全膝关节置换的后稳定型假体和保留后交叉韧带疗效比较

目的比较后交叉韧带保留型假体和后稳定型假体在人工全膝关节置换术后早期的临床疗效。 方法选择自2017年1月至2017年6月在上海长海医院接受人工全膝关节置换术的患者,排除患肢有外伤史和手术史的患者,最终纳入74位患者,其中后交叉韧带保留(CR)组35例,后稳定型假体(PS)组39例。分别记录CR组和PS组患者的手术时间、术后引流量、术后3 d血红蛋白浓度,以及术后2周、1年、3年的膝关节活动度(ROM)、最大屈曲角度、西安大略和麦克马斯特大学(WOMAC)评分和美国特种外科医院(HSS)评分。ROM、最大屈曲、HSS、WOMAC在各时间点的比较采用重复测量的方差分析,两组间比较采用独立样本t检验,计数资料组间比较采用卡方检验。 结果CR组的术后引流量明显小于PS组(t＝-16.68,P<0.001),且术后3 d血红蛋白浓度也明显高于PS组(t＝6.95,P<0.001)。术后2周、1年和3年的随访数据中,CR组的膝关节ROM和最大屈曲度均显著大于PS组,其中术后3年ROM(F＝10.358, P<0.001),最大屈曲度(F＝10.358, P<0.001)。 结论CR假体和PS假体都可以显著改善患者的膝关节功能,均可作为初次膝关节置换的假体选择。但是在术后早期,CR假体失血量更少,更利于患者术后早期康复。同时与PS假体相比,CR假体在术后早期可能会拥有更好的膝关节活动度和屈曲度。

Comparison of early clinical outcome between posterior cruciate-retaining and posterior stabilizing prosthesis of total knee arthoplasty

ObjectiveTo compare the early clinical outcome between posterior cruciate-retaining (CR) and posterior stabilizing (PS) prosthesis of total knee arthroplasty (TKA). MethodsFrom January to June of 2017, 74 patients underwent TKA in Shanghai Changhai Hospital were enrolled in this study, including 35 patients in CR group and 39 patients in PS group. The patients with injury or surgical history of the involved limb were excluded. The operation time, postoperative drainage volume, hemoglobin concentration at three days after surgery were recorded, and the knee range of motion (ROM), maximum flexion angle, the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index and Hospital for Special Surgery (HSS) score at two weeks, one year and three years after surgery were recorded respectively. Independent sample t test was used for comparison between the two groups, and repeated measurement ANOVA was used for comparison at each time point. ResultsThe postoperative drainage volume of CR group was significantly lower than that of PS group (t=-16.68, P<0.001), and the hemoglobin concentration of CR group was significantly higher than that of PS group (t=6.95, P<0.001). In the follow-up of two weeks, one and three years after operation, ROM and maximum flexion of the knee in CR group were significantly higher than those in PS group. The knee ROM (F=10.358, P<0.001) and maximum flexion (F=10.358, P<0.001) in CR group were significantly higher than those in PS group at three years after operation. ConclusionsBoth CR and PS prostheses can significantly improve the knee function of advanced osteoarthritis patients, so both of them are alternative prostheses for primary TKA. However, in the early period after surgery, CR prosthesis has less postoperative blood loss, which is more conducive to early postoperative rehabilitation. In addition, compared with PS prosthesis, CR prosthesis has better knee ROM and flexion range in the early postoperative period.