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。

Recent clinical comparison of mobile-bearing and fixed-bearing total knee arthroplasty

OBJECTIVE: To compare the preliminary effectiveness of mobile-bearing prosthesis and fixed-bearing prosthesis by literature review and observation of cases. METHODS: Ninety-eight knees of 94 patients undergoing total knee arthroplasty (TKA) by using cemented and PCL-substitute prosthesis were reviewed from February 2003 to October 2004. The diagnosis of all patients were osteoarthritis. All cases were followed up at least one year. Group A (fixed-bearing prosthesis): 30 knees of 29 patients, 4 males, 25 females, 20 DePuy Prosthesis, 10 Centerpulse Prosthesis. Group B (mobile-bearing prosthesis): 68 knees of 65 patients, 11 males, 54 females, 68 Centerpulse Prosthesis. Make sure statistical comparability between 2 groups by HSS, age and gender, respectively. Postoperation 6 weeks, 3 months, 6 months, 1 year, all cases were evaluated according to Hss and self-satisfaction. RESULTS: The grades of Hss in different stage were performed statistical analysis. P value in different stage was 0.414 (6 weeks), 0.108 (3 months), 0.235 (6 months), 0.452 (1 year). There were no significant difference between group A and B in different stage by statistical analysis. In one year after operation, the range of motion in 2 groups, group A: 108 degrees (95 degrees - 118 degrees), group B: 107 degrees (90 degrees - 120 degrees), there were no significant difference by ROM (P > 0.05). At the latest follow-up examination, group A: 13.7% of the patients (4 knee joint) complained mild pain, the percent of the patients' self-satisfaction was 90%; group B: 13.1% of the patients (9 knee joint) complained mild pain, the percent of the patients' self-satisfaction was 88%. CONCLUSIONS: Although it is certain about the effectiveness of preliminary clinical outcomes with mobile-bearing prosthesis, it is still uncertain about the advantage of mobile-bearing prosthesis over fixed-bearing prosthesis. The reason for preferring to the former still need being demonstrated.