固定平台与旋转平台全膝关节置换术的疗效对比

[目的]评价膝关节置换固定平台假体(fixed bearing,FB)和旋转平台假体(rotating platforms,RP)的疗效。[方法]64例患者随机接受FB或RP假体的全膝关节置换手术。临床和放射学随访至少2年。HSS评分评定膝关节功能及I-S指数进行髌骨评分;SF-12评分表评估生理及心理状况。术后3、6个月,1、2年复查X线片及上述各项评估。[结果]FB组患者与RP组患者各个随访时间点HSS评分比较,差异均无统计学意义(P>0.05)。两组患者末次随访时年龄、性别、体重指数(BMI)、疼痛评价、膝关节屈曲活动度、HSS总分、I-S指数及SF-12生理、心理状况比较,均无显著性意义(P>0.05)。对术前I-S指数和术后出现局部膝前痛(HSS疼痛评分<15)的比较,发现高位髌骨患者中术后膝前痛的发生率较低位及正常髌骨患者的发生率均升高。[结论]RP假体至少在安全性和有效性上等同于FB假体。使用两种假体均能获得满意的手术效果。     

固定平台与旋转平台假体全膝关节置换术后早期疗效的回顾性观察

目的回顾性观察PFC固定平台假体和RP旋转平台假体2种人工膝关节置换系统治疗成人膝关节骨性关节炎术后早期疗效。方法 54例(58膝)膝关节骨性关节炎行全膝关节置换术(TKA),其中固定平台组28例(30膝);旋转平台组26例(28膝)。结果所有患者均获3~54个月随访,术后切口愈合良好,均能直立行走。末次随访时固定平台组、旋转平台组膝关节评分(HSS)与膝关节活动度(ROM)分别为(87.20±8.12)、(86.34±6.39)分和(106.73±6.24)°、(107.12±4.58)°,与术前比较差异有统计学意义(P<0.05),但组间比较差异无统计学意义(P>0.05)。结论 PFC与RP假体系统全膝关节置换术是治疗成人晚期膝关节骨性关节炎的有效方法,早期假体生存率较满意,术后两者对膝关节功能改善差异无统计学意义。长期的假体生存率需要进一步研究观察。     

膝关节置换旋转平台与固定平台假体的比较

目前的膝关节假体主要分为两类:旋转平台假体(rotating platforms,RP)和固定平台假体(fixed bearing,FB),每种又可分为后十字韧带保留型(posterior cruciate retaining,PCR)、后十字韧带牺牲型(posterior cruciate sacrificing,PCS)和后十字韧带替代型即后稳定型(posterior stabilizing,PS).     

固定平台与旋转平台假体全膝关节置换术的早期疗效比较

目的 评价固定平台和旋转平台假体在人工全膝关节表面置换术中应用及早期临床疗效.方法 2005年1月至2009年1月,38 例49膝行初次人工全膝关节置换术（total knee arthroplasty,TKA）,男13 例19膝,女25 例30膝;年龄42～78 岁,平均年龄（62.47±9.64） 岁;骨关节炎24 例28膝,类风湿性关节炎11 例18膝,创伤性关节炎3 例3膝;膝内翻畸形29膝,外翻畸形12膝;所有患者均采用膝前正中切口内侧髌旁入路,均未进行髌骨置换,其中采用固定平台假体置换26膝,采用旋转平台假体置换23膝.结果 除1 例骨关节炎患者失访,其余37 例48膝均获得随访,随访时间为36～72个月,平均为47.73个月.所有病例术后无伤口感染、下肢深静脉血栓形成、假体松动、假体周围骨折和腓总神经损伤等并发症.除1 例旋转平台假体在术后1年出现假体脱位,其余均获得满意效果.两组术后HSS评分、膝关节活动度的比较差异均无统计学意义（t=0.619,P＞0.05和t=1.044,P＞0.05）.结论 固定平台假体和旋转平台假体TKA术后的早期临床疗效相近,长期疗效有待进一步观察.     

全膝关节置换术股骨假体旋转力线研究进展

股骨假体旋转力线是影响全膝关节置换术预后的极其重要环节.以哪条轴线作为术中参照轴才能够最大程度地保证股骨假体旋转轴线对位准确,目前仍存有争议.该文就全膝关节置换术中各种股骨假体旋转定位参照轴的可靠性等作一综述.     

人工全膝关节置换术中股骨假体旋转的研究进展

目的综述人工全膝关节置换术(total knee arthroplasty,TKA)中股骨假体旋转评估研究进展,以减少假体旋转不良导致的术后并发症。方法查阅近年TKA术中股骨假体旋转定位参考轴线的基础及临床研究相关文献,并进行综合分析。结果股骨假体旋转不良可造成屈曲间隙不平衡和髌骨轨迹不良,术前应采用不同方法确定股骨假体旋转力线,并通过影像学技术及计算机导航技术进行手术前后评估,保证股骨假体的旋转位置良好,使术后膝关节功能获得最大程度的恢复。结论近年发展了多种手术技巧和新技术以确定股骨假体旋转力线,临床应用并获得较好效果。     

人工膝关节假体设计对全膝关节置换术后髌股关节功能的影响(中)

经典膝关节运动学认为，膝关节并不按固定轴线屈曲。在膝关节由伸直到屈曲的过程中，其屈曲轴线不断由股骨髁的前上方向股骨髁的后下方移动，即膝关节的瞬时旋转中心呈反写的“J”形（Jcurved instant center of rotation）。经典的反“J”形瞬时旋转中心理论町以圆满地解释为获得足够的活动度膝关节骨性结构必须满足的两个条件之一，即随着膝关节不断屈曲股骨后髁的曲率半径必须不断减小，以避免股骨后方与胫骨上端发生撞击。另一条件是膝关节屈曲过程中胫股关节的接触点必须不断后移，即经典膝关节运动学中认为的“后滚”。与此同时，“J”形瞬时旋转中心现象的存在，充分体现了生物界解剖与功能相适应的基本法则。随着膝关节逐渐屈曲，躯体中心远离膝关节，重力的力臂延长，对伸膝装置提出了更高的要求。“J”形瞬时旋转中心理论认为，膝关节屈曲过程中膝关节屈曲轴线不断由前上方向后下方移动。     

全膝关节置换术股骨及胫骨假体旋转定位研究进展

全膝关节置换术中股骨假体与胫骨假体的旋转力线至关重要,旋转力线不良影响手术效果.该文就股骨假体旋转定位参照轴中股骨上髁轴、股骨后髁线、股骨髁间前后轴、屈曲间隙平衡技术,以及胫骨假体旋转定位参照轴等研究进展作一综述.     

全膝关节置换术中胫骨假体旋转对线技术的研究进展

目的对国内外有关全膝关节置换术中胫骨假体旋转定位方法的研究及应用进行综述。方法广泛查阅近年来关于全膝关节置换术中胫骨假体旋转定位方法的文献,并进行总结与分析。结果传统的解剖标志线受到多种因素的影响缺乏准确性,因此不存在统一的线性定位。结论胫骨结节内侧缘至中内1/3线被认为是最理想的胫骨假体旋转定位区间,线性的定位应根据患者膝关节内外翻畸形的程度而定。     

比较固定平台和高屈曲旋转平台假体人工膝关节置换术治疗膝骨性关节炎的效果

目的比较固定平台和高屈曲旋转平台假体人工膝关节置换术治疗膝骨性关节炎(OA)的效果。方法回顾性分析2016-10—2018-10间在新乡市第二人民医院接受人工膝关节置换术治疗的176例膝OA患者的资料。按不同假体分为2组,各88例。固定组采用固定平台假体,旋转组采用高屈曲旋转平台假体。比较2组术前,术后6个月、12个月膝关节功能(HSS)评分、膝关节活动度(ROM)、并发症发生率。结果 2组并发症发生率差异无统计学意义(P0.05)。术后12个月旋转组HSS评分、ROM均高于固定组,差异有统计学意义(P0.05)。结论采用高屈曲旋转平台假体实施人工膝关节置换术治疗膝OA,中期效果显著,有利于患者膝关节功能及活动度提升,且不增加并发症风险。     

旋转平台与固定平台假体全膝人工关节置换术的早期疗效比较

目的比较全膝人工关节置换术应用强生旋转平台与固定平台两种假体术后早期临床疗效。 方法回顾性收集2017年1月至2018年01月济宁医学院附属医院收治的79例86侧膝关节骨性关节炎患者进行回顾性研究,其中43例46膝应用强生旋转平台,其中男性18例（18膝,39.13%）,女性25例（28膝,60.87%）;左侧25膝（54.35%）,右膝21膝（45.65%）,年龄为55~77岁,平均（68±8）岁。36例（40膝）应用强生固定平台,其中男性16例（17膝,42.50%）,女性20例（23膝,57.50%）;左侧22膝（55.00%）,右膝18膝（45.00%）。年龄为54~80岁,平均（67±8）岁。所有患者均由同一位医师行固定平台假体或旋转平台假体初次TKA术。分别于手术前后评估膝关节HSS评分、膝关节活动度。 结果固定平台组或旋转平台组患者的术前活动度与末次随访活动度相比,差异均具有统计学意义（t=26.801,t=21.470,P<0.05）;固定平台组或旋转平台组患者的术前HSS评分与末次随访HSS评分相比,差异均具有统计学意义（t=35.180,t=35.053,P<0.05）。固定平台组与旋转平台组患者比较,术前及末次随访活动度差异均无统计学意义（均P>0.05）,固定平台组与旋转平台组患者比较,术前及末次随访HSS评分差异均无统计学意义（均P>0.05）。 结论旋转平台假体与固定平台假体TKA术后早期临床总体疗效相似。两种假体均能明显改善膝关节活动度及膝关节功能。无论使用哪种假体,短期随访时间内都不会影响到效果。     

Early catastrophic failure of rotating hinge total knee prosthesis

The mechanical failure of a prosthesis component is usually observed as a late complication of total knee arthroplasty (TKA). In knees with severe ligament instability and bone deficiency, either a true hinge prosthesis or a rotating hinge implant is commonly used. Failure of the polyethylene bearing bush in a hinge-type prosthesis is a complication that has not been reported to date. We report the cases of 2 rotating hinge TKA prostheses that dislocated as a result of mechanical failure of the prosthetic component within 5 months of initial implantation. Clinicians should be aware of this potential complication when selecting rotating hinge prostheses for certain patients.     

旋转平台与固定平台全膝关节置换术的对比研究及髌骨置换与否对疗效的影响

目的评估旋转平台和固定平台假体全膝关节置换(TKA)两型假体间的疗效有无差异及髌骨置换与否对疗效的影响。方法选取同一医师施行的78侧初次TKA进行回顾。术前诊断包括骨关节炎、类风湿性关节炎等。施行固定平台TKA手术的患者共30侧,14侧置换髌骨;施行旋转平台TKA手术的共48侧,36侧置换髌骨。术前和术后随访行膝HSS评分、测量关节伸直角度和屈曲角度,以比较两型假体TKA疗效;比较髌骨置换组与未置换组TKA疗效;在髌骨置换组与未置换组中,分别比较固定平台TKA和旋转平台TKA的疗效。结果成功随访76侧,平均25.2个月。旋转平台组术后HSS评分、伸直角度与固定平台组间的差异无统计学意义,前者术后的屈曲角度(112.0±11.5)°优于固定平台组间的差异有统计学意义(t=3.270,P0.01)。髌骨未置换组术后HSS评分、伸直角度与髌骨置换组(102.5±15.1)°组间差异有统计学意义(t=2.469,P0.05;t=3.747,P0.01),术后屈曲角度与后者间的差别无统计学意义。髌骨未置换组中,旋转平台TKA与固定平台TKA的术后HSS评分、屈曲角度无差异,伸直角度差别无临床意义。髌骨置换组中,旋转平台TKA术后HSS评分、伸直角度与固定平台TKA间的差异无统计学意义,前者术后的屈曲角度(112.9±13.0)°与后者术后的屈曲角度(96.7±18.4)°比较差异有统计学意义(t=2.838,P0.05)。结论旋转平台假体与固定平台假体TKA术后总体疗效相似,旋转平台假体能够更好地改善关节屈曲角度;置换髌骨并不能更好地改善膝关节功能。     

Late dislocation of rotating platform in New Jersey Low-Contact Stress knee prosthesis

Five patients with late rotational dislocation of the rotating platform bearing in the New Jersey Low-Contact Stress total knee arthroplasty are reported. The prostheses had functioned well for 8 to 12 years before failure. Preoperative radiographs showed asymmetric femorotibial joint spaces. Entrapment of the dislocated bearing in three patients and spontaneous reduction of the dislocated bearing in another two patients were seen at revision. Femorotibial ligamentous instability was found after reduction. The retrieved polyethylene bearings showed advanced wear and cold flow deformities and the thickness was reduced. The revision arthroplasty was accomplished by replacement with a thicker bearing element. Progressive femorotibial ligament laxity and reduction of the thickness of polyethylene with wearing break down the originally well-balanced soft tissue tension of the knee. The rotational degree of the rotating platform bearing is unrestricted, which may result in late dislocation. Polyethylene wear is unavoidable in knee prostheses using metal contact with polyethylene even with a mobile-bearing design. Efforts to reduce polyethylene wear are mandatory.     

NexGen LPS Flex全膝关节置换的近期疗效观察

目的探讨高屈曲型NexGen LPS—Flex人工全膝关节置换的近期疗效。方法41例（47膝）行高屈曲型NexGen LPS-Flex人工膝假体置换。术前、术后测量膝关节活动度,并根据HSS膝关节评分系统进行评估。结果获随访32例（38膝）,时间12～42（28．03±8．86）个月。活动度从术前平均67．45°±10．50°改善到术后平均125．68°±10．14°。各种并发症的发生率低。术前HSS评分平均为44．7分±11分,术后HSS评分平均为90．3分±12分;根据HSS评分系统评定疗效：优14例,良16例,中2例,优良率达93．75％。结论高屈曲型NexGen LPS—Flex全膝关节置换的近期临床效果满意,长期效果还需进一步观察。     

Results of a series of 60 Academia total knee prostheses (30 fixed platform and 30 rotating platform) after two years

Sixty patients received Academia prosthesis (FH Orthopedics) implants between January 2000 and June 2004. The patients were operated on by a surgeon experienced in carrying out knee arthroplasty. There were two series involving this population, which immediately and consecutively followed one another over time; the first between 2000 and 2001 where the fixed platform Academia prosthesis (“FP”) was fitted, and the other was carried out between 2002 and 2004 using the rotating platform Academia prosthesis (“Rot”). The aim of this work was to find out whether there were significant differences in clinical and radiological results between the two types of bases used by the same surgeon within a homogeneous population. The secondary objective was to create a database of clinical and radiological results from these two types of prostheses in order to compare them with other series.     

固定平台后稳定型假体与旋转高屈曲型假体治疗膝骨性关节炎的早期疗效比较

目的评价人工全膝关节置换(total knee replacement,TKR)中使用固定平台后稳定型假体与旋转高屈曲型假体治疗骨性关节炎的早期临床疗效。方法对我院2007年1月—2009年12月收治的68例骨关节炎患者施行TKR手术,其中应用固定平台后稳定型假体32例38膝,旋转高屈曲型假体36例44膝,通过测量手术前及末次随访时的膝关节活动度和美国特种外科医院膝关节评分(hospital for special knee surgery score,HSS)对两种假体置换方式的临床疗效进行比较。结果 68例患者获随访3～26个月,平均19个月。根据HSS评分标准,末次随访时优47例(69.1%),良17例(25.0%),可4例(5.9%),总优良率94.1%。两组之间术前活动度以及术前、末次随访时HSS的差异无统计学意义(P0.05),而旋转高屈曲型假体组在末次随访活动度方面较固定平台后稳定型假体组为高(P0.05)。结论高屈曲度人工膝关节假体在运动学上有潜在的优势,有助于改善关节功能,减轻接触应力和假体磨损;固定平台后稳定型假体手术方式简单、疗效肯定、术后并发症少,对不需要从事高屈曲活动、经济较为困难以及高龄患者是一种可供选择的假体。     

Comparison among total knee arthroplasties with a mobile bearing: menisci versus rotating platform versus AP glide platform

A retrospective study was conducted on 60 patients (53 females, seven males with a mean age of 68 years and 5 months) who underwent a total knee replacement using a mobile bearing. The diagnosis was primary osteoarthritis in 57 cases and rheumatoid arthritis in three cases. None of the patients underwent a bilateral procedure, thus 60 implants (33 all cementless, three all cemented, 24 with only the tibial component cemented) were considered. Three different groups were identified:

• Group 1: first 20 total knee arthroplasties with menisci.
• Group 2: first 20 total knee arthroplasties with rotating platform.
• Group 3: first 20 total knee arthroplasties with AP glide platform.

Clinical and radiological results at the final follow up, although different in time among the three groups, have shown no revision due to mechanical or septic reasons, and no signs of impending failure.     

Comparison between the kinematics of fixed and rotating bearing knee prostheses

Rotating platform mobile bearing knee implants allow for increased tibiofemoral articular conformity without restricting axial rotation. In the current study, the effect of rotating platform knee replacement with and without posterior cruciate ligament substitution on knee kinematics was investigated. Five knees were implanted sequentially implanted with standard (fixed) bearings and then with rotating platform prostheses, each in posterior cruciate retaining and substituting designs. Three-dimensional kinematics for all knees were measured in an Oxford Knee Rig, which simulates dynamic quadriceps-driven closed kinetic chain knee extension under load. Rotating bearings did not significantly change knee kinematics when compared with fixed bearings. In this in vitro model, the cruciate retaining designs stayed more anterior, and had greater net femoral roll back and tibiofemoral valgus angulation with flexion than cruciate substituting designs.