膝关节置换术后不同参照点测得关节线与膝关节功能的相关性研究

doi:10.3877/cma.j.issn.1674-134X.2019.02.008

目的

探讨人工全膝关节置换术(TKA)后选择不同参照点测量关节线(JL)变化与膝关节临床功能评估的相关性。

方法

回顾性分析于2015年5月至2017年5月在安徽省滁州市皖东人民医院骨科接受TKA手术的患者，分别以腓骨头、股骨内收肌止点、胫骨结节为参照点测量JL变化，评估术前及术后12个月后患者美国膝关节协会(KSS)评分、关节活动度(ROM)及Feller髌骨评分。将不同参照点下JL变化情况与KSS评分变化、ROM变化及Feller髌骨评分变化等资料进行相关性检验。

结果

与术前比较，术后患者KSS评分、ROM、Feller髌骨评分均显著增高(P<0.05)。以腓骨头、股骨内收肌止点为参照点测得的JL变化之间呈正相关性(r＝0.874，P<0.01)。术后12个月，以胫骨结节为参照点测得的JL变化，与TKA术后12个月KSS评分变化(r＝－0.521，P<0.01)、髌骨Feller评分变化(r＝－0.493，P<0.01)具有负向相关性。

结论

以胫骨结节为参照点测量JL变化，与TKA术后膝关节KSS评分变化、髌骨Feller评分变化呈负相关性；以胫骨结节为参照点测量JL变化能更好地评估TKA术后膝关节临床功能。

关键词: 关节成形术，置换，膝, 功能恢复

Objective

To investigate the correlation of joint line (JL) with different reference points after total knee arthroplasty (TKA) on clinical evaluation of knee joint function.

Methods

Cases of total knee arthroplasty treated with measurement osteotomy (MR) and PCL retained knee prosthesis in the orthopedic department of East Anhui people’s Hospital, Chuzhou, Anhui province, from May 2015 to May 2017 were retrospectively analyzed. JL changes were measured with fibular head, femoral adductor attachment and tibial tubercle as reference points, and the KSS score, ROM, and Feller patella score were evaluated before and 12 months after surgery. Correlation analysis between JL changes and KSS score changes, ROM changes and Feller patella score changes were conducted.

Results

Compared with preoperative, KSS score, ROM and Feller patella scores were significantly increased after TKA (P<0.05). There was a positive correlation between the JL changes measured by the fibular head and the femoral adductor attachment (r=0.874, P<0.01). At 12 months after surgery, the JL changes measured with the tibial tubercle as the reference point has negative correlations with the changes of KSS scores (r=-0.521, P<0.01) and the Feller patella scores (r=-0.493, P<0.01).

Conclusion

JL changes measured with tibial tubercle as a reference point is negatively correlated with changes in knee KSS score and Feller patella scores after TKA, so measuring JL changes with tibial tubercle as a reference point may better evaluate the clinical function of knee joint after TKA than with fibular head or the femoral adductor attachment.

Key words: Arthroplasty, replacement, knee, Recovery of function

图1 以腓骨头为参照点测量手术前后JL(关节线)变化图示。左图为右膝术前X线正位片、右图为右膝术后12个月X线正位片；图示由腓骨头最高点向股骨内、外侧髁关节面最远端连线作1条垂线，术前、术后长度分别为L1、L2，JL变化即为2者之差(L2－L1)

图2 以胫骨内收肌止点为参照点测量手术前后JL(关节线)变化图示。左图为右膝术前X线正位片、右图为右膝术后12个月X线正位片；由内侧髁干骺段骨皮质拐点处(股内收肌结节)，向股骨内、外侧髁关节面最远端连线作1条垂线，术前、术后长度分别为L3、L4，JL变化即为2者之差(L4-L3)

图3 胫骨结节为参照点下手术前后JL(关节线)变化测量图示。左图为右膝术前X线侧位片、右图为右膝术后X线侧位片；作胫骨前端与后端皮质连线(胫骨平台切线)，过股骨最低点作与胫骨平台切线的平行线(图中l’线)，由胫骨结节凸起向上述l’线，作1条垂线，术前、术后长度分别为L5、L6，JL变化即为2者之差(L6-L5)

表1 手术前及术后12个月膝关节临床功能评分变化[n＝28，(±s)]

评估时间	KSS评分(分)	ROM(°)	Feller髌骨评分(分)
术前	58±10	90±18	10±3
术后12个月	91±10	114±14	24±5
t值	22.873	9.975	21.155
P值	<0.05	<0.05	<0.05

表1 手术前及术后12个月膝关节临床功能评分变化[n＝28，(±s)]

评估时间	KSS评分(分)	ROM(°)	Feller髌骨评分(分)
术前	58±10	90±18	10±3
术后12个月	91±10	114±14	24±5
t值	22.873	9.975	21.155
P值	<0.05	<0.05	<0.05

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Correlation between knee joint function and joint line measured at different reference points after knee arthroplasty

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Correlation between knee joint function and joint line measured at different reference points after knee arthroplasty