内轴膝关节系统中胫骨假体后倾角度对术后功能影响
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摘要
目的探讨内轴型(MP)膝关节系统中胫骨平台后倾角(PSA)对全膝关节置换术(TKA)后关节功能的影响及其相关因素。方法随访40例老年女性单侧膝骨关节炎终末期行单侧TKA手术病人(术中均采用MicroPort公司MP膝关节2号Advance stature假体),随访时间至少4个月,记录病人术前和术后膝关节活动度(ROM)、膝关节手术评分表(KSS)评分、胫骨平台PSA等指标,分析不同胫骨平台PSA角度病人术后ROM的差异,以及BMI、术前ROM、术前KSS评分对术后功能恢复的影响。结果术前膝关节ROM、术后胫骨平台PSA、术前KSS评分与术后膝关节KSS评分呈正相关(r=0.389～0.825,P<0.05),BMI与术后膝关节KSS评分呈负相关(r=-0.623,P<0.05)。术后胫骨平台PSA为5°～7°病人术后功能恢复最优。结论病人BMI增高不利于TKA后功能恢复,较高的术前ROM和KSS评分有利于术后的功能恢复;术后胫骨平台PSA 5°～7°有可能是MP膝关节系统的最适宜PSA。
Objective To investigate the effect of the posterior slope angle(PSA)of the tibial plateau in a medial-pivot(MP)knee system on the knee joint function after total knee arthroplasty(TKA)and its related factors. Methods A follow-up lasting at least 4 months was conducted in 40 elderly female patients who had undergone a TKA(size 2 Advance Stature MP knee prosthesis from MicroPort was used)for end-stage unilateral knee arthritis;the patients were evaluated for preoperative and postoperative knee range of motion(ROM),Knee Society Score(KSS),and PSA of the tibial plateau;analyses were conducted on the difference in the postoperative ROM in patients with different PSAs of the tibial plateaus and the effects of body mass index(BMI),preoperative ROM,and preoperative KSS on postoperative functional recovery. Results The preoperative knee ROM,postoperative PSA of the tibial plateau,and preoperative KSS were positively correlated with the postoperative KSS(r=0.389-0.825,P<0.05);BMI was negatively correlated with the postoperative KSS(r=-0.623,P<0.05).Patients with a postoperative PSA of the tibial plateau of 5°-7°had optimal postoperative functional recovery. Conclusion Increased BMI negatively contributes to functional recovery after TKA,while higher preoperative ROM and KSS positively contribute to functional recovery.The best PSA for a MP knee system may be 5°-7°.
Objective To investigate the effect of the posterior slope angle(PSA)of the tibial plateau in a medial-pivot(MP)knee system on the knee joint function after total knee arthroplasty(TKA)and its related factors. Methods A follow-up lasting at least 4 months was conducted in 40 elderly female patients who had undergone a TKA(size 2 Advance Stature MP knee prosthesis from MicroPort was used)for end-stage unilateral knee arthritis;the patients were evaluated for preoperative and postoperative knee range of motion(ROM),Knee Society Score(KSS),and PSA of the tibial plateau;analyses were conducted on the difference in the postoperative ROM in patients with different PSAs of the tibial plateaus and the effects of body mass index(BMI),preoperative ROM,and preoperative KSS on postoperative functional recovery. Results The preoperative knee ROM,postoperative PSA of the tibial plateau,and preoperative KSS were positively correlated with the postoperative KSS(r=0.389-0.825,P<0.05);BMI was negatively correlated with the postoperative KSS(r=-0.623,P<0.05).Patients with a postoperative PSA of the tibial plateau of 5°-7°had optimal postoperative functional recovery. Conclusion Increased BMI negatively contributes to functional recovery after TKA,while higher preoperative ROM and KSS positively contribute to functional recovery.The best PSA for a MP knee system may be 5°-7°.
引文
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[15]SCHMIDT R,KOMISTEK R D,BLAHA J D,et al.Fluoroscopic analyses of cruciate-retaining and medial pivot knee implants[J].Clinical Orthopaedics and Related Research,2003(410):139-147.
[16]黄文华,姜楠,钟世镇,等.胫骨平台后倾角的测量及临床意义[J].中国骨与关节损伤杂志,2007,22(10):825-828.
[17]HANRATTY B M,THOMPSON N W,WILSON R K,et al.The influence of posterior condylar offset on knee flexion after total knee replacement using a cruciate-sacrificing mobile-bearing implant[J].Journal of Bone and Joint Surgery-British Volume,2007,89B(7):915-918.
[18]WYSS T,SCHUSTER A J,CHRISTEN B,et al.Tension controlled ligament balanced total knee arthroplasty:5-year results of a soft tissue orientated surgical technique[J].Archives of Orthopaedic and Trauma Surgery,2008,128(2):129-135.
[19]MALVIYA A,LINGARD E A,WEIR D J,et al.Predicting range of movement after knee replacement:the importance of posterior condylar offset and tibial slope[J].Knee Surgery,Sports Traumatology,Arthroscopy,2009,17(5):491-498.
[20]KANSARA D,MARKEL D C.The effect of posterior tibial slope on range of motion after total knee arthroplasty[J].Journal of Arthroplasty,2006,21(6):809-813.
[21]SCHURMAN D J,MATITYAHU A,GOODMAN S B,et al.Prediction of postoperative knee flexion in Insall-BursteinⅡtotal knee arthroplasty[J].Clinical Orthopaedics and Related Research,1998(353):175-184.
[22]GATHA N M,CLARKE H D,FUCHS R,et al.Factors affecting postoperative range of motion after total knee arthroplasty[J].Journal of Knee Surgery,2004,17(4):196-202.
[23]吕厚山.人工膝关节置换术的进展和现状[J].中华外科杂志,2004,42(1):30-33.
[24]MENKE W,SCHMITZ B,SALM S.Range of motion after total condylar knee arthroplasty[J].Archives of Orthopaedic and Trauma Surgery,1992,111(5):280-281.
[2]DENNIS D A,KOMISTEK R D,SCUDERI G R,et al.Factors affecting flexion after total knee arthroplasty[J].Clinical Orthopaedics and Related Research,2007,464:53-60.
[3]朱从亚,周海斌,董启榕,等.多重线性回归分析自身因素对全膝关节置换术后疗效的影响[J].中国矫形外科杂志,2010,18(20):1677-1681.
[4]HIGUCHI H,HATAYAMA K,SHIMIZU M A,et al.Relationship between joint gap difference and range of motion in total knee arthroplasty:aprospective randomised study between different platforms[J].International Orthopaedics,2009,33(4):997-1000.
[5]KUROSAKA M,YOSHIYA S,MIZUNO K,et al.Maximizing flexion after total knee arthroplasty-the need and the pitfalls[J].Journal of Arthroplasty,2002,17(4):59-62.
[6]ILBIN S,NAM T S.Early results of high-flex total knee arthroplasty:comparison study at 1year after surgery[J].Knee Surgery,Sports Traumatology,Arthroscopy,2007,15(4):350-355.
[7]BELLEMANS J,BANKS S,VICTOR J,et al.Fluoroscopic analysis of the kinematics of deep flexion in total knee arthroplasty:influence of posterior condylar offset[J].The Journal of Bone and Joint Surgery(British Volume),2002,84-B(1):50-53.
[8]BAUER T,BIAU D,COLMAR M,et al.Influence of posterior condylar offset on knee flexion after cruciate-sacrificing mobile-bearing total knee replacement.A prospective analysis of 410consecutive cases[J].The Knee,2010,17(6):375-380.
[9]IWAKI H,PINSKEROVA V.FREEMAN M A R.Tibiofemoral movement 1:the shapes and relative movements of the femur and tibia in the unloaded cadaver knee[J].Journal of Bone and Joint Surgery,2000,82-B(8):1189-1195.
[10]MOONOT P,MU S,RAILTON G T,et al.Tibiofemoral kinematic analysis of knee flexion for a medial pivot knee[J].Knee Surgery,Sports Traumatology,Arthroscopy,2009,17(8):927-934.
[11]BAE D K,YOON K H,KIM S G,et al.Cruciate retaining medial pivot knee[J].J Korean Orthop Assoc,2007,42(1):71-76.
[12]CHO S,YOUM Y S,JEONG J Y,et al.Total knee arthroplasty with PCL substituting medial pivot knee:short-term follow-up results[J].J Korean Knee Soc,2009,21(1):45-50.
[13]LEE S D,KIM J H,JEON Y W,et al.Total knee arthroplasty using a medial pivot knee:minimum 2-year follow-up results[J].J Korean Knee Soc,2008,20(1):77-82.
[14]MONT M A,BOOTH R E,LASKIN R S,et al.The spectrum of prosthesis design for primary total knee arthroplasty[J].Instr Course Lect,2003,52:397-407.
[15]SCHMIDT R,KOMISTEK R D,BLAHA J D,et al.Fluoroscopic analyses of cruciate-retaining and medial pivot knee implants[J].Clinical Orthopaedics and Related Research,2003(410):139-147.
[16]黄文华,姜楠,钟世镇,等.胫骨平台后倾角的测量及临床意义[J].中国骨与关节损伤杂志,2007,22(10):825-828.
[17]HANRATTY B M,THOMPSON N W,WILSON R K,et al.The influence of posterior condylar offset on knee flexion after total knee replacement using a cruciate-sacrificing mobile-bearing implant[J].Journal of Bone and Joint Surgery-British Volume,2007,89B(7):915-918.
[18]WYSS T,SCHUSTER A J,CHRISTEN B,et al.Tension controlled ligament balanced total knee arthroplasty:5-year results of a soft tissue orientated surgical technique[J].Archives of Orthopaedic and Trauma Surgery,2008,128(2):129-135.
[19]MALVIYA A,LINGARD E A,WEIR D J,et al.Predicting range of movement after knee replacement:the importance of posterior condylar offset and tibial slope[J].Knee Surgery,Sports Traumatology,Arthroscopy,2009,17(5):491-498.
[20]KANSARA D,MARKEL D C.The effect of posterior tibial slope on range of motion after total knee arthroplasty[J].Journal of Arthroplasty,2006,21(6):809-813.
[21]SCHURMAN D J,MATITYAHU A,GOODMAN S B,et al.Prediction of postoperative knee flexion in Insall-BursteinⅡtotal knee arthroplasty[J].Clinical Orthopaedics and Related Research,1998(353):175-184.
[22]GATHA N M,CLARKE H D,FUCHS R,et al.Factors affecting postoperative range of motion after total knee arthroplasty[J].Journal of Knee Surgery,2004,17(4):196-202.
[23]吕厚山.人工膝关节置换术的进展和现状[J].中华外科杂志,2004,42(1):30-33.
[24]MENKE W,SCHMITZ B,SALM S.Range of motion after total condylar knee arthroplasty[J].Archives of Orthopaedic and Trauma Surgery,1992,111(5):280-281.