中国组织工程研究

中国组织工程研究 ›› 2019, Vol. 23 ›› Issue (24): 3780-3785.doi: 10.3969/j.issn.2095-4344.1288

• 人工假体 artificial prosthesis • 上一篇    下一篇

全膝关节置换后下肢力线及假体力线与疗效和假体松动率的关系

杨  硕，冯  硕，徐崇俊，唐金龙，裴  方，查国春，陈向阳   

  1. 徐州医科大学附属医院骨科，江苏省徐州市  221006
  • 出版日期:2019-08-28 发布日期:2019-08-28
  • 通讯作者: 陈向阳，博士，主任医师，副教授，硕士生导师，徐州医科大学附属医院骨科，江苏省徐州市 221006
  • 作者简介:杨硕，男，1992年生，江苏省徐州市人，汉族，徐州医科大学在读硕士，目前从事骨关节外科方面的研究。
  • 基金资助:
    江苏省卫生计生委面上项目(H2017081)，项目负责人：查国春|江苏省青年医学人才项目(QNRC2016800)，项目负责人：查国春

Relationship of lower limb alignment and component alignment with outcomes and implant loosening rate after total knee arthroplasty

Yang Shuo, Feng Shuo, Xu Chongjun, Tang Jinlong, Pei Fang, Zha Guochun, Chen Xiangyang
  

  1. Department of Orthopedics, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221006, Jiangsu Province, China
  • Online:2019-08-28 Published:2019-08-28
  • Contact: Chen Xiangyang, MD, Chief physician, Associate professor, Master’s supervisor, Department of Orthopedics, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221006, Jiangsu Province, China
  • About author:Yang Shuo, Master candidate, Department of Orthopedics, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221006, Jiangsu Province, China
  • Supported by:
    the Health Family Planning Commission Project in Jiangsu Province, No. H2017081 (to ZGC); the Jiangsu Youth Medical Talents Project, No. QNRC2016800 (to ZGC)

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摘要：

文章快速阅读：
 
  
 
 
文题释义：
下肢力线：定义为股骨机械轴与胫骨机械轴的内侧夹角。下肢力线作为影响全膝关节置换后临床疗效和假体失败率的重要因素，一直是研究的热点。尽管最佳下肢力线争议较多，目前针对国人下肢力线与临床疗效关系的研究较少。
全膝关节置换：根据人体膝关节解剖及功能，采用金属等材料制成人工膝关节假体，通过外科技术植入人体内，从而减少患者膝关节疼痛和改善长期功能，改善膝关节炎患者的生活质量的一种术式。
 
摘要
背景：对于全膝关节置换后最佳下肢力线的争议仍然较多，而国内对于下肢力线与临床疗效关系的研究较少。
目的：分析膝骨性关节炎患者全膝关节置换后下肢力线(髋-膝-踝角)、股骨假体力线(股骨假体角)、胫骨假体力线(胫骨假体角)与临床疗效、假体松动率的关系。
方法：回顾性分析2015年3月至2016年12月初次行全膝关节置换的膝关节骨性关节炎患者118例(139膝)，所有患者对治疗方案均知情同意，且得到医院伦理委员会批准。摄患肢下肢全长X射线片、测量置换前后股骨胫骨机械轴夹角(髋-膝-踝角)、股骨假体远端内侧角(股骨假体角)、胫骨假体近端内侧角(胫骨假体角)。术后定期随访膝关节活动度、美国特种外科医院评分评价全膝关节置换后临床疗效。随后根据最新随访复查X射线片，采用EWALD标准查找假体松动、骨溶解、断裂的迹象。分析全膝关节置换后下肢力线(髋-膝-踝角)、股骨假体力线(股骨假体角)、胫骨假体力线(胫骨假体角)与临床疗效、假体松动率的关系。
结果与结论：①118例(139膝)均获得随访，随访时间(35.8±6.2)个月，未发现假体松动、骨溶解、断裂的迹象；②对于下肢力线，中立组与内翻组、外翻组置换后美国特种外科医院评分差异有显著性意义(P < 0.05)，且中立组评分最高；③对于股骨假体力线，只有中立组与外翻组之间置换后美国特种外科医院评分差异有显著性意义(P < 0.05)，且中立组评分更高；④胫骨假体力线3组间置换后美国特种外科医院评分差异无显著性意义(P > 0.05)；⑤提示传统全膝关节置换后中性力线[下肢力线中立组髋-膝-踝角=(180±3)°]依然为全膝关节置换后推荐的恢复力线，应当尽量避免术后内、外翻力线。短期随访中，全膝关节置换后下肢力线及假体力线对假体松动无影响。
 
中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程
ORCID: 0000-0002-1437-0091(杨硕)

关键词: 膝关节置换, 膝骨关节炎, 冠状面, 下肢力线, 膝关节活动度, 美国特种外科医院评分, 髋-膝-踝角, 股骨假体角, 胫骨假体角

Abstract:

BACKGROUND: There is still much controversy about the lower limb alignment after total knee arthroplasty. There are few studies on the relationship between lower limb alignment and clinical outcome in Chinese patients.
OBJECTIVE: To analyze the relationship of limb alignment (angle of femoral and tibial mechanical alignment), coronal alignment of the femoral component (distal medial angle of femoral prosthesis) and coronal alignment of the tibial component (proximal medial angle of tibial prosthesis) with clinical outcome and implant loosening rate after total knee arthroplasty in patients with knee osteoarthritis.
METHODS: Data of 118 patients (139 knees) with knee osteoarthritis after first total knee arthroplasty from March 2015 to December 2016 were retrospectively analyzed. All patients signed the informed consent. The study was approved by the Hospital Ethics Committee. The long-leg weight-bearing radiographs were taken and the angle of femoral and tibial mechanical alignment (angle of femoral and tibial mechanical alignment), distal medial angle of femoral prosthesis (distal medial angle of femoral prosthesis), proximal medial angle of tibial prosthesis (proximal medial angle of tibial prosthesis) were measured before and after surgery. The postoperative follow-up of the knee range of motion and Hospital for Special Surgery scores were used to evaluate the clinical outcome after total knee arthroplasty. Standard radiographs were subsequently obtained at follow-up in order to look for signs of wear and or lucency using the EWALD classification. The relationship of limb alignment (angle of femoral and tibial mechanical alignment), femoral alignment (distal medial angle of femoral prosthesis), and tibial alignment (proximal medial angle of tibial prosthesis) with clinical outcome and implant loosening rate after total knee arthroplasty was analyzed.
RESULTS AND CONCLUSION: (1) All the 118 patients (139 knees) were followed up for 35.8 ± 6.2 months. No complications such as osteolysis, loosening of the prosthesis and prosthesis fracture were found. (2) For the limb alignment, there were significant differences in the Hospital for Special Surgery scores between the neutral group and the varus group and the valgus group (P < 0.05), and the neutral group score was highest. (3) As for femoral component alignment, the difference of the Hospital for Special Surgery scores was statistically significant between the neutral group and the valgus group (P < 0.05), and the score in the neutral group was higher. (4) As for tibial component alignment, there were no significant differences in postoperative Hospital for Special Surgery scores among the three groups (P > 0.05). (5) The traditional neutral alignment [angle of femoral and tibial mechanical alignment = (180±3)°] was still recommended for the recovery alignment after total knee arthroplasty. The residual postoperative varus and valgus alignment should be avoided as much as possible. In the short-term follow-up, the postoperative limb alignment had no effect on the loosening of the prosthesis.

Key words: total knee arthroplasty, knee osteoarthritis, coronal, lower limb alignment, knee motion range, Hospital for Special Surgery scores, angle of femoral and tibial mechanical alignment, distal medial angle of femoral prosthesis, proximal medial angle of tibial prosthesis

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