同期雙側(cè)全膝關(guān)節(jié)置換中髕骨置換與不置換的自身對(duì)照研究
發(fā)布時(shí)間：2018-11-22 18:06
【摘要】：目的比較同期行雙側(cè)全膝關(guān)節(jié)表面置換(total knee arthroplasty,TKA)治療膝關(guān)節(jié)骨性關(guān)節(jié)炎(osteoarthritis,OA)時(shí),髕骨置換與不置換的早期臨床療效。方法隨機(jī)選擇2015年2月至2015年12月青島大學(xué)附屬醫(yī)院關(guān)節(jié)外科收治的,因膝OA入院擬行同期雙側(cè)全膝關(guān)節(jié)表面置換的患者40例(80膝)。將80膝按照隨機(jī)數(shù)字表法隨機(jī)分為兩組,置換組40膝(左側(cè)21膝,右側(cè)19膝),術(shù)中行髕骨置換,對(duì)照組40膝(左側(cè)19膝,右側(cè)21膝),術(shù)中不置換髕骨。所有患者均使用Micro Port公司Advance內(nèi)軸型全膝關(guān)節(jié)表面置換系統(tǒng),手術(shù)均由同一高年資醫(yī)師主刀完成。觀察并記錄兩組手術(shù)時(shí)間、失血量、術(shù)前及術(shù)后3個(gè)月、6個(gè)月、9個(gè)月及12個(gè)月時(shí)美國(guó)膝關(guān)節(jié)協(xié)會(huì)評(píng)分(American Knee Society Score,KSS-clinical score;KSS-function score)、髕骨Feller評(píng)分、膝關(guān)節(jié)活動(dòng)度、膝前痛發(fā)生率、患者滿意度等指標(biāo),通過(guò)術(shù)前及術(shù)后X線片測(cè)量髕骨傾斜角、髕骨適合角、髕韌帶比值等進(jìn)行影像學(xué)評(píng)價(jià)。均采用雙盲的方式進(jìn)行數(shù)據(jù)收集和分析。結(jié)果髕骨置換組和非置換組術(shù)后的KSS臨床評(píng)分和功能評(píng)分、髕骨Feller評(píng)分均較術(shù)前明顯提高,兩組患者術(shù)后均獲得了良好的活動(dòng)能力和膝關(guān)節(jié)功能。兩組患者術(shù)后3個(gè)月、6個(gè)月、9個(gè)月、12個(gè)月的KSS膝關(guān)節(jié)臨床評(píng)分均無(wú)統(tǒng)計(jì)學(xué)差異(P0.05),但術(shù)后9個(gè)月、12個(gè)月的KSS功能評(píng)分差異有統(tǒng)計(jì)學(xué)意義,置換組評(píng)分高于對(duì)照組(P0.05)。兩組患者術(shù)后6個(gè)月、9個(gè)月、12個(gè)月的髕骨Feller評(píng)分差異有統(tǒng)計(jì)學(xué)意義,置換組優(yōu)于對(duì)照組(P0.05)。兩組患者術(shù)后6個(gè)月、9個(gè)月、12個(gè)月的膝前痛發(fā)生率差異有統(tǒng)計(jì)學(xué)意義,非置換組膝前痛發(fā)生率高于置換組(P0.05)。兩組患者術(shù)后影像學(xué)相關(guān)指標(biāo)比較無(wú)統(tǒng)計(jì)學(xué)差異(P0.05),髕骨傾斜角及髕骨適合角等均較術(shù)前改善,兩組均無(wú)獲得性低位髕骨。兩組患者術(shù)后12個(gè)月的滿意度差異有統(tǒng)計(jì)學(xué)意義,置換組高于對(duì)照組(P0.05)。兩組患者術(shù)中失血量無(wú)統(tǒng)計(jì)學(xué)差異,但置換組的手術(shù)時(shí)間高于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。兩組患者均無(wú)髕骨骨折、壞死,假體松動(dòng)等并發(fā)癥發(fā)生。結(jié)論應(yīng)用全膝關(guān)節(jié)表面置換術(shù)治療膝關(guān)節(jié)骨性關(guān)節(jié)炎,可以顯著改善患者的膝關(guān)節(jié)功能。置換髕骨可以提高患者術(shù)后滿意度和膝關(guān)節(jié)功能評(píng)分,降低術(shù)后膝前痛發(fā)生率,髕骨置換與不置換的術(shù)中失血量及影像學(xué)評(píng)價(jià)無(wú)統(tǒng)計(jì)學(xué)差異,但置換組的手術(shù)時(shí)間高于非置換組。
[Abstract]:Objective to compare the early clinical effects of bilateral total knee surface replacement (total knee arthroplasty,TKA) in the treatment of knee osteoarthritis (osteoarthritis,OA). Methods from February 2015 to December 2015, 40 patients (80 knees) with bilateral total knee arthroplasty due to knee OA were randomly selected. 80 knees were randomly divided into two groups: 40 knees (left 21 knees, right 19 knees) in the replacement group, 40 knees in the control group (19 knees on the left and 21 knees in the right). All patients were treated with Micro Port Advance internal axial total knee arthroplasty system. The operation was performed by the same senior surgeon. To observe and record the time of operation, blood loss, preoperative and postoperative 3 months, 6 months, 9 months and 12 months after the American knee Association score (American Knee Society Score,KSS-clinical score; KSS-function score), patellar Feller score, knee motion, incidence of anterior knee pain, and patient satisfaction were evaluated by radiographs before and after radiography. Patellar angle, patellar suitable angle and patellar ligament ratio were measured before and after operation. The data were collected and analyzed in a double blind way. Results the KSS clinical score and functional score and patellar Feller score were significantly improved in the patellar replacement group and the non-replacement group. The patients in both groups obtained good motor ability and knee joint function after operation. There was no significant difference in the clinical score of KSS knee joint between the two groups at 3 months, 6 months, 9 months and 12 months after operation (P0.05), but there was a significant difference in KSS functional score between the two groups at 9 months and 12 months after operation. The score of replacement group was higher than that of control group (P0.05). The patella Feller scores of the two groups were significantly different 6 months, 9 months and 12 months after operation, and the replacement group was better than the control group (P0.05). The incidence of anterior knee pain in the non-replacement group was higher than that in the replacement group (P0.05). There was no significant difference between the two groups in imaging parameters (P0.05). Patellar angle and patellar angle were improved compared with those before operation. There was no acquired low patella in both groups. Two groups of patients 12 months after the satisfaction of the difference was statistically significant, the replacement group was higher than the control group (P0.05). There was no significant difference in intraoperative blood loss between the two groups, but the operative time in the replacement group was higher than that in the control group (P0.05). There were no complications such as patellar fracture, necrosis and loosening of prosthesis in both groups. Conclusion Total knee joint surface replacement can significantly improve knee joint function in patients with knee osteoarthritis. Patellar replacement can improve the postoperative satisfaction and knee function score, and reduce the incidence of anterior knee pain. There is no significant difference in blood loss and imaging evaluation between patellar replacement and non-replacement. But the operative time in the replacement group was higher than that in the non-replacement group.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R687.4
本文編號(hào)：2350155
[Abstract]:Objective to compare the early clinical effects of bilateral total knee surface replacement (total knee arthroplasty,TKA) in the treatment of knee osteoarthritis (osteoarthritis,OA). Methods from February 2015 to December 2015, 40 patients (80 knees) with bilateral total knee arthroplasty due to knee OA were randomly selected. 80 knees were randomly divided into two groups: 40 knees (left 21 knees, right 19 knees) in the replacement group, 40 knees in the control group (19 knees on the left and 21 knees in the right). All patients were treated with Micro Port Advance internal axial total knee arthroplasty system. The operation was performed by the same senior surgeon. To observe and record the time of operation, blood loss, preoperative and postoperative 3 months, 6 months, 9 months and 12 months after the American knee Association score (American Knee Society Score,KSS-clinical score; KSS-function score), patellar Feller score, knee motion, incidence of anterior knee pain, and patient satisfaction were evaluated by radiographs before and after radiography. Patellar angle, patellar suitable angle and patellar ligament ratio were measured before and after operation. The data were collected and analyzed in a double blind way. Results the KSS clinical score and functional score and patellar Feller score were significantly improved in the patellar replacement group and the non-replacement group. The patients in both groups obtained good motor ability and knee joint function after operation. There was no significant difference in the clinical score of KSS knee joint between the two groups at 3 months, 6 months, 9 months and 12 months after operation (P0.05), but there was a significant difference in KSS functional score between the two groups at 9 months and 12 months after operation. The score of replacement group was higher than that of control group (P0.05). The patella Feller scores of the two groups were significantly different 6 months, 9 months and 12 months after operation, and the replacement group was better than the control group (P0.05). The incidence of anterior knee pain in the non-replacement group was higher than that in the replacement group (P0.05). There was no significant difference between the two groups in imaging parameters (P0.05). Patellar angle and patellar angle were improved compared with those before operation. There was no acquired low patella in both groups. Two groups of patients 12 months after the satisfaction of the difference was statistically significant, the replacement group was higher than the control group (P0.05). There was no significant difference in intraoperative blood loss between the two groups, but the operative time in the replacement group was higher than that in the control group (P0.05). There were no complications such as patellar fracture, necrosis and loosening of prosthesis in both groups. Conclusion Total knee joint surface replacement can significantly improve knee joint function in patients with knee osteoarthritis. Patellar replacement can improve the postoperative satisfaction and knee function score, and reduce the incidence of anterior knee pain. There is no significant difference in blood loss and imaging evaluation between patellar replacement and non-replacement. But the operative time in the replacement group was higher than that in the non-replacement group.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R687.4
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相關(guān)期刊論文 前2條
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2 黃志峰;翁習(xí)生;邱貴興;金今;林進(jìn);楊新宇;;髕骨置換與否對(duì)全膝關(guān)節(jié)置換效果的影響[J];實(shí)用骨科雜志;2007年08期
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