根据患者类型选择不同类型人工膝关节假体植入后临床应用效果的回顾性分析

根据患者类型选择不同类型人工膝关节假体植入后临床应用效果的回顾性分析 根据患者类型选择不同类型人工膝关节假 体植入后临床应用效果的回顾性分析 中 Jo 国 urn 组 a 织 lo 工 fC 程 lin 研 ica 究 lR 与 e 临 ha 床 bil 康 ita 复 tive 第 T~s 77 u 卷 eE 第 ngine 朋 ering 20 R 0 e 7_ se 02 ar — ch 25 F 出 e 版 bruary25,2…007.V.o/..,,,N—o.8z5,”r?d Retrospectiveanalysisofthefunctionandclinical applicationsofdifferentkneeprosthesesafter implantation DongJi-yuan,ZhangJian,WangYan Abstract BACKGROUND:Thetotalkneereplacementisconsideredasoneofthemost effectiveandsuccessfuloperationstocure terminalorseveregonarthritis.Howtolowertherevisionrateaswellasincreas etheeffectofprosthesesaftertheknee replacementshouldbesolvedurgently., OBJECTIVE:TOretrospectivelyanalysetheclinicalapplicationsandcurativeeffectsofdifferentkneeprostheses DESIGN:Basedonpatientswhoacceptedkneereplacement.preoperativeandpostoperativeconditionwasobsewed andcomparedsoastocomparethepostoperativeeffectofdifferenttypesofkneeprosthesesreplacements. SE1-FING:DepartmentofOrthopedics.GeneralHospitalofChinesePLA. PARTICIPANTS:Atotalof398patients(523knees)wereselectedfr0mtheDepartmentofOrthopedics.GeneralHospi— talofChinesePLAfr0mJanuaw2002toJanuary2005,including276unilateralkneereplacements(276knees)and122 bilateralkneereplacements(244knees).Patientswerergspectivelydiagnosedasosteoarthritis(OA).rheumatoidarthritis (RA),ankylosingspondylitis(AS).pigmentedvillonodularsynovitis(PVNS).etc. METHODS:Accordingtothepathogeneticcondition,paUentsreceivedtotalkneereplacementswithdifferentkneepros— theses.Typesofkneeprostheses:? Accordingtothereplacingrange.itcouldbedividedintounicondylarprostheses andtotalcondylarprostheses;totalcondylarprosthesescouldbesubdividedintoposteriorcruciateligament(PCL~m- tainingandPCLosubstitutingprostheses.~)Accordingtothedegreeofmecha nicalconstraint.itcouldbedividedintoun. constrained,semiconstrainedorfuIlyconstrainedprostheses.? Accordingtowhetherimitatingmeniscus-function.it couldbedividedintotibialplateaurotatableslidingtypeandfixedtype.Follow-upwasconductedonpatientsthatmen. tionedaboveafterhalfayear.KneejointswerescoredbyusingkneeiointscoringsystemofAmericenspecialsurgicel hospl(HSSscoringwiththetotaIscoreof1oopoints,thoseabove85wereconsideredasexcellent;70—84asgood; 60-69asfainbelow60aspoor).Fellerscoring(totalscoreof30points;thehigherthepointswere.thebetterthesymp- tomwas)cntenawasusedinpatellarscoring.Investigationandcomparisononpain-degreeofanteriorregionofknee. rangeofmotionofkneejointandthestabilizationweredonedunngthefoIlow-up.apandlateralviewsofpatellafr0m30 degreesand90degreesweretakeninradiography. MAINOUTCOMEMEASURES:PreoperativeandpostoperativescoresofHSS,patella.antenorpainofknee.functionof patella,themaximumflexionandtibiofemoralangle. RESULTS:Follow-upwasconductedin372patients(490knees)withthefollow-uprateof93.4%.?Therapeuticeffect: Excellentandgoodrateoftheoperationwas89%.Painandfunctionofpatients afteroperationwereobviouslyamelio. rated.effectonpain?ameliorationandrangeofmotionofkneejointactivationweresignificant.?ScoreofHSS.patellar. anteriorpareofknee,functionofpatellarandthemaximumflexionweremarkedlyincreasedthanthosebeforeoperation (P《0.01).? TherewerenomarkedsignificencesincomparisonofscoreofHSS,patellar,anteriorpainofknee.func- tionofpatellar.themaximumfiexionandtibiofemoralangleondifferentkneeprosthesesreplacementsfP>0. 05). CONCLUTION:Prosthesesshouldbechosencarefullyandappropriatelyaccordingtotheindications. contraindicetions anticipatedattainablefunctions.servicelifeaswellaspathogeneticconditions.andthensatisfactoryCurativeeffectwi ? _NTRoDUCT_oN Currently.thetotalkneereplacementisconsideredas oneofthemosteffectiveandsuccessfuloperationsto CureterminaIorseveregonarthdtis.W.1hrapiddevelop- mentofthetechniqueandincreasingtypesofkneepros. thesesinrecentyears.somemainproblemsshouldbe soIvedurgently.includinghowtochoosecases. howto termloosening chooseprostheses.howtopreventlong— andwearofprostheses.howtoIowertherevisionrateas welIasincreasethesurvivalrateofprosthesesafterthe kneereplacement.Thisstudyretrospectivelyanalyzedthe 沈阳1200邮政信箱110004kf23385083@sina.comwww.zglckf.com kneereplacementsinourhospitalinrecent3yearsand discussedtheclinicalapplicationsandcurativeeffectsof differentkneeprosthesesaccordingtopathogeneticcon— dRionofpatients. SUBJECTSANDMETHoDS Subiects At0lalof398patients(523knees)wereprovidedby.n DepartmentofOrthopedics.GeneralHospitalofChinese PI_Afr0mJanuary2002toJanuary2005.1nclusioncriteri. a:?Thediagnosisreferredtotheosteoarthdtis(OA)and rheumatoidarthritis(RA)diagnosticcdteriaformulatedby ‘DepartmentofOrtho- pedics.GenmaIHos- PitaIorChinesePLA. Beijing100853.Chi? na:epartmentof Orthopedics.GeneraI HospitalofLiaoyuan MiningAdministration. Liaoyuan136201. JilinProvince.China DongJi-yuan.Pro- fessor,Master’stu- tar.Departmemof Orthopedics,GelrteraI HOsDitalofChinese PLA.B~jing 100853.China Received:2006-08-20 Accepted:2006-09-15 (06-50-6-5056/SN) DongJY,ZhangJ. WangY.Retrospective analysisofthe functionandcIinicaI applicationsOf differentknee prosthesesafter implantationZhong. guoZuzhiGongcheng YanjiuyuLinchuang Kangfu2007;11(8): 1563.1566(China) [vw,w.zglckf.om/ zgtckflejoumal/ uPfiles/07-8/ 8k-1563(ps).pdf] 1563 ISSN1673-8225CN21?1539/R 董纪元,等根据患者类型选择不同类型人工膝关节假体植入后的临床应用效果回顾性分析Hzkf23385083~s— ina,o — om AmericanRheumaticDiseaseAcademy11】.(AIlpatientsprovided informedconsent.Exdusioncriteria:Patientsweretreatedwithoth- ertherapiesorwithoutanytherapies.Therewere125malesand 273femalesagedfr0m451081yearswiththemeanageof 63.6vears.Amongthem,therewere279unilateraIkneere- placements(279knees1and122bilateralkneereplacements (244knees).PatientswererespectivelydiagnosedasOA,IRA,anky- losingspondylitis(AS),pigmentedvillonodularsynovitis(PVNS), prostheticlooseningafterkneereplacement.limb-salvageformalig— nantbonetumoraroundkneeioint,etc.OAoccurredfn348knees, RAIn91knees.bonetumorandkneejointrevisionin84knees. Typesofkneeprostheses Firstly,accordingtothereplacingrange,itcouldbedividedintou- nicondylarprostheses(29knees)andtotaIcondylarprostheses f494knees);totalcondylarprosthesescouldbesubdividedintopos- teriorcruciateligament(PCL)retaining(303knees)andPCL—sub- stitutingprostheses(191knees).Secondly,accordingtothedegree ofmechanicaIconstraint.itcouldbedividedintofullyconstrained (84knees),semiconstrained(187knees)andunconstrainedpros. theses(252knees).Thirdly,accordingtowhetherimitatingmenis— cus-function.itcouldbedividedjntotibialplateaurotatablesliding type(281knees)andfixedtype(242knees).Fourthly,allprostheses werecemented.Allofaboveoperationsalwayspreservedpatellas andperformeddenervation. Designer,implementerandsupervisor Thefirstauthorisdesignerandsupervisor.alItheauthorsareimple. menter.Theirprofessionaltitlesareallaboveattendingphysician. TheyallhavereceivedstricttrainingstoHospitalforSpecialSurgery (HSS)scoring,patellascoring,anteriorpainofkneescoring,function ofpatellascoringandstatistics. Methods Theoperationwasperformed4Jndergeneralanaesthesiaandepidu. 阳lanaesthesia.Aeratedthightourniquet,exposedthekneeioint throughastraightlongitudinalincision,enteredthejointfromtheme— diaIborderofthepatella,thoroughlyexcisedmembranasynovialis andmenisci,partlyexcisedthefatpadbelowthepatella.Released tibialand/orfibularcoilateraIligamentandposteriorarticularcapsule tobalancethesofttissueaccordingtopatient’scondition.Setthe tibiofemoralangleto5to7degreesofvarus,choseappropriatetibial plateauprosthesiswiththeprinciplethatkneeiointcouldfullyextend andkeepstable.Fixedtheprosthesiswithbonecement.performed denervationaroundpatellaandpatellaarthroplastyi.releasedreti- naculumpatellaewhennothumbtestwaspositiveaftertrialreduc. tion【3】.stoppedbleedingcompletely.Setnegative-pressuresuction drainIandpressuredressingaftersurgery.Passiveflexion-exten- sionexercisesshouldstartwithin24hoursaftersurgery,removed thenegative-pressuredrainagetubewhendrainagevolumewasless than5omLper24hours:startedactiveandPassiveflexion-exten. sionexercisesofkneejoint15],beganfr0m40degreesofflexionin 10degreesincrementseachday.Allthisgroupofpassiveflexion couldreach90degrees. Evaluationoffunction KneejDintswerescoredbyusingkneejointscor’ingsystemof HSSt.J:Thetotalscorewas1OOpoints,including3Op0intsforpain, 22f0rfunction,18f0rrangofmotion,1Of0rmV0dynamia.1Of0r stabilityand1Of0rflexiondeformity.Thoseabove85wereconsid. eredasexcellent;70—84asgood;60—69asfair;below60aspoor. FellerscoringcriteriaI】wasusedinpatellascoring:Thetotalscore was30points.including15pointsforpain.1Of0rfunctionand5for myodynamiaofquadricepsfemoris. condyleortotalkneereplacementsandwerefoIlowedupbyphone inquisitionorre-examinationinout—patientclinichalfyearafteroper- ation.AtotaIof372cases(490knees)wereconducted,accounting f0r93.4%ofthewholecohort.Kneeiointexaminationwasdonedur- ingthefollow-up.anteroposteriorandIateraIviewsofpatellafrOm3O degreesand90degreesweretakeninradiography. Statisticalanalysis Thepreoperativeandpostoperativeconditionsofpatientswereanal- ysedwithuseofmatchedpairsftestwithStatasoftwarebythesec- ondauthor.andsignificantstatisticaldifferencewassetatP<0.01. Thepostoperativeconditionsofdifferenttypesofkneeprostheses replacementswereanalysed,IvithuseofANOVA.therewasnosig- nificantdi仟erencefP>0.05). RESULTS Quantitativeanalysisoftheparticipants Among398cases(523knees).follow-upwereconductedln372 cases(490knees),26patientswerelosttofollow-up.whosemain reasonswerechangingofphonenumber,refusingtoreply,register- ingincompletelyorincorrectly.Atotalof372casesenteredanalysis ofresults. Comparisonofpreoperativeandpostoperativeindexes (Table1) HSS:HospitalforSpecialSurgery Comparisonofpostoperativeindexesofdifferenttypes ofkneeprosthesesreplacements Comparisonofpostoperativefollow-upconditionsofposteriorstabi- lizedandPCL-retainingfixedmobileplateauprosthesesandPCL-re? tainingmobileplateauprostheseswasshowninTable2. HSS:HospitalforSpecialSurgery;PCL:Posteriorcruciateligament Comparisonofpostoperativefollow-upconditionsofunconstrained, semiconstrainedandfullyconstrainedprostheseswasshownin Table3. Analysisofcurativeeffects Criteriaoffollow.upExcellent:366knees(70%):good:99knees(19%):passable:46 Allthe398patients(523knees)withOAorIRAhadreceivedsingleknees(8.8%):poor:12knees(2.2%). 1564P0.Box1200.Shenyang110004kf23385083@sina.cornwww.zglckf.com ISSN1673-8225CN21-1539/R 董纪元,等.根据患者类型选择不同类型人工膝关节假体植入后的1 应塾墨墅坌塑苎!竺!! Fu?yconstrainedcondy?arprosthes?s ThefemoraIandt.biaI?mponents0fhing争r0tatlngpmstnesesare anatomica?ydesigned,whihcanpmvidegreater?ntadareabe— tweenDrDsthesisandboneandcanavoidpn)stI1eticentrapplngdue tooveH)ressuretospongybone.BDthfemoraIand曲ial?mpo— nentshaveIongstemandarecementedinman.cfwcaVlty,bywhlcn stressesaredispersed.TheprosthesescanIoCkr0tationinhyperex_ tensionandiust阡y?ne0ff0rcebyiIseIf.Advantages0fthepr0slhe— ses:?reduceIimitation:?manipuIationissimpIe.exactprosthetic centengandminimaIboneresectioncanbeachieved.EspeciaIly, suitabIet0patientswhosuffleredfr0mseverekneejointdiseases withtibiaIpIateaudefed.?L0adcanbedeliveredbyhingeand pOIyethyleneontibiaIpIateau,whichn0tonIycanin1pn)vemechanics effect0fknee joint,morethan15degrees0fvanJsder0rmity,morethan25de— grees0fvaIgusdr0mty,sem.1uxation,Iigamentdrectorderault ?mpIicatedmassivebonedefect(especia?ybonedefect,?ithan— te巾postenorinstab.1).?Severe0steopo巾sisthoute仟ective mechanicaIsupport.?Un?nstrainedpr0stheticfaiIure:senilepa— tients,IvithdistaIfemurfracturewhoreauiret0rest0refunctionsas earIyaspOss.b’嘲. REFERENCES 5 6 13 14 manR,AschE,BlOchD,elaI.Dve10pmenl0fce—af0rthedass_m— cati0nand怕p0rting0f0steoarthis.CIass币catbn0f0steoarthmis0f theknee.D_旧gnosticandThe陷peuticCteac0mmittee0ftheAme— canRheumaUsmAss0ciali0n.AnhmisRheum19乏I6:29(8):1031O49 Sco札WN.CIan’eHD.R0utinepatellarresurFacing:aviable00n.O卜 th0pedics2000:26(7):684?686 触ibeckMJ.Cama陷taD,T陷ugerJ.eta1.1ndicati0nsf0rlate陷Ire nacuIarrelease|nt0talkneereplacement.cI|nOrth0p2003:(414): 157—161 W.1lemenD,PauIJ,WhiteSH,eta1.Cl0sedsucti0nd陷inagef0llawing kneeanh?plasty.E仟ectivenessandnsks.ClinOrth0p1991:(264): 232?134 M_圆erRL.stvensJE,Snyde卜MacklerL.VoIuntary鼬aonanddeI creasedf0rceproducti0n0fthequadncepsfem0nsmuscIeaftert0taI kneearthr0pIasty.PhysTher2003:83(4):35365 lnsa?JN,Rana旧tCS,Ag盯ettiP,eta1.A?mpans0naff0urmodeIs0f 吲knee怕placementpheses.JB0neJ0intSurqAm1976:58(6): 754-765 FellerJA.BartlettRJ.LangDM.Palellar怕su哟cingversusrelenli0n.n t0talkneearth?pIasty.JB0neJ0.nlSurgBr1996:78(2):226-228 LjuZH.YangQM.Newprc.9ress0fartmcialj0int.Zh0nghuaChuangshang GukeZazhi20o4,6(2):210-212 S.TecanaleEng,LuS—BTransng.CampbelrsOpe陷veO卜 th0paedics.9med.Jinan:Shand0ngScienceandTechn0logyPublish_mg House.2001:238 WealeAE.HalabiOA,J0nesPW,eta1.Pe啪pU0ns0f0uI?mesa代er uni?mpartmentalandt0talkneereplacements.C1.nOrth0p2O01:(382): 143 Aclcr『dCE.Medial?mpartmenlarth?plasty0ftheknee.JEneJ0inl SufgBr2003:85(7):937 DennD.K0mistekR.ScudeG.eta1.1nviv0three_dimensi0naldete卜 mina砸0n0fkinematicsf0rsubiectsw叶’an0rn1alknee0rauni?mpar卜 men0rtaknee怕placement.JB0neJ0.ntSufgAm2001:83_A (Sup口I):1O4 Ch|uI<Y.NgTP.TangWM.eta1.Reviewacle:knee翻e)’j0na代ertOtal kneeanh?plasty.JOrth0pSufg(H0ngK0ng)2002:10(2):194?202 UG,ZayonS.M0slE.ela1.Cruciale?怕ta_ningandcruciateIsubs1.tul_ ingt0talkneearth?plasty=an.nvn??mpa0n0fkinematicsunder musdeloads.JAnh?plasty2001:16(8supply1):150-156 15S0啊erJl,FedeneD.Kin’PG.eta1.ThepOsten0rcnJciateligamentin t0taIkneearth?pIasty.JAnh?pIa1997:12(8):86g_79, 16LvHS.Pnospectandstatusqu00ft0taIkneerepIacement.Zh0nghua waikeZai20o4:42(1):30_33 17A叼ens0nJN,AubaniacJM.T0taIkneearth?pIasty.nfem0r0tibial insi咐.Orthopade2000:29supp’y1:s45_47 18wangcJ.wangHE.Ea—ycatasI?phicfa.1u怕0frota1.帼hinget0taI kneephesis.JAnhr0pIasty2000:15(3):387_391 19Camer0nHU.HuC.Vyam0ntD.Hinget0talkneereplacementrevisited. CanJSufg1997:40(4):278.283 20ShihLY.S.mFH.PmchardDJ.elaI.SegmenlaIl0talkneearth?pIasty af【erdistaIfem0陷IresecIi0nf0rlum0r.CIinOrth0p1993:292:26281 根据患者类型选择不同类型人工膝关节假体 植入后临床应用效果的回顾性分析 董纪元’,张健,王岩’ ‘解放军总医院骨科,北京市1OO853;辽源矿务局总医院骨科,吉林 省辽源市1362O1 董纪元.男,1957年生,吉林省长春市人,汉族,1983年白求恩医科大学 毕业,教授,硕士生导师,主要从事人工关节及矫形方面的研究. 摘要 背景:人工全膝关节置换术被认为是治疗终末期或严重的膝关节炎的最 有效,最成功的手术之一.如何降低假体返修率,提高膝关节置换术后的 疗效是亟待解决的主要问题. 目的:回顾性分析不同类型人工膝关节假体的临床应用及其疗效. 设计:以膝关节置换术后患者为观察对象,手术前后对照观察,以对比不 同类型人工膝关节假体置换术后效果. 单位:解放军总医院骨科. 对象:选择解放军总医院20O2一O1,20O5一O1收治的398例患者(523个 置换膝关节),其中单膝关节置换术276例.276膝,双膝同时置换122 例,244膝.诊断分别为骨性关节炎,类风湿关节炎,强直性脊柱炎,色素 绒毛结节性滑膜炎. 方法:根据患者病情适当选择不同类型人工膝关节假体进行全膝关节置 换术.假体的类型包括:?按置换范围,分单髁,全髁型;在全髁置换分为 后交叉韧带保留型和后交叉韧带替代型假体.?按限制程度又分限制 性,非限制性和半限制性.?按是否模拟半月板功能.又分为胫骨平台垫 可旋转滑动型和固定型.半年后对以上患者进行随访,膝关节评分采用 美国特种外科医院膝关节评分系统(HSS评分,满分为100分,85分以 上为优:7O,84分为良:6O,69分为尚可:6O分以下为差),髌骨评分采用 Fe?er等评分(满分3O分,得分越高越好),随访时调查膝前区疼痛 轻重,膝关节活动范围及稳定程度比较,拍摄膝关节正,侧及髌骨3O., 90.轴位X射线片. 主要观察指标:患者手术前后HSS评分,髌骨评分,膝前痛评分,髌骨 功能评分,膝关节最大屈曲度,股胫角. 结果:完成随访372例(49O膝),随访率93.4%.?疗效:手术优良率 89%.患者术后在疼痛,功能方面都有明显改善.尤其在缓解疼痛及膝关 节活动范围方面效果显着.?患者术后随访的HSS评分,髌骨评分,膝 前痛评分,髌骨功能评分,最大屈膝度均较术前增加(P<O.O1).?不同 类型人工膝关节