全膝关节置换固定和旋转平台假体的有限元分析

背景:目前有研究对全膝关节置换进行三维有限元分析,但关于全膝关节置换固定平台假体和旋转平台假体聚乙烯衬垫内外侧接触压和接触面积的研究不多。目的:探讨全膝关节置换固定平台假体和旋转平台假体聚乙烯衬垫内外侧接触压和接触面积。方法:建立全膝关节置换固定平台假体和旋转平台假体的三维有限元模型,比较全膝关节置换固定平台假体和旋转平台假体聚乙烯衬垫内外侧接触压和接触面积。结果与结论:全膝关节置换固定平台假体和旋转平台假体的聚乙烯衬垫内侧和外侧接触压峰值以屈膝0°时最小,全膝关节置换固定平台假体和旋转平台假体聚乙烯衬垫内侧接触压峰值在屈膝0°-90°时均高于外侧接触压峰值(P<0.05)。全膝关节置换固定平台假体在屈膝60°-120°时聚乙烯衬垫内外侧接触压峰值均高于旋转平台内外侧接触压峰值(P<0.05)。全膝关节置换固定平台假体和旋转平台假体聚乙烯衬垫内侧和外侧接触面积以屈膝0°时最大。全膝关节置换固定平台假体聚乙烯衬垫内侧接触面积在屈膝0°-30°时均低于外侧接触面积(P<0.05),全膝关节置换固定平台假体聚乙烯衬垫内侧接触面积在屈膝0°-90°时均低于外侧接触面积(P<0.05)。全膝关节置换固定平台假体在屈膝30°-120°时聚乙烯衬垫内外侧接触面积均低于旋转平台内外侧接触面积(P<0.05)。表明全膝关节置换固定平台假体和旋转平台假体内外侧聚乙烯衬垫内侧接触压峰值高于外侧接触压峰值,内侧接触面积低于外侧接触面积,旋转平台假体的内外侧接触压低于固定平台假体,旋转平台假体的内外侧接触面积高于固定平台假体。     

全膝关节置换中应用旋转平台和固定平台假体效果的Meta分析

背景：旋转假体是否优于固定假体学术界目前仍有争议。 目的：全膝关节置换中应用旋转或固定平台型假体的临床结果比较,分析两类假体的疗效差异。 方法：检索Medline、Embase、Cochranelibrary、中国生物医学文献数据库及相关参考文献,收集比较旋转和固定型假体全膝关节置换的随机对照试验,采用Cochrane的随机方法学评价文献质量,应用RevMan5.1.2 进行Meta 分析。使用GRADEpro version3.2.2软件对纳入研究进行证据评级。 结果与结论：纳入10个随机对照试验,总共764例,置换旋转假体的实验组381例,置换平台假体的对照组383例。纳入研究的方法学偏倚均较低。术后疗效均较术前明显提高,组间比较的Meta 分析结果显示,两组膝关节评分、关节活动度及置换后并发症、翻修率均未发现明显的统计学差异。结果显示,目前证据未能证明旋转平台假体优于固定平台假体,需要开展更多高质量的对照试验加以证实,但无论选择何种假体均有可能获得满意的临床效果。     

高屈曲后稳定型旋转平台人工膝关节假体全膝关节置换

背景：传统的人工膝关节假体已成功在临床应用。有报道高屈曲后稳定型固定平台人工膝关节假体置换后有较高的高分子聚乙烯垫磨损,而高屈曲后稳定型旋转平台人工膝关节假体的设计能更好地解决这一问题。 目的：回顾性分析高屈曲后稳定型旋转平台PFC sigma RPF人工膝关节假体全膝关节置换后的近期效果。 方法：78例(113膝)行高屈曲后稳定型旋转平台PFC sigma RPF人工膝关节假体置换,采用骨水泥固定假体,髌骨不进行置换。随访3年,分别比较置换前、置换后膝关节活动度及特种外科医院膝关节功能评分。 结果与结论：随访3年,膝关节活动度从置换前平均110.7°改善到置换后平均124°,特种外科医院膝关节功能评分从置换前平均54.2分改善到置换后平均95.4分,优良率达93.58%,各种并发症发生率低。提示高屈曲后稳定型旋转平台PFC sigma RPF人工膝关节假体的近期置换效果满意,置换后的持续疼痛是患者不满意的主要因素,长期效果还需进一步观察。     

PFC—Sigma固定平台和PFC—Sigma旋转平台人工膝关节应用的早期临床疗效

目的：探讨固定平台膝关节假体和旋转平台膝关节假体的临床疗效。方法：2010年1月～2011年3月,分别接受PFC—Sigma固定平台假体和PFC．Sigma旋转假体置换的患者共66例（83膝）,其中男13例、女53例,年龄27～89岁,平均64岁。术后随访并根据HSS评分、生存质量评分系统、关节活动度、最大屈膝度数评价临床效果,数据采用SPSS13．0统计软件分析。影像学评估采用Centricity Enterprise WebV．30专业图像分析软件。结果：66例均获得随访,随访时间12～24个月,平均18个月。疼痛评分由术前（7．19±2．21）分提高至（26．25±2．68）分（P〈0．05）,HSS评分由术前（43．28±6．72）分提高至（87．50±5．00）分（P〈0．05）,活动度由术前（74．26±19．32）°提高至（115．74±11．44）°（P〈0．05）,最大屈膝度数由术前（111．40±10．22）°提高至（115．7±11．44）°（P〈0．05）,生存质量评分由术前（44．63±7．30）分提高至（83．99±4．36）分（P〈0．05）。影像学评估假体对位、对线良好,无假体松动。结论：合理选择膝关节假体,熟练运用TKA技巧及早期康复功能训练,可使患者获得较好的早期临床效果。     

高屈曲与旋转平台假体全膝关节置换术后早期疗效的比较

目的比较采用高屈曲与旋转平台假体的全膝关节置换术的早期疗效。方法选取2013年2月~10月首次行全膝关节置换术的患者,分为RPF组和RP组,随访时间为6个月。记录术前、6个月的关节活动度与HSS评分。结果 RPF组与RP组术前活动度、HSS评分、一般资料比较均无统计学差异,具有可比性。 RPF组术后6个月活动度较RP组差异有统计学意义,=0.001;HSS评分RPF组较RP组差异有统计学意义,=0.028;术前活动度大于等于100o的RPF假体术后6个月增加的活动度小于术前小于100o的术后6个月增加的活动度,差异有统计学意义。术前小于100o和大于等于100o的RPF假体术后6个月活动度均大于相对应的术前小于100o和大于等于100o的RP假体,差异有统计学意义。术前小于100o的RPF假体术后6个月增加的活动度大于术前小于100o的RP假体,差异有统计学意义。术前大于等于100o的RPF假体术后6个月增加的活动度与RP假体无统计学差异。结论术后6个月活动度及功能评分高屈曲假体优于一般假体;术前活动度小于100o采用高屈曲假体在术后6个月能获得更多的活动度。     

采用Gemini MKⅡ旋转活动平台假体行全膝关节置换

背景：全膝关节置换目前仍以固定平台假体为主,但活动平台假体临床使用量逐年增加,虽然旋转活动平台假体在理论上被认为能显著改善疗效,但至今尚未获得临床证实。 目的：总结Gemini MKⅡ(Link,Germany)旋转活动平台假体的设计特征和临床效果。 方法：选取2004年1月至2009年1月采用Gemini MKⅡ旋转活动平台假体行全膝关节置换的患者108例(119膝),男31例,女77例;单侧97例,双侧一期置换11例;置换前诊断：血友病性关节炎1例,性病性Charcot’s病1例,创伤后关节炎8例,类风湿性关节炎11例,退变性骨关节炎87例。假体均采用骨水泥固定,所有患者均未行髌骨置换。 结果与结论：置换后均未出现感染、股骨髁骨折或血管、神经损伤等并发症。除双侧置换外,单侧置换的平均手术时间为(56±13) min。平均置换后血红蛋白下降值为(25±5) g/L,其中83例(86%)置换后血红蛋白仍维持在100 g/L 以上,无需输血。置换半年后的膝关节评分和功能评分分别恢复至(92.0±4.7)分和(90.3±6.8)分;末次随访时分别为(94.4±3.2)分和(91.6±5.9)分,较置换前显著改善(P < 0.01)。未见因内衬脱出或旋出,以及因骨溶解或假体松动需行翻修者。提示Gemini MKⅡ旋转活动平台假体的早中期临床疗效满意,但远期疗效仍有待临床进一步证实。中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程全文链接：     

全膝关节置换过程中的假体旋转对位

背景：在全膝关节置换过程中对假体旋转对位争论的焦点目前仍集中在旋转对位的参照地标如何设定。 目的：综述全膝关节置换手术中假体旋转对位的相关临床和基础研究进展。 方法：广泛查阅全膝关节置换手术中假体旋转对位的解剖定位标志、定位方法、旋转对位的匹配、手术精确度等临床上遇到的相关文献。 结果与结论：许多研究表明,旋转对位不良,会导致膝前痛,胫股骨和髌股关节间的稳定性失衡,髌骨的运动轨迹失调,步态异常,胫骨侧聚乙烯平台的磨损加速,假体过早松动,出现关节半脱位和脱位,甚至需进一步手术翻修等问题。术中胫股骨侧假体的旋转对位时要综合利用所获得的各种信息,个别校正,必要时结合置换前的CT扫描来进行,以改善全膝关节置换疗效和远期生存率。     

后交叉韧带保留型和后稳定型全膝关节假体置换后早期关节遗忘度的对比

背景:临床长期随访显示,后交叉韧带保留型与后稳定型假体置换后的膝关节活动度、10-15年假体生存率及主要临床表现等方面无明显区别,但针对两种膝关节假体孰优孰劣的争论依然存在。目的:对比后叉韧带保留型和后稳定型假体置换治疗单侧膝关节骨关节炎术后患者早期功能恢复的差别。方法:选择2018年7月至2019年9月安徽医科大学第一附属医院收治的60例膝关节骨关节炎患者,其中男13例,女47例,年龄46-83岁,其中30例接受后叉韧带保留型假体置换治疗,另30例接受后稳定型假体置换治疗。术后3个月及末次随访时,进行关节遗忘评分、膝关节功能HSS评分、目测类比评分与膝关节活动度评价。研究获得安徽医科大学第一附属医院伦理委员会批准。结果与结论:①60例患者获得5-16个月随访,随访期内均未出现假体周围感染、松动、脱位及僵硬等并发症;②术后3个月及末次随访时,两组间关节遗忘评分、膝关节功能HSS评分、目测类比评分与膝关节活动度比较差异均无显著性意义(P>0.05);③结果表明,后叉韧带保留型和后稳定型假体置换治疗单侧膝关节骨关节炎术后患者早期关节遗忘度无差别。     

中年膝骨性关节炎全膝关节置换中应用旋转高屈曲型假体的特点

BACKGROUND: Total knee replacement is the main treatment for the end of the knee joint disease. How to choose prosthesis replacement according to the different situations of the patient is one of the focuses in the field of joint surgery.     

高屈曲型与普通型假体人工全膝关节置换后的早期功能恢复比较

背景：高屈型假体理论上优于普通型假体,尤其是在置入后关节屈曲度方面。 目的：评价高屈曲型与普通型假体单侧人工全膝关节置换后早期的功能康复之间的差异。 方法：回顾性对照分析新疆医科大学第四附属医院骨科中心初次行人工全膝关节置换的133例患者141膝,植入假体分别为高屈曲型与普通型,比较两组患者置入后疗效。 结果与结论：置入后高屈组1例发生一过性腓总神经麻痹,1例置入后切口愈合不良,42 例44 膝获随访,失访2例3膝,随访12~19个月;普通型2例发生切口愈合不良,1例浅静脉血栓,86例91膝获随访,失访3例3膝,随访12~23 个月。置入后1年两组HSS 评分、疼痛评分、肌力评级比较,差异无显著性意义(P > 0.05)。高屈曲型在活动度、屈曲挛缩度方面优于普通型(P < 0.05)。说明高屈曲型假体单侧人工全膝关节置换早期在关节活动范围和屈曲挛缩度方面评分优于普通型。     

Intraoperative kinematics of bicruciate-stabilized total knee arthroplasty during high-flexion motion of the knee

BackgroundIt is unknown whether intraoperative kinematics of bicruciate-stabilized total knee arthroplasty (BCS-TKA) are different for different activities. It has also not been established whether intraoperative high-flexion motions correlate with postoperative patient-reported outcome measures (PROMs). We aimed to clarify the intraoperative kinematics of BCS-TKA during high-flexion activities and describe the relationship between intraoperative and postoperative patient-reported outcomes.MethodsWe examined 33 knees from 31 patients who underwent BCS-TKA and measured intraoperative knee kinematics, passive knee flexion, and cross-legged flexion using a navigation system. We also calculated knee flexion, varus-valgus, and rotation angles. As a secondary evaluation, we divided the patients into two clusters based on the PROMs and compared the kinematics between them.ResultsThe valgus moved by 1.3 ± 1.3° beyond 90° knee flexion during passive flexion. In contrast, during cross-legged flexion, the varus moved by 4.6 ± 5.1° beyond 30° flexion. This indicated significantly increased varus alignment in the cross-legged flexion as compared with passive flexion. Beyond 60° of flexion, the femur displayed 8.8 ± 4.8° of external rotation relative to the tibia. In cross-legged flexion, the femur displayed 9.2 ± 6.5° of external rotation relative to the tibia beyond 45° of flexion. At 90° of flexion, the cross-legged knees rotated more externally. There were no significant postoperative differences between the high- and low-score clusters.ConclusionThe intraoperative knee kinematics after BCS-TKA during high-flexion motions differed depending on the performance of an individual. This will be useful for physicians who might recommend BCS-TKA to new patients.     

The effect of patellar thickness on gait biomechanics following total knee arthroplasty

BackgroundPatella resurfacing is commonly performed during total knee arthroplasty; however, determining the appropriate patellar thickness remains a challenge. The purpose of this study was to evaluate the role of post-TKA patellar thickness on knee extensor strength and biomechanical joint loading forces during walking and stair negotiation.MethodsFifteen patients (21 knees) underwent gait analysis prior to TKA and post-TKA at six weeks, three months, six months, and one year. Knee extensor strength and biomechanics were collected during level walking and stair negotiation and analyzed using Pearson correlation coefficients.ResultsKnee extensor strength was positively correlated to patellar thickness at three months and one year post-TKA (p ≤ .05). During walking, no significant correlations were present. During stair ascent, there was a positive correlation between patellar thickness and peak knee flexion angle one year post-TKA (p ≤ .05). During stair descent, there was a positive correlation between patellar thickness and maximum vertical ground reaction forces at one year post-TKA (p ≤ .01).ConclusionsThe loss of patellar thickness when compared to measured pre-resurfacing thickness was correlated with a decrease in knee extensor strength; however, changes in patellar thickness were not significantly correlated to biomechanical loading forces during walking. Increases in demand of activity increase the torque to the knee joint, which elicit increases in compensatory motions, likely reducing the extent to which differences in joint loading during stair negotiation may be attributable to changes in patellar thickness. Therefore, the effect of post-patellar thickness on patient function in primary TKA is limited.     

Analysis of the factors that correlate with increased knee adduction moment during gait in the early postoperative period following total knee arthroplasty

Background

Analysis of dynamic knee loading during gait is essential to prevent mechanical failures following total knee arthroplasty. External knee adduction moment during gait is the primary factor producing medial joint reaction force, and an increase in the moment is directly related to an increase in the medial compartment load on the knee.

Long-term survivorship of total knee arthroplasty with a single-radius,high-flexion posterior stabilized prosthesis

BackgroundThe purpose of this study was to determine functional outcomes, implant survival rate, and complications of a single-radius, high-flexion posterior stabilized (PS) total knee prosthesis at a minimum follow up of 10 years for a consecutive series.MethodsThis retrospective observational study included 395 consecutive patients who underwent 585 single-radius, PS total knee arthroplasties (TKAs) between January 2009 and December 2009. Their functional outcomes, implant survival rates, radiological findings, and complications were evaluated.ResultsAt a mean follow up of 11.2 years (range, 10.6–11.8 years), 395 (80.8%) patients were available for review. At final follow up, preoperative Knee Society knee scores were improved from 37.3 to 80.1 (P < 0.05) and function scores were improved from 35.7 to 80.5 points (P < 0.05). Sixteen knees (2.7%) in 15 patients required revision surgery due to 11 septic loosening (1.9%) and five aseptic loosening events (0.8%). Cumulative survival for the prosthesis was 97.3% for any cause at 10 years. A total of 34 radiolucent lines (5.8%) were detected an average of 2.4 years following surgery and radiological assessment did not reveal any evidence of component migration at final follow up.ConclusionsSingle-radius, high-flexion PS TKA showed good long-term survival rates and clinical outcomes. Further study is required to determine whether limited radiolucency findings at the tibial component–tibial plateau could progress to or result in the loosening of components.     

Deluxe-ps膝关节假体在一期双膝关节置换过程中的应用

背景：Deluxe-PS型人工膝关节假体是根据中国人膝关节解剖特点尤其是股骨髁的形态特征而设计的,其膝关节假体股骨髁内外侧距(M-L)较进口假体少3.5 mm。 目的：探讨Deluxe-ps膝关节假体行一期双膝关节置换中的近期疗效。 方法：纳入使用Deluxe-ps型膝关节假体行一期双侧膝关节置换的膝关节炎患者15例(30膝)设为实验组,对照组为同期采用P.F.C.Sigma膝关节假体行一期双侧膝关节置换的20例患者(40膝)。采用KSS评分和关节功能HSS评分、膝关节关节活动度评估两组手术前、后膝关节功能,对比两组手术时间、及术中输血量。 结果与结论：两组患者置换后均得到12-24个月随访,平均16个月。置换后患者膝关节疼痛均缓解,关节功能恢复满意。两组膝关节置换后与置换前KSS评分、HSS评分及膝关节关节活动度比较,差异均有显著性意义(P < 0.05)。置换后,两组间KSS评分和HSS评分及膝关节关节活动度,差异均无显著性意义(P > 0.05),两组间置换过程中出血量比较,差异均无显著性意义(P > 0.05),手术时间比较,差异有显著性意义(P < 0.05)。说明采用Deluxe-ps膝关节假体行一期双膝关节置换近期疗效满意。