两种假体组合全膝关节翻修的比较
Comparison of total knee revision with two prosthetic combinations
孙博 1曹耀威 1李科伟 1侯颖周 1王少华 1王金良1
作者信息
- 1. 郑州市骨科医院关节病科Ⅱ,河南郑州 450000
- 折叠
摘要
[目的]比较膝关节翻修术(total knee revision,TKR)使用Sleeve系统与髁限制性假体(constrained condylar knee,CCK)结合垫块的临床疗效.[方法]回顾性分析2017年3月-2020年11月53例在本院行TKR患者的临床资料,根据术前骨缺损情况,结合术前规划及医患沟通结果,22例采用Sleeve系统(Sleeve组),31例采用CCK结合垫块(CCK组).比较两组围手术期、随访及影像资料.[结果]两组患者均顺利完成手术,Sleeve组骨缺损显著大于CCK组[(1.8±0.7)cm vs(1.0±0.4)cm,P＜0.001],但是,前者垫片厚度显著小于后者[(11.2±4.2)mm vs(14.4±5.8)mm,P=0.032].两组手术时间等围手术期指标差异均无统计学意义(P＞0.05),Sleeve组的总治疗费显著多于CCK组[(11.6±2.3)万元vs(9.9±2.5)万元,P=0.015].随访时间平均(36.0±3.5)个月,术后随时间推移,两组VAS评分、KSS临床及功能评分、OKS评分、膝伸-屈ROM均显著改善(P＜0.05).术前Sleeve组的OKS评分[(44.3±10.3)vs(38.2±8.6),P=0.023]显著差于CCK组,但是,术后1个月及末次随访时,两组上述指标的差异均无统计学意义(P＞0.05).影像方面,与术前相比,末次随访时两组HKA、MAD均显著改善(P＜0.05),关节线高度无显著变化(P＞0.05).末次随访时,Sleeve组的关节线高度显著小于CCK组[(20.4±6.0)mm vs(23.4±4.7)mm,P=0.047].[结论]2种假体组合均可获得优异的临床疗效、良好的下肢力线以及假体稳定性.Sleeve在恢复关节线高度、修复更大骨缺损方面更有优势,但需警惕术中骨折发生.
Abstract
[Objective]To compare the clinical efficacy of total knee revision(TKR)using Sleeve system versus constrained condylar knee(CCK)combined with augment.[Methods]A retrospective study was done on 53 patients who received TKR in our hospital from March 2017 to November 2020.According to preoperative bone defects,combined with preoperative planning and surgeon-patient commu-nication,22 patients had TKR performed with Sleeve system(Sleeve group),while other 31 patients were treated with CCK combined with augment(CCK group).The perioperative,follow-up and imaging data of the two groups were compared.[Results]All patients in both groups had TKR performed smoothly,and the Sleeve group had significantly longer bone defect than the CCK group[(1.8±0.7)cm vs(1.0±0.4)cm,P＜0.001],while the former had significantly thinner pad used less than the latter[(11.2±4.2)mm vs(14.4±5.8)mm,P=0.032].There was no statistical significance in perioperative items,such as operation time,between the two groups(P＞0.05).The Sleeve group spent significantly higher medical fee than the CCK group[(11.6±2.3)10 k yuan vs(9.9±2.5)10 k yuan,P=0.015].With time of follow-up period lasted for a mean of(36.0±3.5)months,the VAS scores,KSS clinical and functional scores,OKS scores and knee extension-flexion ROM in both groups significantly improved(P＜0.05).Although the Sleeve group was significantly inferior to the CCK group in term of pre-operative OKS scores[(44.3±10.3)vs(38.2±8.6),P=0.023],but there was no significant difference in the abovesaid score between the two groups at 1 month after surgery and the last follow-up(P＞0.05).As for imaging,the hip-knee-ankle angle(HKA)and mechanical axis de-viation(MAD)significantly improved in both groups at the last follow-up(P＜0.05),but there was no significant change in joint line height(P＞0.05).However,the Sleeve group had significantly lower joint line height than that of CCK group at the last follow-up[(20.4±6.0)mm vs(23.4±4.7)mm,P=0.047].[Conclusion]Both the prosthetic combinations achieve excellent clinical consequence,with good lower limb alignment and stable knee.The Sleeve has advantages in restoring joint line height and repairing larger bone defects,but intraoperative frac-tures must be vigilant.
关键词
全膝关节置换术/翻修术/骨缺损/Sleeve翻修假体/髁限制性膝假体Key words
total knee arthroplasty/revision/bone defect/Sleeve revision prosthesis/condylar restricted knee prosthesis引用本文复制引用
出版年
2024
NETL
NSTL
万方数据