展

为了归纳总结患者报告结局评估量表(PROM)在人工全膝关节置换术(TKA)中的应用,为TKA围术期评估中PROM的选择提供参考,我们通过对近几十年来PROM在TKA中应用的相关文献进行检索,总结出几种目前可用于TKA的PROM,并分析其问卷内容及应用特点。目前常见的可应用于TKA的PROM主要有西安大略与麦克马斯特大学骨关节炎评分、牛津膝关节评分、遗忘关节评分等,主要涉及了患者膝关节疼痛、功能等方面的内容,不同量表的适用范围及优缺点也各不相同,临床中需要根据其特点具体选择,应用于TKA的膝关节评分系统还有待进一步完善。

中国北方60岁以上老年人股骨外翻角、股骨后髁角数字化测量及与中青年的比较

背景:全膝关节置换是终末期膝关节骨性关节炎的有效治疗手段,股骨外翻角及股骨后髁角是术前评估的重要参数,选择适宜的角度进行截骨有利于术后下肢力线的重建及假体的稳定,因此研究股骨外翻角及股骨后髁角对全膝关节置换术中截骨意义重大。目的:测量内蒙古地区不同年龄段人群的股骨外翻角、股骨后髁角,了解不同年龄段人群两项参数的分布情况。方法:选择2018年1月至2021年12月在内蒙古医科大学附属医院及乌兰察布市第二人民医院进行下肢血管检查患者,共纳入175例,分为4组:<60岁(A组,n=41)、60-69岁(B组,n=52)、70-79岁(C组,n=41)、≥80岁(D组,n=41)。收集患者的下肢血管CT资料,使用Mimics 21.0软件进行三维重建并旋转至标准正位,模拟下肢X射线片测量股骨外翻角,在CT横断面测量股骨后髁角。利用SPSS 25.0软件分析同性别不同年龄段间两个参数的差异、同年龄段不同性别间两参数的差异以及两个参数与年龄的相关性。结果与结论:(1)相同性别下,A、B组股骨外翻角小于C、D组(P <0.05);对于男性患者,A、B组股骨后髁角小于C、D组(P <0.05);对于女性患者,A组股骨后髁角小于C、D组(P <0.05),B组小于D组(P <0.05);(2)相同组别下,男女间股骨外翻角、股骨后髁角比较差异均无显著性意义(P> 0.05);(3)Pearson相关分析显示,股骨外翻角、股骨后髁角与年龄存在正相关,相关系数分别为0.31,0.46 (P <0.01);(4)结果表明,老年人全膝关节置换术中截骨应考虑年龄对股骨外翻角及股骨后髁角的影响,建议术前行下肢CT检查及三维重建测量,明确股骨外翻角及股骨后髁角,进行个体化精准截骨。

全膝关节置换术病人恐动症的研究进展

就全膝关节置换术恐动症的相关概念、发生机制、评估工具和干预措施进行综述,旨在为全膝关节置换病人恐动症的临床护理干预提供参考依据。

改良间隙平衡技术对人工全膝关节置换患者股骨假体矢状位力线与功能恢复的影响

目的探究改良间隙平衡技术(GB)对人工全膝关节置换(TKA)患者股骨假体矢状位力线与功能恢复的影响。方法回顾性分析2017年4月—2020年6月因膝骨关节炎于我院初次行TKA的患者96例(96膝),分为A组和B组。A组采用改良GB,B组采用测量截骨技术(MR)。收集所有患者的一般资料、影像学指标、预后指标以及术后1年并发症发生情况。采用随机行走模型评价两组患者的功能恢复情况。结果两组一般资料比较差异均无统计学意义(P>0.05)。A组术后1年屈膝90°应力位胫股关节角及FPFA均较B组显著改善(P<0.05)。A组术后1年目测类比评分及KSS评分均较B组显著改善(P<0.05)。随机行走模型评价结果显示,A组功能恢复情况显著优于B组(P<0.05)。与B组相比,A组术后1年并发症发生风险更低(P<0.05)。结论在TKA中,应用改良GB比MR更有助于维持良好的股骨假体矢状位力线以及屈膝90°稳定性,并有效缓解疼痛,且术后患者膝关节功能恢复更好。

中老年大骨节病性膝关节炎患者膝关节的影像学测量及其临床意义

目的测量适合全膝关节置换术(TKA)治疗的大骨节病性膝关节炎患者相关X线指标,为临床上采用TKA提供帮助。方法选取93例膝关节,分为大骨节病性膝关节炎组、膝关节退行性骨关节病组和正常对照组,拍摄膝关节正位X线片,用AutoCAD10.0软件标识并测量相关指标:股骨内外髁横径、胫骨平台横径、胫骨平台内翻角(PT角)、小腿机械轴垂直线与双侧股骨髁远端切线的夹角(FT角)。结果股骨内外髁横径:大骨节病性膝关节炎组女性与正常对照组女性相比差异有统计学意义;胫骨平台横径和PT角:膝关节退行性骨关节病组女性及正常组女性相比差异均有统计学意义;FT角:各组与正常对照组同性别相比差异均有统计学意义;PT角和FT角在与国外数据的比较上差异均有统计学意义。结论适合TKA治疗的大骨节病性膝关节炎患者的膝关节测量数据有一定特异性,可为设计适合该病的人工膝关节假体、提高TKA精确度与成功率及远期疗效提供理论依据。

西北地区中老年人正常膝关节的影像学测量及临床意义

目的通过膝关节X线片的测量,完善西北地区人群的膝关节影像学资料,为国人(特别是西北地区)的全膝关节置换术提供参考。方法随机选取200例西北地区中老年人,年龄大于40岁,男女各半,拍摄膝关节正、侧位X线片。用AutoCAD软件系统标识并且分别测量记录:胫骨平台内翻角(PT角)、小腿机械轴垂直线与双侧股骨髁远端切线的夹角(FT角)、髌骨厚度和胫骨内侧平台最低点至腓骨头尖端高度的差距(DPF)。将所得数据分别按男女组及左右侧进行统计学处理,并将所得数值同国外相关研究所得的数据进行统计学比较。结果PT角及FT角、髌骨厚度(H)及DPF在肢别上没有统计学差别(P>0.05)。PT角及FT角在性别上无统计学差异(P>0.05);髌骨厚度(H)及DPF在性别上有统计学差别(P<0.05)。本次测得的PT角、FT角、髌骨厚度与国外所报道的数值进行统计学分析,发现均存在着统计学差异(P<0.05)。结论在进行膝关节置换手术前,应该常规测量胫骨平台内翻角、髌骨厚度、DPF等影像学参数,保证手术的顺利进行。

测量截骨联合间隙平衡技术在全膝关节置换股骨外旋截骨中的应用

背景:全膝关节置换是治疗膝关节终末期疾病的有效方法,经典截骨方法包括间隙平衡技术和测量截骨技术。这2种技术各有其优缺点,术中将两者混合使用以期能取长补短,使关节置换效果达到最佳化。目的:探讨测量截骨和间隙平衡技术联合使用在全膝关节置换股骨外旋截骨中的应用操作以及早期疗效。方法:纳入2016年9月至2018年12月采用伸直间隙优先法,术中联合使用测量截骨和间隙平衡技术进行全膝关节置换的患者30例,男4例,女26例,年龄46-81岁;骨关节炎伴膝内翻24例,膝外翻2例;类风湿性关节炎伴膝外翻4例。所有患者对治疗方案均知情同意,且得到医院伦理委员会批准。术前和术后末次随访采用疼痛目测类比评分、美国特种外科医院膝关节评分、解剖股胫角和膝关节活动度评价疗效。结果与结论:①术后切口均Ⅰ期愈合,无感染、无血管神经损伤、无下肢深静脉血栓形成及假体周围骨折等早期并发症发生;②30例患者均获得随访,随访时间6-30个月;③患者术后末次随访疼痛目测类比评分、美国特种外科医院膝关节评分、膝关节活动度及股胫角均较术前显著改善(P<0.05);④提示医生需对全膝关节置换中测量截骨和间隙平衡技术熟悉掌握,基于患者的具体情况在术中联合使用,以期获得更佳的软组织平衡和假体位置。联合技术易于掌握,可以使用传统截骨工具操作,从而取得良好的近期疗效。

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

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。

应用间隙平衡技术可减少人工全膝关节置换中截骨量及维持下肢力线与屈伸间隙平衡

背景:全膝关节置换是治疗终末期膝骨关节病的有效方法,恢复精确力线与良好的屈伸间隙平衡是全膝关节置换的关键。间隙平衡技术与测量截骨技术为两种经典截骨方式,选择何种方式目前仍有争议。目的:通过比较应用间隙平衡技术与测量截骨技术的全膝关节置换患者的影像学表现,分析间隙平衡技术在全膝关节置换患者中的应用效果。方法:回顾性分析118例全膝关节置换患者的临床资料,其中男42例,女76例,年龄53-72岁,根据术中截骨方式分为间隙平衡组61例、测量截骨组57例。术后随访12个月,拍摄X射线片测量冠状面髋-膝-踝角、下线力线角与股骨屈曲角,采用目测类比评分、美国膝关节协会评分KSS分别评估疼痛程度与膝关节功能。研究获得贵阳市第四人民医院伦理委员会批准。结果与结论:(1)间隙平衡组发生局部感染3例,测量截骨组发生局部感染4例、排斥反应1例、免疫反应1例,两组并发症发生率比较差异无显著性意义(4.92%,10.53%,P>0.05);(2)术后随访12个月时,间隙平衡组屈膝90°应力位内侧、外侧的胫股关节角均低于截骨测量组(P<0.001),冠状面髋-膝-踝角、下线力线角小于测量截骨组(P<0.001),关节最大屈曲角大于测量截骨组(P<0.001);(3)术后随访12个月时,间隙平衡组患者的目测类比评分低于测量截骨组(P<0.001),KSS评分高于测量截骨组(P<0.01);(4)结果表明,在全膝关节置换中,应用间隙平衡技术有助于维持良好的下肢力线与屈伸间隙平衡、缓解疼痛程度、改善膝关节功能。

全膝关节置换术患者低体温预防的清单式管理

目的降低全膝关节置换术患者术中低体温发生率,改善患者手术相关体验。方法将281例行单侧全膝关节置换术患者按住院时间段分为对照组137例、观察组144例;对照组行常规保温护理;观察组构建预防低体温清单,用于患者手术全程管理中。结果观察组患者低体温、寒战发生率显著低于对照组,患者舒适度、满意度显著高于对照组(均P<0.05);实施清单式管理后护士满意度显著提高(P<0.05)。结论预防低体温清单用于全膝关节置换术患者,能有效降低低体温发生率、改善患者手术相关体验,提高护士工作满意度。

多模式镇痛下持续髂筋膜间隙阻滞与收肌管阻滞对老年人全膝关节置换术后镇痛及早期康复的影响

目的观察多模式镇痛下持续髂筋膜间隙阻滞(fascia iliaca compartment block, FICB)和收肌管阻滞(adductor canal block,ACB)在老年人全膝关节置换(total knee arthroplasty,TKA)术后镇痛效果及对早期康复的影响。方法选择60例行TKA术患者(男34例,女26例),年龄60～75岁。随机分为两组,术后超声引导下0.25%罗哌卡因240 mL自控镇痛泵连续FICB 30例与连续ACB 30例。所有患者以前均未做过膝关节手术。记录TKA术后6、12、24、48 h静息状态和被动屈膝时视觉模拟评分(visual analogue scale,VAS),不同时间评定术后康复训练依从性、膝关节主动活动度(range of motion, ROM)、膝关节功能。结果 ACB组与FICB组患者术后6、12、24、48 h静息痛、活动痛的VAS评分差异无统计学意义(P>0.05)。ACB组与FICB组术后康复训练依从性、膝关节ROM及HSS评分比较,差异均有统计学意义(P<0.05)。结论超声引导下持续ACB可促进TKA术后早期康复。