【摘要】：目的:探討高屈曲型和標準型兩種膝關(guān)節(jié)假體術(shù)后臨床療效以及患者滿意度。方法:本文采用回顧性研究,對山西醫(yī)科大學(xué)第二醫(yī)院骨關(guān)節(jié)科2012年3月-2014年7月行初次單側(cè)或非同期雙側(cè)TKA的病人進行隨訪,共計91例患者(103膝);按植入假體類型(均為美國SmithNephew公司)分為高屈曲組(50膝)與標準組(53膝)兩組,根據(jù)術(shù)前及末次隨訪進行系統(tǒng)的科學(xué)的評定指標包括:KSS評分、關(guān)節(jié)活動度及活動度增加量、術(shù)后膝關(guān)節(jié)影像學(xué)資料進行分析比較研究臨床療效;比較兩組KSS評分、關(guān)節(jié)活動度和屈曲度、WOMAC評分(疼痛)、SF-36量表滿意度調(diào)查,同時對兩組術(shù)后并發(fā)癥進行總結(jié)和研究。收集資料通過SPASS13.0統(tǒng)計軟件進行數(shù)據(jù)處理得出統(tǒng)計學(xué)依據(jù)。結(jié)果:91例患者平均隨訪時間為15月(13月~28月),兩組術(shù)后KSS評分、ROM、WOMAC評分及自我滿意度均明顯高于術(shù)前,術(shù)后疼痛均明顯緩解。高屈曲組和標準組之間的研究中:(1)兩組間末次隨訪KSS評分,P0.05,差異無統(tǒng)計學(xué)意義;末次關(guān)節(jié)活動度和最大屈曲度兩組間比較,P0.05(差異無統(tǒng)計學(xué)意義);但是比較了術(shù)前膝關(guān)節(jié)活動度能達到110°的38膝末次隨訪結(jié)果,高屈曲組KSS評分高于標準組;高屈曲組18膝關(guān)節(jié)平均活動度為123.39°(0~128°)、最大屈曲度為124.66°(120~128°),標準組20膝關(guān)節(jié)活動度是115.02°(0~120°)、最大屈曲度116.12°(100~120°),這38膝中高屈曲組術(shù)后膝關(guān)節(jié)活動度、最大屈曲度和KSS評分均優(yōu)于標準組;(2)兩組末次隨訪(1年)WOMAC疼痛評分高屈曲組為1.01±1.29分,標準組為3.93±1.79分,兩者比較P0.05;VAS疼痛評分中高屈曲組為2.02±1.24分,標準組為3.11±1.42分,兩者比較P0.05,差異有統(tǒng)計學(xué)意義,即緩解疼痛方面高屈曲組優(yōu)于標準組。在患者滿意度方面的研究結(jié)果中,總的SF-36量表兩組間比較,P0.05(差異有統(tǒng)計學(xué)意義),即術(shù)后高屈曲組患者自我滿意度高于標準組,尤其在軀體健康部分滿意度更高。(3)術(shù)后并發(fā)癥標準組和高屈曲組間沒有明顯差異,嚴格控制易感因素本研究中無一感染病例,DVT的發(fā)生在高屈曲組中發(fā)生1例,標準組為2例;術(shù)后隨訪發(fā)現(xiàn)標準組有1例出現(xiàn)無癥狀性假體周圍透亮X線,經(jīng)后期隨訪并未發(fā)現(xiàn)給例患者出現(xiàn)假體松動跡象;兩組間術(shù)后隨訪均無關(guān)節(jié)僵硬發(fā)生。結(jié)論:高屈曲型假體作為一種通過穩(wěn)定假體設(shè)計來獲得較大活動度以便滿足不同患者的需求,在臨床應(yīng)用中日趨廣泛。本研究中發(fā)現(xiàn)使用高屈曲型假體相對傳統(tǒng)標準假體術(shù)后臨床總體療效提升,尤其是具有術(shù)前良好屈膝的關(guān)節(jié),在術(shù)后使用高屈曲型假體可以恢復(fù)更好的屈膝功能獲得更大的膝關(guān)節(jié)活動度,而且術(shù)后膝前痛發(fā)生率方面低于傳統(tǒng)假體,高屈曲型假體術(shù)后患者滿意度更高;術(shù)后并發(fā)癥方面兩組沒有明顯差異。因此,充分了解并掌握術(shù)前屈膝范圍,綜合評估關(guān)節(jié)功能,選擇與良好屈膝相匹配的假體和術(shù)中精準的軟組織平衡是手術(shù)成功的重要因素�？傊畬τ谔厥庑枨蠡蛘吒咝g(shù)后要求的患者來說高屈曲型假體也是一個不錯的選擇,當然高屈曲假體遠期臨床療效還需長期隨訪進一步研究。
[Abstract]:Objective: To investigate the clinical efficacy and patient satisfaction of high flexion and standard knee prosthesis. Methods: A retrospective study was conducted in 91 patients (103 knees) who underwent primary unilateral or asynchronous bilateral TKA from March 2012 to July 2014 in the Department of Orthopaedics and Arthroplasty, Second Hospital of Shanxi Medical University. Body types (Smith Nephew, USA) were divided into two groups: high flexion group (50 knees) and standard group (53 knees). According to the preoperative and final follow-up, systematic and scientific evaluation indicators included: KSS score, joint mobility and activity increase, postoperative knee imaging data were analyzed and compared to study the clinical efficacy of the two groups. Joint mobility and flexion, WOMAC score (pain), SF-36 scale satisfaction survey, and two groups of postoperative complications were summarized and studied. Data collected by SPASS 13.0 statistical software for data processing obtained statistical basis. Results: The average follow-up time of 91 patients was 15 months (13-28 months), two groups of postoperative KSS score, ROM, WOMAC evaluation. There was no significant difference between the high flexion group and the standard group: (1) KSS score of the last follow-up between the two groups, P 0.05, there was no significant difference; there was no significant difference between the last joint mobility and maximum flexion between the two groups, P 0.05 (no significant difference); but there was no significant difference between the pre-operative knee joint viability; The final follow-up results of 38 knees with 110 degrees of motion showed that the KSS score of the high flexion group was higher than that of the standard group; the average range of motion of the 18 knees in the high flexion group was 123.39 degrees (0-128 degrees), the maximum flexion was 124.66 degrees (120-128 degrees), the 20 knees in the standard group were 115.02 degrees (0-120 degrees), and the maximum flexion was 116.12 degrees (100-120 degrees). Joint mobility, maximum flexion and KSS scores were superior to the standard group; (2) WOMAC pain score was 1.01 (+ 1.29) in the high flexion group and 3.93 (+ 1.79) in the standard group at the last follow-up (1 year), compared with P 0.05; VAS pain score was 2.02 (+ 1.24) in the high flexion group and 3.11 (+ 1.42) in the standard group, the difference was statistically significant (P 0.05). In the study of patient satisfaction, the total SF-36 scale was compared between the two groups, P 0.05 (statistically significant), that is, the self-satisfaction of the high flexion group was higher than that of the standard group, especially in the physical health part. (3) Postoperative complications standard group and high flexion group were higher than that of the standard group. (3) Postoperative complications standard group and high flexion group. There was no significant difference between the two groups. No infection was found in this study. DVT occurred in 1 case in the high flexion group and 2 in the standard group. Conclusion: High flexion prosthesis, as a kind of stable prosthesis design to obtain greater mobility to meet the needs of different patients, has been widely used in clinical application. Knee joint, the use of high-flexion prosthesis can restore better flexion function after surgery to obtain greater knee mobility, and postoperative pain rate is lower than the traditional prosthesis, high-flexion prosthesis postoperative patients satisfaction is higher; postoperative complications of the two groups are not significantly different. Therefore, fully understand and master the preoperative flexion. Knee range, comprehensive assessment of joint function, selection of prostheses matching good knee flexion, and accurate intraoperative soft tissue balance are important factors for successful surgery. Follow up study.
【學(xué)位授予單位】：山西醫(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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本文編號：2251210