膝关节置换术后不同参照点测得关节线与膝关节功能的相关性研究
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摘要
目的探讨人工全膝关节置换术(TKA)后选择不同参照点测量关节线(JL)变化与膝关节临床功能评估的相关性。方法回顾性分析于2015年5月至2017年5月在安徽省滁州市皖东人民医院骨科接受TKA手术的患者,分别以腓骨头、股骨内收肌止点、胫骨结节为参照点测量JL变化,评估术前及术后12个月后患者美国膝关节协会(KSS)评分、关节活动度(ROM)及Feller髌骨评分。将不同参照点下JL变化情况与KSS评分变化、ROM变化及Feller髌骨评分变化等资料进行相关性检验。结果与术前比较,术后患者KSS评分、ROM、Feller髌骨评分均显著增高(P <0. 05)。以腓骨头、股骨内收肌止点为参照点测得的JL变化之间呈正相关性(r=0. 874,P <0. 01)。术后12个月,以胫骨结节为参照点测得的JL变化,与TKA术后12个月KSS评分变化(r=-0. 521,P <0. 01)、髌骨Feller评分变化(r=-0. 493,P <0. 01)具有负向相关性。结论以胫骨结节为参照点测量JL变化,与TKA术后膝关节KSS评分变化、髌骨Feller评分变化呈负相关性;以胫骨结节为参照点测量JL变化能更好地评估TKA术后膝关节临床功能。
Objective To investigate the correlation of joint line( JL) with different reference points after total knee arthroplasty( TKA) on clinical evaluation of knee joint function. Methods Cases of total knee arthroplasty treated with measurement osteotomy( MR) and PCL retained knee prosthesis in the orthopedic department of East Anhui people's Hospital,Chuzhou,Anhui province,from May 2015 to May2017 were retrospectively analyzed. JL changes were measured with fibular head,femoral adductor attachment and tibial tubercle as reference points,and the KSS score,ROM,and Feller patella score were evaluated before and 12 months after surgery. Correlation analysis between JL changes and KSS score changes,ROM changes and Feller patella score changes were conducted. Results Compared with preoperative,KSS score,ROM and Feller patella scores were significantly increased after TKA( P < 0. 05). There was a positive correlation between the JL changes measured by the fibular head and the femoral adductor attachment( r =0. 874,P < 0. 01). At 12 months after surgery,the JL changes measured with the tibial tubercle as the reference point has negative correlations with the changes of KSS scores( r =-0. 521,P < 0. 01) and the Feller patella scores( r =-0. 493,P < 0. 01). Conclusion JL changes measured with tibial tubercle as a reference point is negatively correlated with changes in knee KSS score and Feller patella scores after TKA,so measuring JL changes with tibial tubercle as a reference point may better evaluate the clinical function of knee joint after TKA than with fibular head or the femoral adductor attachment.
Objective To investigate the correlation of joint line( JL) with different reference points after total knee arthroplasty( TKA) on clinical evaluation of knee joint function. Methods Cases of total knee arthroplasty treated with measurement osteotomy( MR) and PCL retained knee prosthesis in the orthopedic department of East Anhui people's Hospital,Chuzhou,Anhui province,from May 2015 to May2017 were retrospectively analyzed. JL changes were measured with fibular head,femoral adductor attachment and tibial tubercle as reference points,and the KSS score,ROM,and Feller patella score were evaluated before and 12 months after surgery. Correlation analysis between JL changes and KSS score changes,ROM changes and Feller patella score changes were conducted. Results Compared with preoperative,KSS score,ROM and Feller patella scores were significantly increased after TKA( P < 0. 05). There was a positive correlation between the JL changes measured by the fibular head and the femoral adductor attachment( r =0. 874,P < 0. 01). At 12 months after surgery,the JL changes measured with the tibial tubercle as the reference point has negative correlations with the changes of KSS scores( r =-0. 521,P < 0. 01) and the Feller patella scores( r =-0. 493,P < 0. 01). Conclusion JL changes measured with tibial tubercle as a reference point is negatively correlated with changes in knee KSS score and Feller patella scores after TKA,so measuring JL changes with tibial tubercle as a reference point may better evaluate the clinical function of knee joint after TKA than with fibular head or the femoral adductor attachment.
引文
[1]赵巍,米尔阿里木·木尔提扎,王利,等.人工全膝关节置换术后躯体重心转移与患者恢复程度的关系[J].临床骨科杂志,2015,18(2):177-180.
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[9]孙振辉,孙云波,任志帅,等.Gemini MK-帅活动垫片膝关节假体置换术中胫骨结节内1/3解剖定位法对胫骨假体旋转力线的影响[J].中国修复重建外科杂志,2015,29(9):1062-1066.
[10]王韬.全膝关节置换后关节线变化对髌股关节生物力学的影响[J].中国组织工程研究,2016,20(13):1845-1851.
[11]Sharma A,Leszko F,Komistek RD,et al.In vivo patellofemoral forces in high flexion total knee arthroplasty[J].J Biomech,2008,41(3):642-648.
[12]昝鹏飞,杨勇,李国东,等.全膝关节置换术中髌骨翻转对术后早期膝关节功能的影响[J].国际骨科学杂志,2015,36(1):66-69.
[13]ClavéA,Le HG,Roger T,et al.Joint line level in revision total knee replacement:assessment and functional results with an average of seven years follow-up.[J].Int Orthop,2016,40(8):1-8.
[14]蒋超,叶灿华,钱文伟,等.人工全膝关节置换术中两种截骨技术的系统评价[J].骨科,2016,7(5):322-327.
[15]Moon YW,Kim HJ,Ahn HS,et al.Comparison of soft tissue balancing,femoral component rotation,and joint line change between the gap balancing and measured resection techniques in primary total knee arthroplasty:a meta-analysis[J/OL].Med(Baltimore),2016,95(39):e5006.doi:10.1097/MD.0000000000005006.
[17]Seon JK,Song EK.Joint line and patellar height restoration after revision total knee arthroplasty[J].Indian J Orthop,2016,50(2):159-165.
[18]Sadaka C,Kabalan Z,Hoyek F,et al.Joint line restoration during revision total knee arthroplasty:an accurate and reliable method[J].Springerplus,2015,4(1):736-742.
[19]Jawhar A,Hutter K,Scharf HP.Are joint line changes after primary navigated total knee arthroplasty predictable?[J].JOrthop Sci,2015,20(1):93-100.
[20]王新光,史占军,郭汉明,等.术前胫骨力线X线定位对提高膝关节置换术后假体力线的作用[J].实用医学杂志,2015,31(16):2669-2672.
[2]Babazadeh S,Dowsey MM,Swan JD,et al.Joint line position correlates with function after primary total knee replacement[J].JBone Joint Surg,Am 2011,93(9):1223-1231.
[3]张胤,程涛,张先龙.全膝关节置换术中股骨假体旋转力线参考轴及放置位置研究进展[J].国际骨科学杂志,2014,35(6).
[4]及松洁,田伟,姜旭,等.全膝关节置换术后关节线位置变化及其与膝关节临床功能的关系[J].山东医药,2015,55(12):10-13.
[5]陈彤,曲铁兵,潘江,等.中国人膝关节解剖标志点和关节线距离的测量及特性分析[J].中国组织工程研究,2015(46).
[6]Mason M,Belisle A,Bonutti P,et al.An accurate and reproducible method for locating the joint line during a revision total knee arthroplasty[J].J Arthroplasty,2006,21(8):1147-1153.
[7]Hofmann AA,Kurtin SM,Lyons S,et al.Clinical and radiographic analysis of accurate restoration of the joint line in revision total knee arthroplasty[J].J Arthroplasty,2006,21(8):1154-1162.
[8]Figgie HE,Goldberg VM,Heiple KG,et al.The influence of tibial-patellofemoral location on function of the knee in patients with the posterior stabilized condylar knee prosthesis[J].J Bone Joint Surg,1986,68(7):1035-1040.
[9]孙振辉,孙云波,任志帅,等.Gemini MK-帅活动垫片膝关节假体置换术中胫骨结节内1/3解剖定位法对胫骨假体旋转力线的影响[J].中国修复重建外科杂志,2015,29(9):1062-1066.
[10]王韬.全膝关节置换后关节线变化对髌股关节生物力学的影响[J].中国组织工程研究,2016,20(13):1845-1851.
[11]Sharma A,Leszko F,Komistek RD,et al.In vivo patellofemoral forces in high flexion total knee arthroplasty[J].J Biomech,2008,41(3):642-648.
[12]昝鹏飞,杨勇,李国东,等.全膝关节置换术中髌骨翻转对术后早期膝关节功能的影响[J].国际骨科学杂志,2015,36(1):66-69.
[13]ClavéA,Le HG,Roger T,et al.Joint line level in revision total knee replacement:assessment and functional results with an average of seven years follow-up.[J].Int Orthop,2016,40(8):1-8.
[14]蒋超,叶灿华,钱文伟,等.人工全膝关节置换术中两种截骨技术的系统评价[J].骨科,2016,7(5):322-327.
[15]Moon YW,Kim HJ,Ahn HS,et al.Comparison of soft tissue balancing,femoral component rotation,and joint line change between the gap balancing and measured resection techniques in primary total knee arthroplasty:a meta-analysis[J/OL].Med(Baltimore),2016,95(39):e5006.doi:10.1097/MD.0000000000005006.
[17]Seon JK,Song EK.Joint line and patellar height restoration after revision total knee arthroplasty[J].Indian J Orthop,2016,50(2):159-165.
[18]Sadaka C,Kabalan Z,Hoyek F,et al.Joint line restoration during revision total knee arthroplasty:an accurate and reliable method[J].Springerplus,2015,4(1):736-742.
[19]Jawhar A,Hutter K,Scharf HP.Are joint line changes after primary navigated total knee arthroplasty predictable?[J].JOrthop Sci,2015,20(1):93-100.
[20]王新光,史占军,郭汉明,等.术前胫骨力线X线定位对提高膝关节置换术后假体力线的作用[J].实用医学杂志,2015,31(16):2669-2672.