股骨后髁偏率对后稳定型TKA术后功能恢复的影响

目的探讨后稳定型全膝关节置换术(total knee arthroplasty,TKA)后股骨后髁偏率(posterior femoral condylar offset ratio,PCOR)的变化对关节功能恢复的影响。方法回顾性分析2016年1月至2018年1月在徐州医科大学附属医院接受单侧后稳定型全膝关节置换术治疗的53例女性骨关节炎患者的临床资料,其中左膝25例,右膝28例;年龄56~75岁,平均(63.57±5.90)岁。根据术前、术后股骨后髁偏率的改善值将患者分为A组(不变或增大)和B组(减小)。采用末次随访时的膝关节主、被动活动范围、美国膝关节协会评分(knee society score,KSS)、西大略湖麦克马斯特大学(Western Ontario McMaster Universities,WOMAC)评分评估两组患者关节功能。对术后PCOR改善值与各临床指标进行相关性分析。结果53例患者均获得随访,随访时间12~15个月,平均13个月。A组、B组股骨后髁偏率改善值分别为(0.03±0.02)及(-0.03±0.02)。末次随访时,两组患者膝关节活动度(range of motion,ROM)比较差异无统计学意义。A组患者术后KSS行走、爬楼评分分别为(41.96±5.17)分及(45.22±4.88)分,B组患者平均为(36.17±5.52)分及(39.67±4.14)分,两组术后WOMAC评分分别为(18.34±6.91)分及(23.57±9.26)分,均较术前明显改善且A组优于B组,差异有统计学意义。股骨后髁偏率的改善值与术后主、被动屈曲角度、屈曲角度的改善值、WOMAC评分均无相关性。PCOR改善值与行走、爬楼评分呈正相关。结论PCOR的改变对后稳定型TKA术后ROM无显著影响,但恢复或适当增加PCOR可以获得更好的膝关节功能。

Effect of Posterior Condylar Offset Ratio on the Recovery of Joint Function after Posterior-Stabilized Total Knee Arthroplasty

Objective To explorethe effect of the change of posterior femoral condylar offset ratio(PCOR)on the recovery of joint function after TKA.Methods The clinical data of 53 female patients with osteoarthritis who hadundergone total knee arthroplasty at the Affiliated Hospital of Xuzhou Medical University from January 2016 to January 2018 were retrospectively analyzed.Based on the PCOR change,patients were divided into A(maintain or increased)group and B(decreased)group.The joint function was evaluated by theactive and passive flexion angle,the knee society score,and the WOMAC scoreat the last follow-up.The associations between the PCOR changes and the clinical variables in all patients were analyzed by Pearson linear correlation.Results All patients were followed up for 12-15 months,withanaverage of 13 months.The PCOR change was 0.03±0.02 in the group A and-0.03±0.02 in the group B.In the last follow-up,active and passive range of knee flexion and their improvement had no statistical difference between the two groups.The Knee Society function scores and Western Ontario and McMaster Universities Osteoarthritis Index in group A were better thangroup B,the difference was statistically significant(P<0.05).the PCOR change was not significantly correlated with theWOMAC score,active and passive range of flexion and their improvement.While the PCOR change was positively correlated with the KSS function score.Conclusion The change of PCOR has no significant effect on the postoperative flexion angle after TKA,but restore or increasethe PCOR properly can obtain joint function.