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中华关节外科杂志(电子版) ›› 2018, Vol. 12 ›› Issue (01) : 24 -29. doi: 10.3877/cma.j.issn.1674-134X.2018.01.005

所属专题: 文献

临床论著

自制组配式截骨工具行微创膝关节置换术的早期随访结果
何沛恒1, 徐栋梁1,(), 李帅华1, 李兴1, 黄帅1, 瓦庆德1, 张娟1   
  1. 1. 510080 广州,中山大学附属第一医院关节外科
  • 收稿日期:2015-05-14 出版日期:2018-02-01
  • 通信作者: 徐栋梁
  • 基金资助:
    中山大学临床医学研究"5010"计划项目(2010005); 广东省自然科学基金(2015A030310451)

Early follow-up outcomes of homemade modular osteotomy instrumentation in minimally invasive total knee arthroplasty

Peiheng He1, Dongliang Xu1,(), Shuaihua Li1, Xing Li1, Shuai Huang1, Qingde Wa1, Juan Zhang1   

  1. 1. Department of Joint Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
  • Received:2015-05-14 Published:2018-02-01
  • Corresponding author: Dongliang Xu
  • About author:
    Corresponding author: Xu Dongliang, Email:
引用本文:

何沛恒, 徐栋梁, 李帅华, 李兴, 黄帅, 瓦庆德, 张娟. 自制组配式截骨工具行微创膝关节置换术的早期随访结果[J]. 中华关节外科杂志(电子版), 2018, 12(01): 24-29.

Peiheng He, Dongliang Xu, Shuaihua Li, Xing Li, Shuai Huang, Qingde Wa, Juan Zhang. Early follow-up outcomes of homemade modular osteotomy instrumentation in minimally invasive total knee arthroplasty[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2018, 12(01): 24-29.

目的

评价自制组配式截骨工具行微创全膝关节置换术的临床及早期随访效果。

方法

对95例中山大学附属第一医院关节外科行全膝关节置换的重度膝关节骨关节炎的患者随机分组,分别使用自制组配式截骨工具行微创全膝关节置换术或常规全膝关节置换术。对患者术前、术后的膝关节评分法(KSS)、视觉模拟评分法(VAS)、X线影像学(下肢力线、股骨角、胫骨角和胫骨平台后倾角)进行随访对比研究,微创组和传统组之间的差异采用独立样本t检验进行比较。

结果

成功随访2年以上的手术患者87例,其中微创组42例,传统组45例。微创组手术时间比传统组长(t=9.275,P<0.05),但两组在术中出血量、输血量、引流量的比较无统计学差异(P>0.05)。两组患者均未出现皮肤坏死,深部感染和神经血管损伤的并发症。下肢力线、股骨角、胫骨角和胫骨平台后倾角比较无统计学差异(P>0.05)。术后2周内,KSS评分、VAS评分微创组要优于传统组(t=1.518,P<0.05)(除外术后第2周KSS临床评分),但术后3月后两组比较无统计学差异(P>0.05)。

结论

自制组配式截骨工具行微创全膝关节置换手术早期的临床效果要优于常规人工全膝关节置换术,两组的影像学结果相当,但尚需更长时间的随访以全面评价其临床疗效。

Objective

To evaluate the clinical efficacy of applying self-designed modular osteotomy instrumentation in minimally invasive total knee arthroplasty and the outcomes of the early follow-up.

Methods

A total of 95 patients with severe osteoarthritis of the knee underwent total knee arthroplasty in the First Affiliated Hospital of Sun Yat-sen University were randomly divided into the minimally invasive and conventional groups. The minimally invasive group were treated with minimally invasive total knee arthroplasty applying self-designed modular osteotomy instrumentation. Preoperative and postoperative Knee Society score (KSS), visual analogue scale (VAS) and Ⅹ-ray image data (axial alignment of lower extremity, femural angle, tibial angle and posterior tibial slope, ) were statistically compared between two groups by subsequent follow-up by student t test.

Results

In total, 87 patients were followed up for over two years, 42 in the minimally invasive group and 45 in the conventional group. In the minimally invasive group, the operation time was considerably longer than that in the conventional group (t=9.275, P<0.05). Intraoperative hemorrhage, transfusion and drainage volumes did not significantly differ between two groups (all P>0.05). No skin necrosis, deep infection or nerve blood vessel injury was observed in two groups. X-ray imaging data, such as axial alignment of lower extremity, femoral angle, tibial angle and posterior tibial slope did not significantly differ between two groups (all P>0.05). During two-week follow-up, parameters including KSS, VAS in the minimally invasive group were significanly higher than those in the conventional group (t=1.518 P<0.05), except KSS clinical score at postoperative two weeks which was not significant different (P>0.05). However, the scores of each parameter did not significantly differ between two groups after three-month follow-up(P>0.05).

Conclusion

Minimally invasive total knee arthroplasty using the self-designed modular osteotomy instrumentation yields higher short-term clinical efficacy and a similar radiological results compared with conventional artificial TKA; the whole clinical efficacy remains to be further investigated by a longer follow-up.

图1 微创膝关节置换手术过程。图A术前定位;图B手术切口;图C胫骨平台截骨;图D股骨远髁截骨;图E安装股骨截骨定位支架;图F安装股骨假体型号测量;图G股骨前髁截骨;图H股骨髁间窝截骨
表1 KSS临床及功能评分(±s)
表2 VAS评分各时间点对比(±s)
表3 术后两组力线角度偏差对比[°,(±s)]
表4 两组手术情况对比(±s)
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