TKA胫骨平台冠状位倾斜度与临床结果

目的研究TKA患者膝关节胫骨平台冠状位倾斜度与临床结果之间的关系。方法回顾性分析我科自2004年1月至2005年2月期间TKA的骨关节炎病例261例。按术后胫骨平台假体内外翻情况分为3组：A组（外翻组）、B组（中立组）和C组（内翻组）。结果 A、B、C三组间在患者性别比例、年龄、体重指数、止血带时间、术后引流量、术后住院时间方面无显著差异。术前膝关节畸形情况各组间无显著差异。各组间术前ROM及HSS评分无显著差异。在术后2周时的膝关节活动度方面,A组与B、C两组间均存在显著差异（P〈0.01）,B组与C组间存在显著差异（P〈0.05）。术后2周时HSS评分,A组与B、C两组间均存在显著差异（P〈0.05）,但B组与C组间无显著差异。术后2年HSS评分A、B、C三组间无显著差异。A组中有1例、B组中有2例,C组中有2例伤口脂肪液化;B组中有3例、C组中有1例术后出现患肢小腿肌间静脉血栓。结论 TKA术后冠状位倾斜度与术前因素、手术因素及手术并发症之间无显著相关性。TKA术后力线对近期临床结果可能有显著影响。通过进一步康复锻炼可弥补力线对长期临床结果的影响。

Influence of coronal balance of tibila prosthesis on clinical results in total knee arthroplasty

Objective To analyze the relationship between coronal balance of tibial prosthesis and clinical results of total knee arthroplasty.Methods We retrospectively reviewed 261 cases underwent unilateral TKA for osteoarthritis.All the patients are divided to 3 groups according to the coronal balance of tibial plate,Group A（valgus group）,Group B （neutral group） and Group C（varus group）.Results There is no significant difference between gender ratio,age, BWI,tourniquet time,total drainage volume,post - operative hospitalization time and pre - operative deformity of the three groups.There is no significant difference between pre - operative ROM and pre - operative HSS scores.But the post - operative ROM of group A at the time of two weeks is significantly less than group B and C（P0.01）,and there is obvious difference between group B and C（P0.05）.There is significant difference between post - operative HSS score at the time of two weeks of group A and the other groups（P0.05）,but there is no difference between group B and C.There is no difference between post - operative HSS scores of the three groups at the time of two years.There are 1 case,2 cases and 2 cases of delayed union in group A,B and C respectively.There are 3 cases and 1 case of post - operative intramuscular venous thrombosis in group B and C respectively.Conclusion For total knee arthroplasty,the alignment of tibial prosthesis in coronal plane has no significant correlation with pre - operative circumstance,operative characteristics and complications.The difference between post - operative ROM and HSS scores at the time of 2 weeks may indicate influence of the post - operative tibial prosthesis alignment on the short term function.While patients could achieve good long term results through further rehabilitation.