TC-Dynamic后稳定型人工全膝关节系统术后近期疗效分析

目的探讨应用TC-Dynamic后稳定型人工全膝关节系统行全膝关节置换术(totalknee arthroplasty,TKA)的近期临床效果,评价其临床应用的可行性、安全性和有效性。方法2003年9月～2004年3月,应用TC-Dynamic人工全膝关节系统行TKA10例12膝(TC-Dynamic组),术前膝关节KSS(kneesocietyscore)评分为16.08±11.58分,功能评分为13.75±19.79分,膝关节活动度(rangeofmotion,ROM)为75.00±26.46°。同期使用Scorpio假体行TKA30例50膝(Scorpio组),术前膝关节KSS评分为19.48±9.67分,功能评分为3.16±19.82分,膝关节ROM为80.80±22.82°。比较两组患者术后疼痛缓解情况、KSS评分和功能评分改善情况,以及膝关节ROM的提高程度。结果所有患者术后获随访40～210d,平均130d。TC-Dynamic组术后KSS评分为88.83±4.04分,较术前改善72.75±14.47分,功能评分为79.17±5.15分,较术前改善65.42±19.47分;ROM为107.92±11.57°,较术前提高32.92±32.22°。Scorpio组术后KSS评分为85.68±7.36分,较术前改善66.20±10.44分,功能评分为71.40±12.70分,较术前改善68.24±25.35分;ROM为109.20±11.13°,较术前提高28.40±26.41°。术后各指标组间比较差异均无统计学意义(P>0.01)。两组患者术后X线片均示下肢力线良好,假体位置满意,无透亮线及任何松动迹象。结论TC-Dynamic后稳定型膝关节假体设计合理,术后近期效果良好;但远期疗效仍需大样本长期随访观察。TKA中正确的下肢力线、合理截骨和软组织平衡及屈曲伸直间隙平衡等,是获得良好临床效果和保证假体长期存活的关键。

ANALYSIS OF SHORT-TERM RESULTS OF POST TOTAL KNEE ARTHROPLASTY USING TC-DYNAMIC POSTERIOR STABILIZED PROSTHESIS

OBJECTIVE: To assess the feasibility, safety, and validity of the TC-Dynamic posterior stabilized prosthesis implanted in the total knee arthroplasty (TKA). METHODS: Twelve knees of 10 patients (the TC-Dynamic group) were followed up, who had been implanted with the TC-Dynamic posterior stabilized prosthesis from September 2003 to March 2004. Preoperative KSS knee scores were 16.08 +/- 11.58, function scores 13.75 +/- 19.79, and the range of motion (ROM) of the knee 75.00 +/- 26.46 degrees. Meanwhile, 50 knees of 30 patients (the Scorpio group) were followed up, who had undergone TKA with the Scorpio posterior stabilized prosthesis. Preoperative KSS knee scores were 19.48 +/- 9.67, function scores 3.16 +/- 19.82, and the ROM of the knee 80.80 +/- 22.82 degrees. The anteroposterior and lateral X-ray films of each knee were examined before and after operation. The statistical Z-test was used to analyze the differences between the 2 groups in the improvement of the KSS knee scores, function scores, and ROM after operation. RESULTS: The average of the 130 days' follow-up revealed that the patients implanted with the TC-Dynamic prosthesis had an excellent result. In the TC-Dynamic group, the KSS knee scores were 88.83 +/- 4.04 with improved scores of 72.75 +/- 14.47 compared with those before operation; function scores were 79.17 +/- 5.15 with improved scores of 65.42 +/- 19.47; the ROM of the knee was 107.92 +/- 11.57 degrees with increased degrees of 32.92 +/- 32.22 degrees. Meanwhile, in the Scorpio group, the KSS knee scores were 85.68 +/- 7.36 with improved scores of 66.20 +/- 10.44 compared with those before operation; function scores were 71.40 +/- 12.70 with improved scores of 68.24 +/- 25.35; the ROM of the knee was 109.20 +/- 11.13 degrees with increased degrees of 28.40 +/- 26.41 degrees. There was no significant difference in the improvement of the KSS knee scores, function scores, and ROM after operation between the 2 groups (P > 0.01). All the X-ray films of the knees implanted with both the Scorpio prosthesis and the TC-Dynamic prosthesis were analyzed. No mal-alignment or lucent line with the prosthesis was seen in all these X-ray films. CONCLUSION: The short-term follow-up indicates that the patients implanted with the TC-Dynamic prosthesis have an excellent result. The TC-Dynamic prosthesis with a scientific and proper design is more suitable for the Chinese. However, the long-term outcome of the patients implanted with the TC-Dynamic prosthesis should be observed in a larger number of TKA operations. The basic surgical principles, including excision of both the cruciate ligaments and correction of the bone deformity with the proper balancing of the soft tissues in flexion and extension, are still crucial to successful TKA and to the long-term high survival rate of the knee prosthesis.