發(fā)布時(shí)間：2018-04-27 07:10

  本文選題：全膝關(guān)節(jié)置換術(shù) + 固定平臺�。� 參考：《昆明醫(yī)科大學(xué)》2017年碩士論文

【摘要】：[目的]對比分析PS型固定平臺與旋轉(zhuǎn)平臺置換術(shù)后的近期臨床療效、膝關(guān)節(jié)形態(tài)學(xué)糾正情況及三維步態(tài)恢復(fù)情況。[方法]選取2015年3月至2016年3月到昆明醫(yī)科大學(xué)第一附屬醫(yī)院確診的膝關(guān)節(jié)骨性關(guān)節(jié)炎病例30例30膝,其中男性11例,女性19例,平均年齡(64.86±5.37)歲,隨機(jī)分為固定平臺組及旋轉(zhuǎn)平臺組,分別行固定平臺及旋轉(zhuǎn)平臺假體置換術(shù)。對所有患者進(jìn)行臨床隨訪、膝關(guān)節(jié)形態(tài)學(xué)測量及三維步態(tài)分析。[結(jié)果]固定平臺組與旋轉(zhuǎn)平臺組術(shù)后較術(shù)前的HSS評分、KSS評分及WOMAC評分明顯改善。固定平臺組與旋轉(zhuǎn)平臺組術(shù)后各隨訪時(shí)間點(diǎn)的KSS膝評分、KSS功能評分、HSS評分及WOMAC評分比較,差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。PS型固定平臺組與旋轉(zhuǎn)平臺組組內(nèi)術(shù)前與術(shù)后測量數(shù)值之間差異有統(tǒng)計(jì)學(xué)意義(P0.05);兩組術(shù)前測量數(shù)值與國人標(biāo)準(zhǔn)值比較差異有統(tǒng)計(jì)學(xué)意義(P0.05);兩組術(shù)后測量數(shù)值與國人標(biāo)準(zhǔn)值比較差異無統(tǒng)計(jì)學(xué)意義(P0.05);固定平臺組與旋轉(zhuǎn)平臺組組間術(shù)后測量角度進(jìn)行比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。通過對術(shù)后1年的兩組患者進(jìn)行步態(tài)分析,并將兩組所獲相關(guān)參數(shù)進(jìn)行對比,發(fā)現(xiàn)兩組患者在行走過程中的最大伸直角、最大屈曲角、最大內(nèi)翻角、最大外翻角、最大內(nèi)旋角、最大外旋角、最大后位移、最大前位移、最大下位移、最大上位移、最大內(nèi)位移及最大外位移等參數(shù)的比較,差異無顯著性意義(P0.05),但兩組患者在行走過程中的最大內(nèi)翻角、最大外翻角、最大內(nèi)旋角、最大外旋角、最大后位移、最大前位移、最大下位移、最大上位移、最大內(nèi)位移及最大外位移等參數(shù)與正常人相關(guān)參數(shù)對比,差異有顯著性意義(P0.05)。[結(jié)論]膝關(guān)節(jié)PS型固定平臺型假體與旋轉(zhuǎn)平臺型假體置換術(shù)后均能獲得較好的手術(shù)效果、很好的恢復(fù)正常膝關(guān)節(jié)形態(tài)學(xué)及較好的步態(tài)恢復(fù)情況。第一部分膝關(guān)節(jié)PS型固定平臺與旋轉(zhuǎn)平臺假體置換術(shù)后早期臨床療效對比分析[目的]對比分析PS型固定平臺與旋轉(zhuǎn)平臺置換術(shù)后的近期臨床療效。[方法]選取2015年3月至2016年3月到昆明醫(yī)科大學(xué)第一附屬醫(yī)院確診的膝關(guān)節(jié)骨性關(guān)節(jié)炎病例30例30膝,其中男性11例,女性19例,平均年齡(64.86±5.37)歲,隨機(jī)分為固定平臺組及旋轉(zhuǎn)平臺組,分別行固定平臺及旋轉(zhuǎn)平臺假體置換術(shù)。對所有患者手術(shù)前及術(shù)后1月、3月、6月、1年進(jìn)行HSS評分、KSS評分及WOMAC評分,探討兩組假體的近期臨床療效。[結(jié)果]術(shù)前旋轉(zhuǎn)平臺組和固定平臺組的年齡、體重指數(shù)、膝關(guān)節(jié)HSS評分、KSS評分及WOMAC評分無統(tǒng)計(jì)學(xué)差異(P0.05)。術(shù)后所有患者恢復(fù)良好,無切口皮緣壞死、感染、深靜脈血栓等并發(fā)癥。固定平臺組與旋轉(zhuǎn)平臺組術(shù)后較術(shù)前的HSS評分、KSS評分及WOMAC評分明顯改善。固定平臺組與旋轉(zhuǎn)平臺組術(shù)后各隨訪時(shí)間點(diǎn)的KSS膝評分、KSS功能評分、HSS評分及WOMAC評分比較,差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。[結(jié)論]膝關(guān)節(jié)PS型固定平臺型假體與旋轉(zhuǎn)平臺型假體置換術(shù)后均能獲得較好的手術(shù)效果,均能明顯改善膝關(guān)節(jié)功能。第二部分膝關(guān)節(jié)PS型固定平臺與旋轉(zhuǎn)平臺假體置換術(shù)后膝關(guān)節(jié)三維數(shù)字化測量對比分析[目的]基于CT二維圖像數(shù)據(jù)構(gòu)建出旋轉(zhuǎn)平臺組及固定平臺組膝關(guān)節(jié)置換術(shù)前及術(shù)后雙下肢三維數(shù)字模型并對膝關(guān)節(jié)相關(guān)形態(tài)學(xué)進(jìn)行測量;對比分析其差異性。[方法]1.選取2015年3月至2016年3月在昆明醫(yī)科大學(xué)第一附屬醫(yī)院確診的膝關(guān)節(jié)骨性關(guān)節(jié)炎病例30例30膝,其中男性11例,女性19例,平均年齡(64.86±5.37)歲,隨機(jī)分為固定平臺組及旋轉(zhuǎn)平臺組,分別行固定平臺及旋轉(zhuǎn)平臺假體置換術(shù)。每組各15膝。2.收集患者的術(shù)前、術(shù)后雙下肢二維CT全長位片;數(shù)據(jù)運(yùn)用Mimics17.0軟件將術(shù)前及術(shù)后患肢全長進(jìn)行三維重建。選擇患者術(shù)中所用對應(yīng)型號的全膝關(guān)節(jié)假體,通過三維激光掃描逆向重建相應(yīng)假體三維模型,在Mimics17.0軟件中使用點(diǎn)對點(diǎn)配準(zhǔn)技術(shù)將假體三維模型裝配到術(shù)后患肢三維模型膝關(guān)節(jié)上;3.三維重建后通過軟件自帶測量工具對兩組模型測量如下指標(biāo):髖-膝-踝角、脛骨平臺后傾角、脛骨角、股骨角、股骨外翻角、脛骨平臺內(nèi)翻角,并將測量結(jié)果進(jìn)行對比,并與正常國人標(biāo)準(zhǔn)值進(jìn)行對比分析。[結(jié)果]PS型固定平臺組與旋轉(zhuǎn)平臺組組內(nèi)術(shù)前與術(shù)后測量數(shù)值之間差異有統(tǒng)計(jì)學(xué)意義(P0.05);兩組術(shù)前測量數(shù)值與國人標(biāo)準(zhǔn)值比較差異有統(tǒng)計(jì)學(xué)意義(P0.05);兩組術(shù)后測量數(shù)值與國人標(biāo)準(zhǔn)值比較差異無統(tǒng)計(jì)學(xué)意義(P0.05);固定平臺組與旋轉(zhuǎn)平臺組組間術(shù)后測量角度進(jìn)行比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。[結(jié)論]基于CT二維圖像能對膝關(guān)節(jié)置換術(shù)后進(jìn)行精確三維重建,并通過三維重建模型能夠精確的測量膝關(guān)節(jié)形態(tài)學(xué),避免了因通過手工測量、X線拍攝時(shí)存在患肢的旋轉(zhuǎn)或姿勢擺放不正導(dǎo)致骨性標(biāo)志輪廓的不清晰而引起測量誤差。PS型旋轉(zhuǎn)平臺與固定平臺假體置換均能較好的恢復(fù)正常膝關(guān)節(jié)形態(tài)學(xué)。第三部分膝關(guān)節(jié)PS型固定平臺與旋轉(zhuǎn)平臺假體置換術(shù)后的三維步態(tài)對比分析[目的]觀察兩組全膝關(guān)節(jié)置換術(shù)后近期步態(tài)恢復(fù)情況,通過三維步態(tài)對比固定平臺假體與旋轉(zhuǎn)平臺假體置換術(shù)后膝關(guān)節(jié)行走步態(tài)方面的差異。[方法]選取2015年3月至2016年3月到昆明醫(yī)科大學(xué)第一附屬醫(yī)院確診的膝關(guān)節(jié)骨性關(guān)節(jié)炎病例30例30膝,其中男性11例,女性19例,平均年齡(64.86±5.37)歲,隨機(jī)分為固定平臺組及旋轉(zhuǎn)平臺組,分別行固定平臺及旋轉(zhuǎn)平臺假體置換術(shù)。術(shù)后1年對所有患者進(jìn)行三維步態(tài)分析,同時(shí)收集15例健康志愿者膝關(guān)節(jié)三維步態(tài)數(shù)據(jù),對兩組患者三維步態(tài)數(shù)據(jù)進(jìn)行對比,并將兩組患者與正常人數(shù)據(jù)進(jìn)行對比。[結(jié)果]通過對術(shù)后1年的兩組患者進(jìn)行步態(tài)分析,并將兩組所獲相關(guān)參數(shù)進(jìn)行對比,發(fā)現(xiàn)兩組患者在行走過程中的最大伸直角、最大屈曲角、最大內(nèi)翻角、最大外翻角、最大內(nèi)旋角、最大外旋角、最大后位移、最大前位移、最大下位移、最大上位移、最大內(nèi)位移及最大外位移等參數(shù)的比較,差異無顯著性意義(P0.05),但兩組患者在行走過程中的最大內(nèi)翻角、最大外翻角、最大內(nèi)旋角、最大外旋角、最大后位移、最大前位移、最大下位移、最大上位移、最大內(nèi)位移及最大外位移等參數(shù)與正常人相關(guān)參數(shù)對比,差異有顯著性意義(P0.05)。
[Abstract]:[Objective] to compare the short-term clinical efficacy of PS type fixed platform and rotating platform replacement, the morphological correction of knee joint and the recovery of three dimensional gait. [Methods] 30 cases of 30 knee osteoarthritis cases were selected from March 2015 to March 2016 to the First Affiliated Hospital of Kunming Medical University, of which 11 cases were male and 19 of women were 19. The average age (64.86 + 5.37) years was randomly divided into fixed platform group and rotating platform group. The fixed platform and rotating platform prosthesis replacement were performed respectively. All patients were followed up, the morphological measurement of the knee joint and the three-dimensional gait analysis. [results] the HSS score, KSS score and WOMAC of the fixed platform group and the rotating platform group were compared with that of the rotation platform group. There was no significant difference in KSS knee score, KSS function score, HSS score and WOMAC score (P0.05) between the fixed platform group and the rotation platform group after the operation (P0.05), and there was a significant difference between the preoperative and postoperative measurements (P0.05) between the group.PS and the rotation platform group (P0.05); the two groups were measured before operation. There was significant difference between the values and the national standard values (P0.05), and there was no significant difference between the two groups after operation and the standard values of the Chinese people (P0.05). There was no statistical difference between the fixed platform group and the rotation platform group after the operation (P0.05). The gait analysis was carried out in two groups of patients after 1 years of operation, And comparing the related parameters of the two groups, the maximum extension angle, maximum angle of flexion, maximum angle of valgus, maximum angle of valgus, maximum angle of extroversion, maximum angle of rotation, maximum angle of rotation, maximum displacement, maximum displacement, maximum displacement, maximum upper displacement, maximum displacement, maximum internal displacement and maximum external displacement are compared. There was no significant difference (P0.05), but the maximum angle of valgus, maximum angle of valgus, maximum rotation angle, maximum rotation angle, maximum lateral rotation angle, maximum displacement, maximum displacement, maximum upper displacement, maximum displacement, maximum internal displacement and maximum external displacement were compared with those of normal human related parameters in the two groups (P0.05). Conclusion: the knee joint PS fixed platform prosthesis and the rotating platform prosthesis can achieve better results after the replacement of the rotary platform prosthesis. The normal knee joint morphology and the better gait recovery are well restored. The comparison of the early clinical efficacy of the first part of the knee joint PS fixed platform and the rotating platform prosthesis is compared. The short-term clinical effects of PS type fixed platform and rotating platform replacement were analyzed. [Methods] 30 cases of 30 knee osteoarthritis cases confirmed by the First Affiliated Hospital of Kunming Medical University from March 2015 to March 2016 were selected, including 11 males and 19 females, with an average age of 64.86 + 5.37 years old, randomly divided into fixed platform group and rotating flat. The HSS score, KSS score and WOMAC score were performed for all patients before and after operation, January, March, June, and WOMAC. [results] the age, body mass index, HSS score of knee joint, KSS score, and WOMAC of the pre operation rotating platform group and the fixed platform group were studied. There was no statistical difference (P0.05). All patients recovered well after operation without incision skin necrosis, infection, deep vein thrombosis and other complications. The fixed platform group and the rotation platform group were compared with the preoperative HSS score, KSS score and the WOMAC score. The KSS knee score and the KSS function at the fixed platform group and the rotation platform group were followed up at each follow-up time point. There was no significant difference in score, HSS score and WOMAC score (P0.05). [Conclusion] both knee joint PS fixed platform prosthesis and rotary platform prosthesis were all able to obtain better surgical results and significantly improve the function of knee joint. Second part of the knee joint PS fixed platform and the knee joint prosthesis replacement after the rotation platform prosthesis replacement. Three dimensional digital measurement comparative analysis [Objective] to construct the three dimensional digital model of the knee joint before and after the operation of the rotation platform group and the fixed platform group based on the CT two-dimensional image data and measure the knee joint related morphology, and compare the differences. [method]1. selected the Kunming Medical University from March 2015 to March 2016. In a Affiliated Hospital, 30 cases of knee osteoarthritis were diagnosed as 30 knees, including 11 males and 19 females, with an average age of 64.86 + 5.37 years old. The fixed platform group and rotating platform group were randomly divided into fixed platform and rotating platform prosthesis replacement. Each group of 15 knee.2. collected the patients before and after the operation. The total length of the affected limb before and after the operation was reconstructed by Mimics17.0 software. The total knee prosthesis of the corresponding model used in the patient's operation was selected, the three-dimensional model of the corresponding prosthesis was reconstructed by the three-dimensional laser scanning, and the 3D model of the false body was assembled by point to point registration in the Mimics17.0 software to the three dimensional model of the affected limb after the operation. On the knee joint; 3. after three dimensional reconstruction, the following indexes were measured by software self measuring tools: hip knee ankle angle, tibial plateau tilt angle, tibial angle, femur angle, femur valgus angle, tibial plateau inverted angle, and compared the measured results, and compared with normal national standard value. [result]PS type fixed platform group and There was a statistically significant difference between the preoperative and postoperative measurements in the group of rotating platforms (P0.05); there was a significant difference between the two groups before operation and the standard values of the National People (P0.05); there was no statistical difference between the two groups after the operation (P0.05) and the postoperative measurement between the fixed platform group and the rotating platform group. There is no significant difference between the angles and the differences (P0.05). [Conclusion] the two-dimensional image based on CT can accurately reconstruct the knee joint after the replacement of the knee joint, and can accurately measure the morphology of the knee joint through the three-dimensional reconstruction model. The uncertainty of the profile and the measurement error caused by the measurement error.PS rotary platform and the fixed platform prosthesis can better restore the normal knee joint morphology. Third part of the knee joint PS fixed platform and the rotation platform prosthesis replacement of the three-dimensional gait analysis [Objective] to observe the recent gait recovery after two groups of total knee arthroplasty The difference in walking gait of knee joint after replacement of fixed platform prosthesis and rotating platform prosthesis was compared by three dimensional gait. [Methods] 30 cases of 30 knees were selected from March 2015 to March 2016 to the First Affiliated Hospital of Kunming Medical University, including 11 males and 19 females with an average age of (64.86 + 5.37) years. The fixed platform group and the rotating platform group were randomly divided into fixed platform and rotating platform prosthesis replacement. Three dimensional gait analysis was carried out for all patients 1 years after operation, and the three dimensional gait data of 15 healthy volunteers were collected at the same time. The three dimensional gait data of the two groups were compared, and the data of the two groups were carried out with the normal person data. Comparison. [results] by analyzing the gait of two groups of patients after 1 years of operation, and comparing the related parameters of the two groups, the maximum extension angle, maximum angle of flexion, maximum angle of turn, maximum angle, maximum rotation angle, maximum external rotation angle, maximum back angle, maximum displacement, maximum displacement, maximum displacement and maximum displacement of two groups of patients were found in the course of walking. There is no significant difference between the maximum displacement, maximum internal displacement and maximum external displacement (P0.05), but the maximum angle of inversion, maximum angle, maximum rotation angle, maximum external rotation angle, maximum displacement, maximum displacement, maximum displacement, maximum upper displacement, maximum displacement, maximum internal displacement and maximum displacement in the two groups of patients in the course of walking. There was a significant difference between parameters and normal human parameters (P0.05).

【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.4

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