【摘要】：目的比較活動(dòng)平臺與固定平臺假體行人工全膝關(guān)節(jié)置換術(shù)(total knee arthroplasty,TKA)的10年療效,為臨床選擇TKA假體提供參考。方法回顧分析2002年1月—2005年12月符合選擇標(biāo)準(zhǔn)的113例初次行TKA的膝關(guān)節(jié)骨關(guān)節(jié)炎患者臨床資料,其中47例采用活動(dòng)平臺假體(A組),66例采用固定平臺假體(B組)。兩組患者年齡、性別、體質(zhì)量指數(shù)、膝關(guān)節(jié)內(nèi)翻和屈曲畸形以及術(shù)前膝關(guān)節(jié)活動(dòng)度、美國膝關(guān)節(jié)學(xué)會評分系統(tǒng)(KSS)評分、美國西部Ontario與Mc Master大學(xué)骨關(guān)節(jié)炎指數(shù)評分(WOMAC)等一般資料比較,差異均無統(tǒng)計(jì)學(xué)意義(P0.05),具有可比性。結(jié)果 A、B組手術(shù)時(shí)間分別為(88.1±6.5)、(90.3±7.2)min,比較差異無統(tǒng)計(jì)學(xué)意義(t=1.666,P=0.099)。術(shù)后兩組患者切口均Ⅰ期愈合,無切口感染及下肢深靜脈血栓形成等術(shù)后早期并發(fā)癥發(fā)生。兩組患者均獲隨訪,A組隨訪時(shí)間10.2~12.3年,平均10.8年;B組隨訪時(shí)間10.2~12.6年,平均11.3年。A、B組分別有3例和4例行假體翻修,假體存活率分別為93.6%和93.9%,比較差異均無統(tǒng)計(jì)學(xué)意義(χ~2=0.005,P=0.944)。兩組患者術(shù)后各時(shí)間點(diǎn)膝關(guān)節(jié)活動(dòng)度、KSS評分及WOMAC評分均較術(shù)前顯著改善(P0.05)。B組術(shù)后6周膝關(guān)節(jié)活動(dòng)度和KSS評分優(yōu)于A組(P0.05),術(shù)后1、3、10年兩組比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后6周及1、3年兩組WOMAC評分比較差異均無統(tǒng)計(jì)學(xué)意義(P0.05),但術(shù)后10年A組WOMAC評分優(yōu)于B組,差異有統(tǒng)計(jì)學(xué)意義(t=2.086,P=0.037)。術(shù)后10年A、B組KSS評分優(yōu)良率分別為87.2%和84.8%,比較差異無統(tǒng)計(jì)學(xué)意義(χ~2=0.018,P=0.893)。結(jié)論采用活動(dòng)平臺和固定平臺假體行TKA均能獲得優(yōu)良的中遠(yuǎn)期療效,采用固定平臺假體手術(shù)操作相對簡便,早期康復(fù)效果更佳;活動(dòng)平臺假體可提供更好的遠(yuǎn)期WOMAC評分滿意度,但要求更高的手術(shù)技巧和軟組織平衡技術(shù)。
[Abstract]:Objective to compare the 10-year efficacy of total knee arthroplasty (total knee arthroplasty,TKA) with active platform and fixed platform prosthesis in order to provide reference for clinical selection of TKA prosthesis. Methods Clinical data of 113 patients with knee osteoarthritis who met the selection criteria from January 2002 to December 2005 were retrospectively analyzed. Among them, 47 cases were treated with active platform prosthesis (group A) and 66 cases with fixed platform prosthesis (group B). Age, sex, body mass index (BMI), varus and flexion deformity of knee joint and preoperative knee motion, (KSS) score of the American Society of knee Association (AKS) were used in both groups. There were no significant differences between Ontario and Mc Master University osteoarthritis index scores (WOMAC) and other general data (P0.05). Results the time of operation in group A was (88.1 鹵6.5), (, 90.3 鹵7.2) min,. There was no significant difference between group A and group B (t = 1.666), (, P < 0.099). There was no incision infection and deep vein thrombosis in both groups. The mean follow-up time of group B was 10.2 ~ 12.6 years (mean 10.2 ~ 12.6 years), and the average of 11.3 years and 4 cases of prosthetic revision in group A were 93.6% and 93.9%, respectively. There was no significant difference between the two groups (蠂 2 0.005 P 0.944). KSS and WOMAC scores were significantly improved at each time point after operation in both groups (P0.05). Group B was superior to group A in knee motion and KSS score at 6 weeks after operation (P0.05), and there was no significant difference between the two groups in 10 years (P0.05). There was no significant difference in WOMAC score between the two groups at 6 weeks and 1 and 3 years after operation (P0.05), but the WOMAC score of group A was better than that of group B 10 years after operation (t0. 086%, P < 0. 037). The excellent and good rates of KSS score in group A were 87.2% and 84.8% respectively 10 years after operation, and there was no significant difference between them (蠂 2 / 0. 018 / P = 0. 893). Conclusion both active platform and fixed platform prosthesis can obtain good medium- and long-term curative effect, the operation of fixed platform prosthesis is relatively simple and the effect of early rehabilitation is better, the active platform prosthesis can provide better satisfaction with long-term WOMAC score. But higher surgical skills and soft tissue balance techniques are required.
【作者單位】： 青島大學(xué)附屬醫(yī)院關(guān)節(jié)外科;
【基金】：國家自然科學(xué)基金資助項(xiàng)目(81672197)~~
【分類號】：R687.4

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