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。

Comparison of early clinical outcomes between mobile-bearing and fixed-bearing total knee arthroplasty for the valgus knee

Objective:To compare the early clinical outcomes of primary total knee arthroplasty in the valgus knee between mobile-bearing prosthesis and fixed-bearing prosthesis.Methods:From January 2011 to December 2013,17 patients (23 knees) treated by the same surgeon were selected for a retrospective study in the First Hospital of Jilin University,including 2 males and 15 females with a mean age of 61.5 years old(48 to 75 years). The pre-operative diagnosis included osteoarthritis(14 patients,19 knees) and rheumatoid arthritis(3 patients,4 knees). The patients with valgus deformity were divided into group A and group B. The patients in group A were treated with the fixed-bearing prosthesis(9 patients,12 knees),and the patients in group B were treated with the mobile-bearing prosthesis(8 patients,11 knees). The Knee Society Score (KSS),Hosptial for Special Surgery (HSS),Western Ontario MacMaster (WOMAC),the range of motion (ROM) and femorotibial angle were collected at pre-operation and post-operation follow-up for statistical analysis.Results:All the patients were followed up,and the duration ranged from 6 to 36 months (mean 25 months). The valgus deformity was corrected in all patients,and there were significant differences for all patients between pre-operation and post-operation at the latest follow-up with regard to the KSS knee score,function score,HSS score,WOMAC score,ROM and femorotibial angle(P<0.01). There were no significant differences in KSS knee score,function score,HSS score,WOMAC score,improvement in ROM and femorotibial angle between two groups at the latest follow-up. However there were significant differences in ROM(P<0.05) between fixed-bearing group(101.8±8.8)°and mobile-bearing group(108.4±7.2)°at the latest follow-up. No case with spin-out of mobile bearing was observed. There were no complications in any patient,such as infection,common peroneal nerve injury,dislocation and instability. The X-ary imaging showed no osteolysis or implant loosening.Conclusion:The early clinical outcomes of primary total knee arthroplasty by using mobile-bearing prosthesis and fixed-bearing prosthesis are satisfactory for the treatment of the valgus knee,and the short term clinical outcomes of mobile-bearing TKA and fixed-bearing TKA are similar.