运动学对线与机械对线全膝关节置换早期临床结果比较

doi:10.3877/cma.j.issn.1674-134X.2022.04.006

目的

探讨并对比分析应用专用工具的运动学对线全膝关节置换和机械对线全膝关节置换的早期临床结果。

方法

回顾性分析2019年3月至2021年3月间，在首都医科大学附属北京朝阳医院因膝骨关节炎行单侧全膝关节置换术，术后随访时间大于3个月且随访资料完整的患者，排除类风湿性关节炎等炎性关节病、髌股关节严重对位不良以及既往有膝关节侧副韧带或后交叉韧带损伤的患者；按对线方法分为专用工具运动学对线全膝关节置换(KA-TKA)组和机械对线全膝关节置换(MA-TKA)组，记录手术前后髋－膝－踝(HKA)角度，术前及术后3个月的膝关节临床评分(KS-C)和膝关节功能评分(KS-F)，术后3个月的遗忘关节评分(FJS)，采用独立样本t检验行统计学分析。

结果

共有162例患者纳入研究，其中KA-TKA组82例，MA-TKA组80例。两组患者术后HKA差异无统计学意义(P>0.05)；术后3个月KA-TKA组患者的KS-C评分(t＝2.259)、KS-F评分(t＝1.994)和FJS评分(t＝2.945)均高于MA-TKA组，两组间差异有统计学意义(均为P<0.05)。

结论

KA-TKA与MA-TKA相比，术后下肢力线相似，具有更好的临床评分表现和更高的膝关节功能表现，以及更高的FJS评分。

关键词: 骨关节炎，膝, 关节成形术，置换

Objective

To explore and compare the early clinical results between kinematic alignment using special tools and mechanical alignment in total knee arthroplasty.

Methods

A retrospective analysis was performed on patients who underwent unilateral total knee arthroplasty due to knee osteoarthritis with a follow-up time of more than three months and complete follow-up data.in Beijing Chaoyang Hospital, Capital Medical University from March 2019 to March 2021. The patients with inflammatory arthropathy such as rheumatoid arthritis, severe misalignment of patellofemoral joint, and previous knee collateral ligament or posterior cruciate ligament injury were excluded. According to alignment method, patients were divided into special tools kinematically aligned total knee arthroplasty (KA-TKA) group and mechanically aligned total knee arthroplasty (MA-TKA) group. The hip-knee-ankle (HKA) angle before and after the surgery, the knee joint clinical score (KS-C), the knee joint functional score (KS-F) before and three months after the surgery were recorded, as well as the postoperative forgotten joint score (FJS). Independent sample t test was used to compare the data.

Results

A total of 162 patients were enrolled, including 82 in the KA-TKA group and 80 in the MA-TKA group. There was no statistically significant difference in the postoperative HKA angle between the two groups (P>0.05). Three months after the surgery, the KS-C score (t=2.259), KS-F score (t=1.994) and FJS score (t=2.945) in the KA-TKA group were higher than those in the MA-TKA group, the differences between the two groups were statistically significant (all P<0.05).

Conclusion

KA-TKA has similar postoperative lower limb alignment, better clinical performance and higher knee function, and a higher FJS compared with MA-TKA.

Key words: Osteoarthritis, knee, Arthroplasty, replacement

图1 股骨远端髓内定位导板及插片的放置和固定。图A示定位板在内外翻平面上可进行±12°调整；图B~C示预置的2 mm厚度插片，紧贴股骨远端骨面进行定位并补偿软骨磨损

图3 胫骨侧髓外定位装置及应用。图A为垂直胫骨机械轴线放置髓外定位杆；图B为在原有的髓外定位杆上加装的与切骨导板相连接的角度卡盘，调整胫骨的切骨内外翻方向与原有的关节线方向相一致；图C为角度卡盘标尺，示可以在±8°的范围内进行内外翻调整

表1 KA-TKA与MA-TKA组患者术前资料比较(±s)

分组	例数	年龄(岁)	BMI(kg/m²)	术前HKA(°)	术前KS-C	术前KS-F
KA-TKA组	82	70±7	27±3	8±4	52±18	34±20
MA-TKA组	80	71±7	27±4	7±4	50±16	30±16
t值		0.924	0.243	0.301	0.570	1.331
P值		>0.05	>0.05	>0.05	>0.05	>0.05

表1 KA-TKA与MA-TKA组患者术前资料比较(±s)

分组	例数	年龄(岁)	BMI(kg/m²)	术前HKA(°)	术前KS-C	术前KS-F
KA-TKA组	82	70±7	27±3	8±4	52±18	34±20
MA-TKA组	80	71±7	27±4	7±4	50±16	30±16
t值		0.924	0.243	0.301	0.570	1.331
P值		>0.05	>0.05	>0.05	>0.05	>0.05

表2 KA-TKA与MA-TKA组患者术后3月随访资料比较(±s)

分组	例数	术后HKA(°)	术后3个月KS-C	术后3个月KS-F	术后3个月FJS
KA-TKA组	82	2.7±1.9	78.9±7.7	75.9±10.3	74.2±9.9
MA-TKA组	80	2.3±1.4	76.2±7.3	72.7±9.9	69.7±9.0
t值		1.528	2.259	1.994	2.945
P值		>0.05	0.025	0.048	0.004

表2 KA-TKA与MA-TKA组患者术后3月随访资料比较(±s)

分组	例数	术后HKA(°)	术后3个月KS-C	术后3个月KS-F	术后3个月FJS
KA-TKA组	82	2.7±1.9	78.9±7.7	75.9±10.3	74.2±9.9
MA-TKA组	80	2.3±1.4	76.2±7.3	72.7±9.9	69.7±9.0
t值		1.528	2.259	1.994	2.945
P值		>0.05	0.025	0.048	0.004

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Early clinical outcomes comparison of kinematic and mechanical alignments in total knee arthroplasty

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Early clinical outcomes comparison of kinematic and mechanical alignments in total knee arthroplasty