活动和固定衬垫型假体在全膝关节表面置换术中的早期临床比较研究

目的通过文献回顾以及病例观察比较活动衬垫型假体和固定衬垫型假体在人工膝关节表面置换中的早期应用情况。方法2003年2月至2004年10月共对94例骨关节炎患者行初次全膝关节表面置换术。全部病例选用不保留后交叉韧带骨水泥型假体。A组(固定衬垫型假体)29例患者,30侧关节(20侧选用DePuy假体,10侧选用Centerpulse假体)。B组(活动衬垫型假体)65例患者,68侧关节,全部选用Centerpulse假体。A,B两组术前资料进行HSS评分、年龄、性别等可比性分析。术后6周、3个月、6个月、1年分别随访,进行HSS评分、患者满意度调查等评价。所得数据采用SPSS10.0软件系统进行统计学分析。结果A、B两组术后6周、3个月、6个月、1年所得HSS评分进行阶段统计学分析,所得P值分别为0.414,0.108,0.235,0.452,两组术后HSS评分差异无统计学意义。术后1年,两组膝关节活动度比较A组,平均ROM为108°(95°~118°);B组,平均ROM为107°(90°~120°),两组关节活动度差异无统计学意义(P>0.05)。术后1年,A组患者主诉4侧关节(13.7%)仍有疼痛,B组9侧关节(13.1%)主诉患肢仍有疼痛;A组90%患者对手术效果满意,B组88%患者对手术效果满意。结论本组研究结果尚未证实活动衬垫型假体相对于固定衬垫型假体在早期人工关节表面置换术后的优越性。     

活动平台与固定平台假体全膝关节置换术疗效的Meta分析

目的 对采用活动平台或固定平台假体膝关节置换术的疗效差异进行Meta分析.方法 检索Ovid Medline和PubMed(1966年至2008年6月),Embase(1980年至2008年6月),Cochrane Central Register of Controued Trials(2008年)和中国生物医学文献数据库(1990至2008年),搜集全部有关活动平台和固定平台假体膝关节置换术疗效差异的随机对照研究,采用RevMan 4.2.10统计软件进行Meta分析.结果 纳入前瞻性随机对照研究9篇,英文文献8篇、德文文献1篇.Meta分析结果显示采用活动平台假体与固定平台假体西组术后膝关节最大屈曲度差异有统计学意义,加权均数差值-1.63,95%置信区间[-2.51,-0.74],P=0.0003;术后膝关节KSS评分(加权均数差值-0.25,95%置信区间[1.09,0.59],P=0.56)、髌骨倾斜率(风险差0.01,95%置信区间[-0.02,0.03],P=0.64)、假体周围放射透光影率(相对危险度0.88,95%置信区间[0.61,1.29],P=0.52)、膝关节翻修率(风险差0.01,95%置信区间[0.00,0.03],P=0.12)差异无统计学意义.结论 早、中期随访结果显示,活动平台与固定平台的术后膝关节最大屈曲度差异有统计学差异,但活动平台平均仅增加1.6°,无明显临床意义.在膝关节评分、髌骨轨迹、假体周围放射透光影、膝关节翻修等方面活动平台没有明显优势,但却存在易脱位的风险.     

后交叉韧带保留型和后稳定型全膝关节置换术后早期临床疗效比较

目的评价后交叉韧带保留（PCR）型和后稳定（PS）型全膝关节置换（TKA）的早期临床疗效，探讨两种不同假体置换术的临床相关问题。方法回顾2000年4月～2005年10月139例（166膝）初次行TKA的患者资料，比较PCR型（PCR组）58例（69膝）和PS型（PS组）81例（97膝）的早期疗效，结合文献分析两种不同假体的优缺点及相关技术问题。结果术后随访1年，患者对手术的满意率PCR组为94.2％，PS组为93．8％，两组比较差异无统计学意义（P〉0．05）。HSS评分PCR组平均为93．9分，PS组平均为94．3分，两组比较差异无统计学意义（P〉0．05）。膝关节活动度PCR组平均为105．8°，PS组平均为107．4°，两组比较差异无统计学意义（P〉0．05）。患者主诉患膝有轻微疼痛者，PCR组有7膝（占10．1％），PS组有10膝（占10，3％），均不需特殊治疗。有明显髌骨弹响征者PCR组2例，PS组4例，但对功能活动无影响。结论PCR型或PS型TKA后早期随访疗效满意；对膝关节畸形较轻，术中探查后交叉韧带结构完整者，可考虑采用PCR型假体，但应松解PCR，原则上宁松勿紧；对于PS型假体，手术技术要求相对较低，容易掌握，临床适用范围更广。     

移动平台型假体与固定平台型假体全膝置换术治疗膝关节炎疗效的Meta分析

目的 用Meta分析方法对移动平台型全膝关节置换术(mobile-bearing TKA)与固定平台型全膝置换术(fixed-bearing TKA)术后疗效进行系统评价的文献近期未见有发表,本文即用Meta分析方法对使用两种假体全膝关节置换术术后两年以上的疗效进行评价。方法 检索关于移动平台型全膝关节置换术和固定平台型全膝关节置换术病例对照的相关文献,按照特定的纳入和排除标准选择文献并提取数据,用Review Manager5.0软件对数据进行meta分析。结果 最终共纳入12篇随机对照研究(Jadad评分均在3~5分之间)。数据分析结果显示,应用两组假体的临床疗效在KSS-膝关节评分[MD=0.76,95%CI(-0.07,1.69),P=0.07]、SF-12生命质量生理评分[MD=-0.16,95%CI(-2.15,1.83),P=0.88]和SF-12生命质量心理评分[MD=0.64,95%CI(-1.28,2.57),P=0.51]方面的差别无统计学意义,而在KSS-膝功能评分[MD=3.26,95%CI(1.39,5.13),P=0.0006]和关节活动度[MD=2.68,95%CI(1.73,3.61),P<0.00001]方面的差别有统计学意义。结论 本Meta分析发现,使用移动平台型假体全膝置换术后,能在一定程度上提高患者的KSS-膝功能评分和关节活动度,但并不能提高患者KSS-膝关节评分、SF-12生命质量生理和心理方面评分。     

全膝关节置换中固定平台假体和活动平台假体相比较的Meta分析

[目的]应用Meta分析的方法,评价全膝关节置换术(total knee arthroplasty,TKA)中应用固定平台型假体(fixed bearing total knee arthroplasty,FB)和活动平台型假体(mobile bearing total knee arthroplasty,MB)的疗效差异,为临床选择适当类型假体进行TKA术提供依据。[方法]计算机检索Pubmed、EMBASE、Ovid和Cochrane图书馆关于TKA术中应用FB和MB的随机或半随机对照试验,按照文中所述纳入标准收集后进行比较,利用RevMan5.0软件进行异质性分析及Meta分析,绘制森林图。[结果]本文检索了1979～2009年间发表的1 718篇关于TKA术中应用FB和MB的文献,经过筛选和评价,最后收集到已发表的14篇(共1 305例患者)随机或半随机的对照试验,符合本次Meta分析所纳入的试验标准。结果发现两组在KSS评分、关节活动度、患者满意率、放射学指标和假体相关并发症上差异无统计学意义(95%显著区间有重叠)。[结论]相对MB的先进设计理念,现有临床研究结果尚不支持在TKA术中应用MB疗效显著优于FB。     

全膝关节置换术中旋转平台假体与固定平台假体短期随访对比(英文)

[目的]观察对照全膝关节置换术中旋转平台假体与固定平台假体的早期效果。[方法]从2011年8月~2012年12月收集了120位患者的样本,包括162例在此期间进行了膝关节置换术的膝关节。膝关节假体(旋转平台与固定平台)是通过随机抽样选出的。对所有患者在手术前与手术后1、6、12个月进行评估,全部使用标准评分方法 (美国膝关节协会评分,功能评分,活动度)。[结果]A组66位患者共85膝使用的是旋转平台假体,平均年龄为(63.13±7.18)岁。B组54位患者共77膝使用的是固定平台假体。平均年龄为(61.35±6.75)岁。平均随访时间为(8.25±6.22)个月。全膝关节置换术固定平台假体与旋转平台假体的平均膝关节协会评分在1年之后分别为(84.5±13.8)分和(82.2±15.7)分,平均膝关节功能评分在1年之后分别为(70.3±20.5)分和(71.4±19.3)分,全膝置换的固定平台假体与旋转平台假体平均活动度在一年之后分别为(103.2±13.5)°和(104.3±13.7)°。两组的术后效果并无差异(P0.05)。[结论]在旋转平台假体与固定平台假体设计中,当前研究表示没有明显的临床性、功能性和影像学上的差异。研究表明,控制其他可变因素,不论使用旋转平台假体或者固定平台假体设计,都不会在短期随访时间内影响到效果。     

后稳定型全膝关节假体置换术后疗效分析

目的　分析后稳定型全膝关节假体置换术的处理方式、手术经验及疗效。方法　对 14例15膝行关节置换 ,使用Apollo后稳定型假体 ,单膝关节置换 13例 ,双膝同期置换 1例。原发疾病为类风湿性关节炎 3例 4膝 ,骨关节炎 11例 11膝。术后随访时间平均 11个月。结果　 15个膝关节术前伸曲活动度平均 75°,全膝关节置换术后 2个月关节活动度恢复至平均 10 0°。 14例患者均可自如行走、上下楼梯 ,膝关节稳定性好。 1膝术后脂肪液化致表层伤口裂开 ,清创后愈合 ,余膝术后伤口均愈合良好。结论　后稳定型假体植入的全膝关节置换手术方式简单、疗效肯定、术后并发症少。     

固定平台后稳定型假体全膝关节置换术后的运动学研究

 目的 探讨固定平台后稳定型假体全膝关节置换(total knee arthroplasty,TKA)术后膝关节在负重屈膝下蹲时的运动学特征。方法 选取10名健康志愿者和10例固定平台后稳定型假体TKA术后患者。制作骨骼及膝关节假体三维模型,在持续X线透视下完成负重下蹲动作,膝关节屈曲度每增加15°截取一幅图像。通过荧光透视分析技术完成三维模型与二维图像的匹配,再现股骨与胫骨在屈膝过程中的空间位置,通过连续的图像分析比较正常与固定平台后稳定型假体TKA术后膝关节在负重下蹲时股骨内、外髁前后移动及胫骨内外旋转幅度。结果 负重下蹲时,正常膝关节平均屈曲136°,股骨内、外髁分别后移(7.3±1.2) mm和(19.3±3.1) mm,胫骨平均内旋23.8°±3.4°;TKA术后膝关节平均屈曲125°,股骨内、外髁分别后移(1.4±1.6) mm和(6.4±1.7) mm,胫骨平均内旋8.5°±3.4°。结论 固定平台后稳定型假体TKA术后膝关节运动与正常膝关节相似,均表现出股骨内、外髁后移及胫骨内旋运动,但幅度小于正常膝关节,且在屈膝过程中存在股骨矛盾性前移及胫骨外旋现象。     

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.     

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。     

Meta-analysis comparing outcomes of fixed-bearing and mobile-bearing prostheses in total knee arthroplasty

Study findings have been inconsistent in confirming advantages for mobile-bearing compared with fixed-bearing prostheses for total knee arthroplasty. Therefore, we did meta-analysis of trials comparing outcomes from using the 2 different designs. Of 5670 citations identified for screening, 10 trials reporting 620 participants (906 knees) at final follow-up were eligible for data extraction and meta-analysis. The meta-analysis did not find a significant difference in the American Knee Society Knee Scores, Knee Society Functional and Pain Scores, range of motion, occurrence of radiolucent lines, prosthesis-related complications, and participant preference. The results suggest that the mobile-bearing prosthesis does not offer clinical or radiologic advantage over the fixed-bearing prosthesis.     

Long-term comparison of mobile-bearing vs fixed-bearing total knee arthroplasty

Few published reports have been published regarding a comparison of the long-term outcomes between mobile- (MB) and fixed-bearing component designs for knee arthroplasty. The minimum 10-year clinical and radiologic follow-up of an unselected consecutive series of 89 patients (107 knees) who were randomized to have one of these different designs for primary arthroplasty was done. Twenty-six patients (30 knees) who had a fixed-bearing design and 24 patients (33 knees) who had an MB prosthesis were available for follow-up. Two MB knees were revised for aseptic loosening of a tibial component in one and femoral component fracture in the other. In patients who did not have revision surgery, there were no differences between the groups with respect to mean Knee Society scores, knee flexion, or pain scores.     

Greater satisfaction in older patients with a mobile-bearing compared with fixed-bearing total knee arthroplasty

A prospective, randomized, controlled, double-blind trial was performed to compare outcomes between 61 mobile- and 58 fixed-bearing primary TKAs in patients aged 70 years or older. At last follow-up, no difference was found for Knee Society score. The mobile-bearing group had greater knee flexion at 3 and 6 months, but this was similar at 2 years. The patient satisfaction was better in the mobile-bearing group than in fixed-bearing group, with respect to Knee Society functional score, Western Ontario MacMasters University score, Short-Form 12 score, and visual analog scale score. A multivariate analysis confirmed that the only independent factors predictive of postoperative quality of life were early postoperative flexion. We believe that better perception and satisfaction with mobile-bearing in older patients was due to the earlier regain of their knee flexion. Our results justify the use of mobile-bearing design in the older population.     

Early clinical results of a high-flexion, posterior-stabilized, mobile-bearing total knee arthroplasty: a US investigational device exemption trial

Between May 2001 and June 2004, 388 total knee arthroplasty cases were enrolled in a prospective, randomized, multicenter investigational device exemption trial. Patients received either the investigational high-flexion mobile-bearing knee or a fixed-bearing control. At 2 to 4 years of follow-up, results in 293 patients with degenerative joint disease were compared using Knee Society Assessment and Function scores, radiographic results, complications analysis, and survival estimates. The mobile-bearing and fixed-bearing groups demonstrated similar, significant improvement over preoperative assessments in Knee Scores, maximum flexion, and range of motion. One mobile-bearing arthroplasty required revision. Radiographic results were unremarkable, and implant-related complications were rare in both groups. At this early follow-up, the investigational high-flexion mobile-bearing knee and its fixed-bearing counterpart demonstrated comparable, effective performance.     

固定平台与旋转平台假体用于外翻膝的早期疗效观察

目的:比较外翻膝人工全膝关节置换术应用旋转平台和固定平台两型假体的早期临床疗效。方法:选取2011年1月至2013年12月吉林大学第一医院骨关节外科由同一医师进行初次人工膝关节置换的17例(23膝)进行回顾性随访研究,其中男2例,女15例;年龄48～75岁,平均61.5岁。术前诊断为骨性关节炎14例(19膝),类风湿性关节炎3例(4膝),所有膝关节有外翻畸形。其中9例(12膝)使用固定平台型假体(PFC Sigma),8例(11膝)使用旋转平台型假体(PFC Sigma RP).术前和术后随访行KSS、HSS、WOMAC评分,测量关节活动度、胫股角等指标,进行统计学分析。结果:所有患者获随访,时间6～36个月,平均25个月。两组患者膝外翻畸形均得到矫正,术后末次随访的KSS、HSS、WOMAC评分及膝关节活动度、胫股角较术前明显改善(P<0.01).其中固定平台组和旋转平台组在术后KSS、HSS、WOMAC评分以及胫骨角、膝关节活范围改善度方面比较,差异无统计学意义(P>0.05);而术后末次随访膝关活动范围固定平台组(101.8±8.8)°与旋转平台组(108.4±7.2)°差异有统计学意义(P<0.05).旋转平台组没有发现垫片脱位,两组术后均无感染、腓总神经麻痹、脱位、膝关节不稳等并发症发生,X线检查未见假体骨溶解及松动发生。结论:外翻膝人工全膝关节置换术使用旋转平台和固定平台型假体均能获得满意的早期临床效果,两者的近期临床疗效比较无明显差异。     

Anterior-posterior glide mobile-bearing total knee arthroplasty: complications related to prosthesis design

The aim of this study was to evaluate complications related to prosthesis design in patients managed with cemented total knee arthroplasty using anterior-posterior glide mobile-bearing prosthesis. One hundred eighty-three total knee arthroplasties were performed using this prosthesis on 146 patients, with a minimum of 7 years of follow-up. There were late dislocations of the bearing in 2 knees, anterior soft tissue impingements in 6 knees at an earlier follow-up, excessive anteroposterior translation in 5 knees, and a fracture of the femoral component induced by osteolysis in 1 knee. Design modifications in the restraint mechanisms of the anterior-posterior glide mobile-bearing prosthesis may be required to minimize the development of complications with regard to sagittal instability and to improve the prosthesis' longevity.     

Dislocated polyethylene inserts in fixed-bearing total knee arthroplasty

Three cases of a dislocated polyethylene insert in a fixed-bearing total knee arthroplasty are presented. This brief report demonstrates the presentation of this rare mode of failure and highlights the unique complications associated with its treatment.     

Rotational kinematics of a modern fixed-bearing posterior stabilized total knee arthroplasty

The purpose of this study was to evaluate the rotational kinematics of a fixed-bearing posteriorly stabilized total knee design in moderate and deep flexion. Three-dimensional kinematics analyses were conducted on 20 knees in 4 weight-bearing positions using 3-dimensional shape-matching techniques. Average maximum skeletal flexion was 138 degrees . Internal tibial rotation was demonstrated in 19 of 20 knees. The average internal tibial rotation in midflexed lunge was 5.5 degrees (-3.8 degrees to 14.1 degrees ) and in maximum flexion kneeling was 4.0 degrees (-3.1 degrees to 10.6 degrees ). Separation of articular surfaces was not identified. In this study, patients with this device demonstrated patterns of rotation similar to those previously reported for both the normal knee and rotating platform designs.     

Prevalence of osteolysis after simultaneous bilateral fixed- and mobile-bearing total knee arthroplasties in young patients

This study aimed to evaluate the clinical and radiographic results and to document the prevalence of osteolysis associated with fixed-bearing (anatomic modular knee) and mobile-bearing (low contact stress) total knee arthroplasties (TKAs) in 61 patients younger than 55 years who had bilateral simultaneous primary TKAs. Forty-five patients were female and 16 patients were male. The mean age of the patients was 48.3 years (range, 34-55 years). The mean postoperative Knee Society knee and functional score were similar in both groups (91 and 90 points and 85 and 86 points, respectively). Three knees (5%) in each group were revised for wear of the tibial bearing, and 1 knee (2%) in the mobile-bearing TKA was revised for dislocation of the meniscal bearing. Osteolysis was identified in both radiographs and computed tomography scans in 6 knees (10%) in the anatomic-modular-knee group and 4 knees (7%) in the low-contact-stress group.