中国组织工程研究

中国组织工程研究 ›› 2011, Vol. 15 ›› Issue (4): 571-574.doi: 10.3969/j.issn.1673-8225.2011.04.001

• 人工假体 artificial prosthesis •    下一篇

骨关节炎患者全膝关节置换：多中心的随机对照

王国伟1，孙  水2，林永杰1，陈继营3，周勇刚3，石恩东1   

  1. 1山东省交通医院，山东省济南市  250031
    2山东省立医院，山东省济南市 250100
    3解放军总医院关节外科，北京市  100037
  • 收稿日期:2010-07-19 修回日期:2010-12-25 出版日期:2011-01-22 发布日期:2011-01-22
  • 作者简介:王国伟★，男，1979年生，山东省龙口市人，汉族，2008年山东大学毕业，硕士，主治医师，主要从事骨外科（关节、脊柱外科）研究。 alexrt@126.com
  • 基金资助:

    山东省交通厅资助项目[2008Y023(6)]。

Total knee arthroplasty for osteoarthritis patients: A multi-central randomized controlled trial

Wang Guo-wei1, Sun Shui2, Lin Yong-jie1, Chen Ji-ying3, Zhou Yong-gang3, Shi En-dong1   

  1. 1Shandong Jiaotong Hospital, Jinan  250031, Shandong Province, China
    2Shandong Provincial Hospital, Jinan  250100, Shandong Province, China
    3Department of Joint Surgery, General Hospital of Chinese PLA, Beijing  100037, China
  • Received:2010-07-19 Revised:2010-12-25 Online:2011-01-22 Published:2011-01-22
  • About author:Wang Guo-wei★, Master, Attending physician, Shandong Jiaotong Hospital, Jinan 250031, Shandong Province, China alexrt@126.com
  • Supported by:

    a grant from Communication Department of Shandong Province, No. 2008Y023(6)*

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摘要：

背景：年龄在60岁以上存在关节疼痛、功能障碍和关节畸形的骨关节炎患者均可以考虑行全膝关节置换。
目的：比较传统全膝关节置换、微创全膝置换和避开股四头肌的微创全膝置换后早期膝关节功能恢复情况的差异。
方法：选择北京301医院、山东省立医院、山东省交通医院获得随访的120例骨关节炎患者，其中42例接受常规全膝关节置换，42例接受微创全膝关节置换，36例接受避开股四头肌的微创全膝关节置换。所有患者置换后第2，6，12周进行膝关节HSS评分及关节活动度检测。
结果与结论：微创全膝关节置换组及避开股四头肌的微创全膝关节置换组较常规全膝关节置换组手术时间长(P < 0.01)，出血量少(P < 0.01)；两微创手术组间差异无显著性意义(P > 0.05)。置换后2周微创全膝关节置换组及避开股四头肌的微创全膝关节置换组关节活动度、HSS评分均优于常规全膝关节置换组(P < 0.01)，两微创组间关节活动度差异无显著性意义(P > 0.05)，但避开股四头肌的微创全膝关节置换组HSS评分优于微创全膝关节置换组(P < 0.01)；置换后6，12周3组HSS评分及关节活动度差异无显著意义(P > 0.05)。提示避开股四头肌的微创全膝关节置换与微创全膝关节置换以及常规全膝关节置换相比，手术损伤较小，术后疼痛程度更轻，术后能早期进行康复锻炼。

关键词: 全膝关节置换, 微创手术, 股四头肌避开, HSS评分, 关节活动范围, 骨关节炎

Abstract:

BACKGROUND: Total knee arthroplasty (TKA) can be performed for osteoarthritis patients, aged more than 60 years, with joint pain, dysfunction and joint deformity.
OBJECTIVE: To compare differences in early joint functional recovery between three kinds of TKA surgery, i.e. TKA, minimally invasive surgery (MIS)-TKA and MIS-quadriceps sparing (QS)-TKA. 
METHODS: 120 osteoarthritis patients were selected from Beijing 301 Hospital, Shandong Provincial Hospital, and Shandong Jiaotong Hospital, including 42 undergoing traditional TKA, 42 MIS-TKA and 36 MIS-QS TKA. Each knee was rated according to the Hospital of Special Surgery (HSS) scoring system at 2, 6, and 12 weeks post-operatively. Range of motion was detected.
RESULTS AND CONCLUSION: The operation time was longer in MIS-TKA and MIS-QS TKA groups compared with TKA group (P < 0.01), but the bleeding amount was less (P < 0.01). There was no obvious difference between MIS-TKA and MIS-QS TKA groups (P > 0.05). Range of motion and HSS scores of MIS-TKA and MIS-QS TKA groups were superior over traditional TKA at postoperative 2 weeks (P < 0.01), but there was no prominent difference of ROM between MIS-TKA and MIS-QS TKA groups (P > 0.05). The HSS scores were significantly greater in MIS-QS TKA compared with MIS-TKA (P < 0.01). At 6 and 12 weeks, there were no significant differences in HSS scores or range of motion among three groups (P > 0.05). Compared with traditional TKA, MIS-TKA and MIS-QS TKA showed less bleeding amount, less injury to the quadriceps, and this could contribute to the earlier recovery of the patients.

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