發(fā)布時間：2018-05-03 15:55

  本文選題：全膝關節(jié)置換術(shù) + MP膝關節(jié)系統(tǒng)�。� 參考：《青島大學》2017年碩士論文

【摘要】：目的對比內(nèi)軸型膝關節(jié)假體(Medial pivot,MP)與經(jīng)典后穩(wěn)定膝關假體(Posterior Cruciate-Stabilizing,PS)系統(tǒng)在中國人群中全膝關節(jié)置換(Total Knee Arthroplasty TKA)術(shù)后中期效果、滿意度及相關并發(fā)癥的發(fā)生率,系統(tǒng)評價內(nèi)軸型膝關節(jié)假體的應用效果。方法選取2010-2011年間由同一醫(yī)師實施內(nèi)軸型膝關節(jié)假體(Wright公司MP膝關節(jié))與經(jīng)典后穩(wěn)定膝關假體系統(tǒng)(Zimmer公司PS膝關節(jié))單側(cè)置換術(shù)后患者各60人進行隨訪,采集患者術(shù)后最新的HSS活動疼痛評分、HSS靜息疼痛評分、HSS活動度評分、HSS肌力評分、HSS屈曲畸形評分、HSS功能評分,HSS穩(wěn)定性評分與我院已存檔的該患者術(shù)前HSS評分計算差值,對兩種假體的各項指標的改善程度,進行統(tǒng)計學分析,評價兩種假體在中國人群的應用效果,同時利用WOMAC(The Western Ontario and Mc Master Universities)評分系統(tǒng)對患者術(shù)后滿意度進行評價,對比兩種假體置換后中期效果、滿意度及相關并發(fā)癥的發(fā)生率。結(jié)果1.實際到訪101人,其中Wright組49人,Zimmer組52人,未到訪病人中死亡1例,為Zimmer組患者,死于術(shù)后2年,死因系內(nèi)科系統(tǒng)疾病(心梗誘發(fā)多器官功能衰竭),余未述明顯不適;2.兩組患者術(shù)前在年齡、體重、HSS各項評分等指標無明顯統(tǒng)計學差異(P0.05)、兩組隨訪年限無顯著統(tǒng)計學差異(P0.05);3.兩組患者術(shù)后5年的HSS活動疼痛評分、HSS靜息疼痛評分、HSS活動度評分、HSS肌力評分、HSS屈曲畸形評分、HSS功能評分等與術(shù)前評分差值對比均無明顯統(tǒng)計學差異(P0.05);4.術(shù)后滿意度無顯著統(tǒng)計學差異(P0.05);5.術(shù)后五年隨訪兩組均未出現(xiàn)翻修、感染等情況;6.Wright組有1例疼痛不適患者。結(jié)論1.內(nèi)軸型膝關節(jié)假體與經(jīng)典后穩(wěn)定膝關假體中期隨訪在療效、滿意度、假體松動率、翻修率、感染率無顯著差異,兩者在置換術(shù)后均能取得了良好的康復效果;2.在實際操作過程中內(nèi)軸型膝關節(jié)假體系統(tǒng)通過球面設計實現(xiàn)了膝關節(jié)的穩(wěn)定,較后穩(wěn)定型假體中央立柱結(jié)構(gòu)更為穩(wěn)定,髁間截骨明顯少于后者,操作方便,同時可大幅度降低后期翻修所致骨缺損量,減少因骨缺損所致翻修難度,對于翻修較為有利;3.疼痛不適患者考慮為過度勞累所致;4.內(nèi)軸型膝關節(jié)系統(tǒng)的墊片磨損壽命,遠期翻修率尚需長期隨訪。
[Abstract]:Objective to compare the efficacy, satisfaction and incidence of complications between medial pivot and posterior stable knee arthroplasty (MPP) and postoperatively stabilized knee arthroplasty (PSS) system in Chinese population after total knee arthroplasty (TKR) total Knee Arthroplasty TKA). The application effect of internal axial knee joint prosthesis was systematically evaluated. Methods A total of 60 patients were followed up from 2010 to 2011 after unilateral arthroplasty with internal axial knee prosthesis (MP) and classic posterior stable knee closure prosthesis (Zimmer PS). The latest postoperative HSS activity pain score (HSS) resting pain score (HSS) activity score (HSS) muscle strength score (HSS) flexion deformity score (HSS) function score and HSS stability score (HSS stability score) were collected and compared with the preoperative HSS score of the patient who had been archived in our hospital. The improvement degree of each index of the two kinds of prosthesis was analyzed statistically, the application effect of the two kinds of prostheses in Chinese population was evaluated, and the satisfaction degree of the patients after operation was evaluated by using WOMAC(The Western Ontario and Mc Master Universities) scoring system. The mid-term effect, satisfaction, and incidence of related complications were compared between the two prosthesis replacements. Result 1. There were 49 patients in Wright group and 52 patients in Zimmer group. One patient in Zimmer group died 2 years after operation. The cause of death was a disease of internal medicine system (MI induced multiple organ failure, the rest of which was obviously unwell). There was no significant difference in age, weight and HSS scores between the two groups before operation (P 0.05), and there was no significant difference in the follow-up years between the two groups (P 0.05). There was no significant difference between the HSS activity pain score and the rest pain score and the muscle strength score, the flexion deformity score, the functional score and the preoperative score difference between the two groups. There was no significant difference in postoperative satisfaction (P 0.05). There was no revision and infection in both groups. 6. There was one case of pain and discomfort in Wright group. Conclusion 1. There was no significant difference in efficacy, satisfaction, prosthesis loosening rate, revision rate and infection rate between the internal axis knee joint prosthesis and the classic posterior stable knee closure prosthesis. In the process of practical operation, the internal axial knee joint prosthesis system realizes the stability of the knee joint by spherical design, which is more stable than the central column structure of the posterior stable prosthesis, and the intercondylar osteotomy is obviously less than the latter, and the operation is convenient. At the same time, it can greatly reduce the amount of bone defects caused by later revision and reduce the difficulty of revision caused by bone defects, which is more favorable for revision. Patients with pain and discomfort are considered to be overworked and overworked. Long-term follow-up is needed for the wear life and long-term revision rate of the internal shaft knee joint system.
【學位授予單位】：青島大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R687.4

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本文編號：1839129