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[摘要]目的探讨内轴型(MP)膝关节系统中胫骨平台后倾角(PSA)对全膝关节置换术(TKA)后关节功能的影响及其相关因素。方法随访40例老年女性单侧膝骨关节炎终末期行单侧TKA手术病人(术中均采用MicroPort公司MP膝關节2号Advance stature假体),随访时间至少4个月,记录病人术前和术后膝关节活动度(ROM)、膝关节手术评分表(KSS)评分、胫骨平台PSA等指标,分析不同胫骨平台PSA角度病人术后ROM的差异,以及BMI、术前ROM、术前KSS评分对术后功能恢复的影响。结果术前膝关节ROM、术后胫骨平台PSA、术前KSS评分与术后膝关节KSS评分呈正相关(r=0.389~0.825,P<0.05),BMI与术后膝关节KSS评分呈负相关(r=-0.623,P<0.05)。术后胫骨平台PSA为5°~7°病人术后功能恢复最优。结论病人BMI增高不利于TKA后功能恢复,较高的术前ROM和KSS评分有利于术后的功能恢复;术后胫骨平台PSA 5°~7°有可能是MP膝关节系统的最适宜PSA。
[关键词]关节成形术,置换,膝;MP膝关节系统;胫骨平台后倾角;关节动度测量法,关节
[ABSTRACT]ObjectiveTo investigate the effect of the posterior slope angle (PSA) of the tibial plateau in a medial`-pivot (MP) knee system on the knee joint function after total knee arthroplasty (TKA) and its related factors. MethodsA follow`-up lasting at least 4 months was conducted in 40 elderly female patients who had undergone a TKA (size 2 Advance Stature MP knee prosthesis from MicroPort was used) for end`-stage unilateral knee arthritis; the patients were evaluated for preoperative and postoperative knee range of motion (ROM), Knee Society Score (KSS), and PSA of the tibial plateau; analyses were conducted on the difference in the postoperative ROM in patients with different PSAs of the tibial plateaus and the effects of body mass index (BMI), preoperative ROM, and preoperative KSS on postoperative functional recovery. ResultsThe preoperative knee ROM, postoperative PSA of the tibial plateau, and preoperative KSS were positively correlated with the postoperative KSS (r=0.389-0.825,P<0.05); BMI was negatively correlated with the postoperative KSS (r=-0.623,P<0.05). Patients with a postoperative PSA of the tibial plateau of 5°-7° had optimal postoperative functional recovery. ConclusionIncreased BMI negatively contri`-butes to functional recovery after TKA, while higher preoperative ROM and KSS positively contribute to functional recovery. The best PSA for a MP knee system may be 5°-7°.
[KEY WORDS]arthroplasty, replacement, knee; posterior slope angle; medial pivot; arthrometry, articular
人工膝关节置换术的历史可以追溯至20世纪40年代,但全膝关节置换术(TKA)术后病人存在多种不适,主要是疼痛、关节异响、关节不稳[1`-2],TKA术后满意率并不高。在多种影响TKA术后病人满意率的因素中,假体设计与手术技术最为重要[3],其中膝关节置换术假体不符合自然膝关节的生理运动是TKA术后满意率相对较低的一个重要原因。内轴型(MP)膝关节系统由于避免了凸轮和立柱的撞击,从而延长了假体寿命[4]。另外,MP膝关节系统取消了股骨髁的凸轮,减少股骨髁间截骨,保留了更多的骨量,为可能存在的翻修留有余地。大量的膝关节翻修资料证实,胫骨假体的位置改变如松动移位等仍是导致膝关节假体翻修的主要原因。关于术中胫骨截骨的角度仍未达成共识,起初部分膝关节假体并未设计后倾角(PSA),但有学者认为自然膝关节均存在一定PSA[6],一旦水平截骨可导致术后胫骨平台载荷不均匀,因其前方皮质骨量丢失,应力集中于松质骨,后者承受应力的能力有限,可能会引起远期的胫骨假体下沉。多数临床医生后倾截骨时根据不同假体设计采用不同的PSA[8]。后稳定型假体PSA设计多为5°~7°。关于MP膝关节假体PSA尚无统一标准[9]。本研究对MP膝关节假体的相关手术因素及术后功能进行分析,以探讨MP膝关节系统中最适合的术后胫骨平台PSA,从而为指导临床医生手术及判断预后提供参考。
[关键词]关节成形术,置换,膝;MP膝关节系统;胫骨平台后倾角;关节动度测量法,关节
[ABSTRACT]ObjectiveTo investigate the effect of the posterior slope angle (PSA) of the tibial plateau in a medial`-pivot (MP) knee system on the knee joint function after total knee arthroplasty (TKA) and its related factors. MethodsA follow`-up lasting at least 4 months was conducted in 40 elderly female patients who had undergone a TKA (size 2 Advance Stature MP knee prosthesis from MicroPort was used) for end`-stage unilateral knee arthritis; the patients were evaluated for preoperative and postoperative knee range of motion (ROM), Knee Society Score (KSS), and PSA of the tibial plateau; analyses were conducted on the difference in the postoperative ROM in patients with different PSAs of the tibial plateaus and the effects of body mass index (BMI), preoperative ROM, and preoperative KSS on postoperative functional recovery. ResultsThe preoperative knee ROM, postoperative PSA of the tibial plateau, and preoperative KSS were positively correlated with the postoperative KSS (r=0.389-0.825,P<0.05); BMI was negatively correlated with the postoperative KSS (r=-0.623,P<0.05). Patients with a postoperative PSA of the tibial plateau of 5°-7° had optimal postoperative functional recovery. ConclusionIncreased BMI negatively contri`-butes to functional recovery after TKA, while higher preoperative ROM and KSS positively contribute to functional recovery. The best PSA for a MP knee system may be 5°-7°.
[KEY WORDS]arthroplasty, replacement, knee; posterior slope angle; medial pivot; arthrometry, articular
人工膝关节置换术的历史可以追溯至20世纪40年代,但全膝关节置换术(TKA)术后病人存在多种不适,主要是疼痛、关节异响、关节不稳[1`-2],TKA术后满意率并不高。在多种影响TKA术后病人满意率的因素中,假体设计与手术技术最为重要[3],其中膝关节置换术假体不符合自然膝关节的生理运动是TKA术后满意率相对较低的一个重要原因。内轴型(MP)膝关节系统由于避免了凸轮和立柱的撞击,从而延长了假体寿命[4]。另外,MP膝关节系统取消了股骨髁的凸轮,减少股骨髁间截骨,保留了更多的骨量,为可能存在的翻修留有余地。大量的膝关节翻修资料证实,胫骨假体的位置改变如松动移位等仍是导致膝关节假体翻修的主要原因。关于术中胫骨截骨的角度仍未达成共识,起初部分膝关节假体并未设计后倾角(PSA),但有学者认为自然膝关节均存在一定PSA[6],一旦水平截骨可导致术后胫骨平台载荷不均匀,因其前方皮质骨量丢失,应力集中于松质骨,后者承受应力的能力有限,可能会引起远期的胫骨假体下沉。多数临床医生后倾截骨时根据不同假体设计采用不同的PSA[8]。后稳定型假体PSA设计多为5°~7°。关于MP膝关节假体PSA尚无统一标准[9]。本研究对MP膝关节假体的相关手术因素及术后功能进行分析,以探讨MP膝关节系统中最适合的术后胫骨平台PSA,从而为指导临床医生手术及判断预后提供参考。