活动平台与固定平台全膝关节置换的比较研究

目的评价人工全膝关节置换术中使用活动平台和固定平台假体治疗膝骨关节炎的早期疗效。方法对2009年3月至2011年3月收治的诊断为膝骨关节炎的患者,随机应用活动平台型假体和固定平台型假体行全膝关节置换（total knee arthroplasty,TKA）手术。记录术前及随访时术膝的膝关节评分、疼痛评分、功能评分、髌骨评分和膝关节活动度,以及股骨角、胫骨角、膝外翻角、胫骨平台后倾角、截骨高度。结果术前活动平台组和固定平台组的年龄、体重指数、患膝内翻畸形、最大屈曲角度及屈曲挛缩度均无统计学差异（P〉0.05）。术后平均随访26个月,活动平台组和固定平台组的术前术后膝关节评分、疼痛评分、功能评分、髌骨评分均无统计学差异（P〉0.05）,都明显地改善了患膝的症状和功能。活动平台组和固定平台组的术后最大屈曲度间存在显著性差异（P〈0.05）。两组的股骨角、胫骨角、膝外翻角、胫骨平台后倾角、截骨高度和术前术后髌骨高度无显著性差异（P〉0.05）。结论活动平台型假体和固定平台型假体TKA均明显改善了患膝的症状和功能,两组的膝关节评分、功能评分、疼痛评分、髌骨评分及X线检查评价差异均无统计学意义。固定平台组的术后最大屈曲度大于活动平台组的最大屈曲度。

Comparison of Mobile and Fixed-Bearing Total Knee Arthroplasty

Objective To compare the postoperative recovery and early clinical results of two groups of patients undergoing total knee arthroplasty（TKA）：one group received a fixed-bearing propsthesis and the other group received a mobile-bearing prosthesis.Methods From March 2009to March 2011,patients with osteoarthritis were assigned to receive a fixed-bearing propsthesis or a mobile-bearing prosthesis.At each follow-up recored the total knee score,pain score,patient function score,patellar score and the range of motion of the knee.And anteroposterior and lateral radio-graphies were taken to evaluate the position of the prosthesis.Results There was no significant difference between the two groups for age,BMI,vagus deformity,maximum knee flexion and flexion contracture preoperatively（P0.05）. The patients of two groups were followed up 26months.There was no significant difference between the two groups（P 0.05）at preoperatively and postoperatively the total knee score,preoperatively and postoperatively pain score,preop-eratively and postoperatively patient functional score,preoperatively and postoperatively patellar score.The fixed-bearing prosthesis group showed a significantly higher maximum flexion than the mobile-bearing prosthesis group（P0. 05）.There was no significant difference between the two groups（P0.05）at the femoral valgus angle,the tibial angle the tibial slope angle,and preoperatively and postoperatively the patellar height（Install-Salvati ratio）.Conclusion We found no advantage of the mobile-bearing arthroplasty over the fixed-bearing arthroplasty with regard to the clinical results at short-term follow-up.There was no significent difference between the two groups for the total knee score,pain score,function score,patellar score and radiographic results.The postoperative maximum flexion in fixed-bearing group was higher than in mobile-bearing group.