|摘要||背景:虽然活动衬垫膝关节假体在体外的研究中显示具有更好的关节运动学表现、更低的磨损率,但是否具有更好的体内临床效果仍有争议.目的:对比观察活动衬垫型和固定衬垫型膝关节假体在置换后1年时膝关节活动度和临床效果.设计、时间及地点:回顾性病例对比分析.2003-11/2006-07首尔国立大学盆唐医院关节重建中心.对象:共纳入接受全膝关节置换488例患者669膝.244例患者341膝采用了固定衬垫型假体,244例患者328膝采用活动衬垫型假膝.方法:所有手术皆由一位固定医师(TK Kim)完成.采用髌旁内侧入路,术中不翻转髌骨,而将髌骨向外侧脱位进行显露.以间隙测量器作为间隙撑开工具并进行间隙的准确测量,根据测量结果进行软组织松解平衡,直到达到下述标准:屈曲间隙大于伸直间隙不超过3.0～4.0 mm或伸直间隙大于屈曲间隙不超过1.0～2.0mm,对于内翻畸形膝关节,外侧间隙大于内侧间隙2.0～3.0mm是可以接受的.常规行髌骨置换,所有假体都采用骨水泥固定.主要观察指标:以角尺测量患者置换前后膝关节屈曲挛缩程度和最大屈曲度.置换前后膝关节的疼痛和功能状态采用AKS评分、髌股关节评分、WOMAC评分和SF-36系统评分进行评价.结果:两组患者在性别、年龄、身高、体质量和体质量指数方面差异没有显著性.置换后两组在PF膝前痛评分、WOMAC疼痛评分和SF-36躯体疼痛评分方面两组差异无显著性(P>0.05):固定衬垫组平均AKS疼痛评分略高于活动衬垫组(48.5±3.2,47.5±4.8,P=0.010).置换后两组患者的屈曲畸形得到了很好的矫正(P=0.341),两组的膝关节活动度差异没有显著性(P=0.412).置换后所有反映膝关节功能的评价指标两组问差异均无显著性(P>0.05).结论:活动衬垫型膝关节假体置换后在膝关节活动度、疼痛缓解以及膝关节功能方面与固定衬垫型膝关节假体相比并没有显著性优势.手术技术是获得置换后良好临床效果的关键.
BACKGROUND: Although mobile bearing knee prosthesis exhibits good movement and low wear rate in vitro studies,its clinical effect in vivo is still contraversial. OBJECTIVE: To compare and observe the range of motion and clinical outcomes of mobile bearing knee prosthesis and fixed bearing knee prothesis at least 1 year after operation. DESIGN,TIME AND SETTING: A randomized controlled observation. The experiment was performed at the Joint Reconstruction Center,Seoul National University Bundang Hospital,Seoul,Korea between November 2003 and July 2006. PARTICIPANTS: Four hundrend and eighty-eight patients (669 knees) with knee osteoarthritis undergoing total knee arthroplasty (TKA) were selected,of them 244 (341 knees) were treated with fixed bearing knee prothesis and 244 (328knees) with mobile bearing knee prosthesis.METHODS: The surgery was performed by the same physician (TK Kim). With patellar medial approach,the patella was not turned over,but dislocated laterally to expose the bone. Space measurer was used to expand and measure the Space. According to the measurements,soft tissues were released and balanced until the flexion gap was within 3-4 mm more than extension gap or 1-2 mm extension gap more than flexion gap. For varus knees,2-3 mm larger lateral gap was accepted. In all cases,the patella was resuffaced,and implant fixation was carried out with cement.MAIN OUTCOME MEASURES: Degrees of flexion contracture and maximum flexion angle were measured with a goniometer. The knee pain and functional status were evaluated by American Knee Society (AKS) scores,Patellofemoral scores,Western Ontario McMaster Universities Osteoarthritis Index scales (WOMAC) and SF-36 systems.RESULTS: There was no significant difference between two groups in terms of sex,age,body height,body mass and body mass index. No differences wre found in postoperative socres of Patellofemoral scores,WOMAC and SF-36systems (P>0.05). The mean AKS scores of fixed bearing knee prothesis group were higher than mobile group (48.5±3.2,47.5±4.8,P=0.010). The flexion defomity of two groups was significantly corrected following surgery (P=0.341). No differences were found in terms of range of motion (P=0.412) and knee function (P>0.05).CONCLUSION: The mobile bearing design has no advantages in postoperative range of motion,pain relief and knee function relative to fixed bearing design. Surgical technique is critical to achieve good clinical outcomes.|
李子剑,张克,Kim, Tae Kyun. 活动衬垫和固定衬垫全膝关节置换治疗膝骨性关节炎的早期临床结果比较[J]. 中国组织工程研究与临床康复,2008,12(48):9589-9593.