探讨股骨假体屈曲角、胫骨平台后倾角对人工全膝关节置换术后关节活动度的影响。

选择2014年1月至2016年12月在广西壮族自治区龙潭医院接受人工全膝关节置换的387例患者病历资料进行回顾性分析，记录患者性别、年龄、身体质量指数、置换关节数、手术时间、术前关节活动度、术前最大屈膝度、术前美国特种医院(HSS)评分、术前疼痛评分、伴随疾病、个人史、康复介入时间、术后1 d疼痛评分、胫骨平台后倾角、股骨假体屈曲角。计量资料组内比较采用配对样本t检验，组间比较采用独立样本t检验，以术后1年患者关节活动度为因变量，其他参数为自变量行秩相关分析和多元回归分析，观察上述指标与术后1年膝关节活动度≥90°的相关性。

术前HSS评分为(47±10)分，术后1年HSS评分为(87±6)分，差异有统计学意义(t＝15.820，P<0.01)；术前关节活动度为(86±7)°，术后关节活动度为(106±9)°，差异有统计学意义(t＝6.058，P<0.01)。性别、术前关节活动度、术前最大屈膝度、术前HSS评分、胫骨平台后倾截骨角度与膝关节活动度呈正相关(P<0.05)；年龄、身体质量指数、置换关节数、术中出血量、术前疼痛评分、高血压、糖尿病、康复介入时间、术后1 d疼痛评分、股骨假体屈曲度与关节活动度呈负相关(P<0.05)；手术时间、吸烟、饮酒与术后膝关节活动度无显著相关性(P>0.05)。多元线性逐步回归分析结果显示，胫骨平台后倾截骨角度、股骨假体屈曲角、术前疼痛评分、术前关节活动度是影响膝关节置换术后1年关节活动度的独立因素(P <0.05)。

股骨假体屈曲角与全膝关节置换术后关节活动度呈负相关，胫骨平台后倾截骨角度与全膝关节置换术后关节活动度呈正相关。

To explore the effects of femoral flexion angle and tibial plateau tilt angle on the range of motion after total knee arthroplasty.

A total of 387 cases of total knee arthroplasty in department of orthopaedic, Longtan Hospital from January 2014 to December 2016 were retrospectively analyzed. Sex, age, body mass index, number of replacement joints, operation time, preoperative joint activity, preoperative maximum flexion, preoperative Hospital for Special Surgery (HSS) score, preoperative pain score, accompanying disease, personal history, rehabilitation intervention time, pain score of the postoperative first day, tibial plateau tilt angle, femoral prosthesis flexion angle of patients were recorded, paired t-test was used to compare the data in the measurement group. The independent sample t test was used to compare the joint activity of the patients in the one-year postoperative period. The other parameters were the rank correlation analysis and multiple regression analysis of the independent variables. The correlation between the above indexes and the knee range of motion over 90° at one year after the operation.

The preoperative HSS score was (47±10), and the HSS score at one year after operation was (87±6), the difference was statistically significant (t =15.820, P <0.01). The preoperative joint mobility was (86±7)°, and the postoperative joint mobility was (106±9)°, the difference was statistically significant (t =6.058, P <0.01). The Pearson correlation showed that there was a positive correlation between sex, preoperative joint activity, maximum flexion, preoperative HSS score, tibial plateau posterior truncation angle and knee joint activity (P <0.05). The age, body mass index, number of replacement joints, intraoperative bleeding, preoperative assessment of pain, hypertension, diabetes, rehabilitation intervention There was a negative correlation between time, pain score on the postoperative first day, femoral prosthesis flexion degree and joint activity (P <0.05), and there was no significant correlation between operation time, smoking, drinking and postoperative knee joint activity (P >0.05). The multiple linear stepwise regression analysis showed that the posterior tibial plateau angle, the femoral prosthesis flexion angle, the preoperative pain score, and the preoperative joint movement were independent factors affecting the joint activity one year after the knee joint replacement (P <0.05).

There is a negative correlation between the flexion angle of the femoral prosthesis and the degree of joint activity after total knee replacement, and the angle of tibial plateau posterior truncation is positively correlated with the degree of joint activity after total knee replacement.