单髁与全膝关节置换术后步态与平衡能力比较

doi:10.3877/cma.j.issn.1674-134X.2020.01.003

目的

探讨膝关节单髁置换术(UKA)和全膝关节置换术(TKA)术后步态及平衡能力。

方法

回顾安徽医科大学第一附属医院和安徽医科大学第四附属医院骨科2016年1月至2017年12月间进行的70例膝关节手术患者，根据手术方式不同分为UKA组和TKA换组；另外招募35名无髋膝关节疼痛和髋膝关节活动功能障碍病史的健康老年人作为健康对照组(对照组)。纳入标准：膝内侧间室骨关节炎，交叉韧带和侧副韧带结构完整，非术侧下肢无严重疾病。排除标准：有神经性疾病及其他的严重下肢疾病，双侧膝关节同期关节置换患者，身体质量指数(BMI)>30 kg/m²。UKA组男14例、女21例，平均年龄(63.4±7.0)岁；TKA组男13例、女22例，平均年龄(65.0±6.1)岁；对照组男16例、女19例，平均年龄(64.6±7.1)岁。全部病例均由同一主刀医师完成。记录术后步态和单足站立稳定性参数，包括步速、步频、步长、单足支撑相(SLS)、足底压力中心(COP)路径长度、90%COP包络面积。年龄、BMI、步态运动学参数、稳定性参数采用单因素方差分析和Tukey检验，3组性别比较采用卡方检验，UKA组和TKA组HSS评分比较采用独立样本t检验。

结果

两组术后平均随访(23±15)个月。所有患者均无假体松动下沉、脱位及对侧间室病变。UKA组在SLS、COP路径长度、90%COP包络面积优于TKA组(P < 0.05)，UKA组与正常对照组比较，COP路径长度、90%COP包络面积差异有统计学意义(P < 0.05)。

结论

UKA术后步态和平衡能力优于TKA，但平衡能力与正常老年人仍有差别。

关键词: 关节成形术, 置换, 膝, 步态, 姿势平衡

Objective

To investigategait kinetics and balance after unicompartmental knee arthroplasty(UKA) and total knee arthroplasty(TKA).

Methods

A retrospective study of 70 patients with knee replacement in the First Affiliated Hospital of Anhui Medical University and the Fourth Affiliated Hospital of Anhui Medical University from January 2016 to December 2017 was carried out, and they were divided into UKA group and TKA group according to the different operation methods. Thirty five healthy elderly people without history of hip and knee pain or dysfunction were recruited as the control group. Inclusion criteria: medial compartmental knee osteoarthritis with intact cruciate ligament and lateral collateral ligaments, no serious disease of the lower limbs on the non operative side. Exclusion criteria: neurological diseases and other serious lower extremity diseases, bilateral knee replacement at the same time, body mass index (BMI)>30 kg/m².In the UKA group, there were 14 males and 21 females, with an average age of (63.4±7.0)years. The TKA group included 13 males and 22 females with an average age of (65.0±6.1)years old. In the control group, there were 16 males and 19 females with an average age of (64.6±7.1) years. All the cases were completed by the same surgeon. The gait and postural balance parameters were recorded, including gait speed, step length, cadence, single-limb support phase(SLS), center of pressure (COP) path length, 90 %COP postural sway area. One-way ANOVA and Tukey test was applied in age, BMI, gait kinematics parameters and postural balance parameters. Chi-square test were used for gender comparison of three groups. t test was used for HSS score comparison of UKA group and TKA group.

Results

The average follow-up period was (23±15)months. No prosthetic loosening, dislocation, lesions of contralateral compartment joint developed. SLS, COP path length and 90 %COP postural sway area of UKA group were better than those of TKA group (P<0.05). There were significant differences in terms of COP path length and 90 %COP postural sway area between the UKA group and the control group (P<0.05).

Conclusion

This study shows gait kinetics and balance after UKA may be superior to THA, but the balance is still inferior to the normal elderly.

Key words: Arthroplasty, replacement, knee, Gait, Postural balance

图2 单足站立时COP(压力中心)移动轨迹图，椭圆形面积为包含90% COP移动轨迹的面积

表1 参试者基本资料结果比较(±s)

组别	例数	年龄(岁)	性别(男/女)	BMI(kg / m²)	术前HSS评分(分)
UKA组	35	63.4±7.0	14 / 21	23.8±2.8	46.3±5.8
TKA组	35	65.0±6.1	13 / 22	24.3±3.1	45.2±5.2
对照组	35	64.6±7.1	16 / 19	22.6±3.2	NA
统计值		F＝0.532 9	χ²＝0.551 4	F＝2.89 5	t＝0.835 4
P值		>0.05	>0.05	>0.05	>0.05

表1 参试者基本资料结果比较(±s)

组别	例数	年龄(岁)	性别(男/女)	BMI(kg / m²)	术前HSS评分(分)
UKA组	35	63.4±7.0	14 / 21	23.8±2.8	46.3±5.8
TKA组	35	65.0±6.1	13 / 22	24.3±3.1	45.2±5.2
对照组	35	64.6±7.1	16 / 19	22.6±3.2	NA
统计值		F＝0.532 9	χ²＝0.551 4	F＝2.89 5	t＝0.835 4
P值		>0.05	>0.05	>0.05	>0.05

表2 参试者HSS评分及步态运动学参数比较(±s)

组别	例数	术后HSS评分(分)	步速(m / s)	步频(步/ min)	步长(m)	单足支撑相(%)
UKA组	35	85.10±4.90	1.04±0.08	103.50±6.80	0.59±0.06	39.80±2.50^a
TKA组	35	81.30±5.20^a	1.02±0.06	102.80±8.70	0.58±0.05	38.20±2.80^ab
对照组	35	NA	1.07±0.11	105.40±9.70	0.61±0.06	40.10±3.00
统计值		t＝3.146	F＝3.009	F＝0.8798	F＝2.526	F＝4.744
P值		<0.05	>0.05	>0.05	>0.05	<0.05

表2 参试者HSS评分及步态运动学参数比较(±s)

组别	例数	术后HSS评分(分)	步速(m / s)	步频(步/ min)	步长(m)	单足支撑相(%)
UKA组	35	85.10±4.90	1.04±0.08	103.50±6.80	0.59±0.06	39.80±2.50^a
TKA组	35	81.30±5.20^a	1.02±0.06	102.80±8.70	0.58±0.05	38.20±2.80^ab
对照组	35	NA	1.07±0.11	105.40±9.70	0.61±0.06	40.10±3.00
统计值		t＝3.146	F＝3.009	F＝0.8798	F＝2.526	F＝4.744
P值		<0.05	>0.05	>0.05	>0.05	<0.05

表3 参试者稳定性参数比较(±s)

组别	例数	COP路径长度(mm)	90%COP包络面积(mm²)
UKA组	35	584±224^ab	493±197^ab
TKA组	35	752±291^ab	875±296^ab
对照组	35	458±108	368±117
F值		15.59	52.28
P值		<0.01	<0.01

表3 参试者稳定性参数比较(±s)

组别	例数	COP路径长度(mm)	90%COP包络面积(mm²)
UKA组	35	584±224^ab	493±197^ab
TKA组	35	752±291^ab	875±296^ab
对照组	35	458±108	368±117
F值		15.59	52.28
P值		<0.01	<0.01

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Comparison of gait and balance in total and unicompartmental knee arthroplasties

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Comparison of gait and balance in total and unicompartmental knee arthroplasties