中国组织工程研究 ›› 2022, Vol. 26 ›› Issue (15): 2323-2329.doi: 10.12307/2022.584

• 人工假体 artificial prosthesis • 上一篇    下一篇

中长期随访全膝关节置换后膝关节韧带松弛度对患者满意度的影响

夏培格,殷  力,王海涛,张  翼,乔仁秋,孔智恒,赵洪波,石翔宇    

  1. 郑州大学第一附属医院骨科,河南省郑州市   450000
  • 收稿日期:2021-08-02 修回日期:2021-08-04 接受日期:2021-09-01 出版日期:2022-05-28 发布日期:2022-01-05
  • 通讯作者: 殷力,博士,主任医师,硕士生导师,郑州大学第一附属医院骨科,河南省郑州市 450000
  • 作者简介:夏培格,男,1995年生,河南省洛阳市人,汉族,郑州大学第一附属医院在读硕士,主要从事关节外科的相关研究。
  • 基金资助:
    河南省高校重点科研项目(20A310022),项目负责人:殷力

Effect of knee ligamentous laxity on patient satisfaction after total knee arthroplasty: a medium to long-term follow-up

Xia Peige, Yin Li, Wang Haitao, Zhang Yi, Qiao Renqiu, Kong Zhiheng, Zhao Hongbo, Shi Xiangyu   

  1. Department of Orthopedics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China
  • Received:2021-08-02 Revised:2021-08-04 Accepted:2021-09-01 Online:2022-05-28 Published:2022-01-05
  • Contact: Yin Li, MD, Chief physician, Master’s supervisor, Department of Orthopedics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China
  • About author:Xia Peige, Master candidate, Department of Orthopedics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China
  • Supported by:
    Key Scientific Research Project of Colleges in Henan Province, No. 20A310022 (to YL)

摘要:

文题释义:
间隙平衡技术:指在全膝关节置换术中利用膝关节周围软组织张力,结合垂直胫骨机械轴的平台截骨获得在屈伸时大小一致的矩形间隙。当屈伸间隙不一致时,参照胫骨截骨调整股骨远端及后髁截骨。
双膝间松弛度差异:以角度或长度分别测量双膝间软组织松弛度,再以术侧膝关节松弛度减去健侧膝关节松弛度,结果若为负值表示术侧膝关节松弛度小于健侧,若为正值表示术侧膝关节松弛度大于健侧,结果绝对值表示双膝间松弛度差异大小。

背景:全膝关节置换的成功需要在术中选取适宜的软组织松弛度,但不同患者术后的软组织变化情况不同。
目的:探究全膝关节置换后中长期随访中膝关节软组织松弛度对患者满意度的影响,初步检验以长度测量膝关节软组织松弛度的效能。
方法:选择在郑州大学第一附属医院行全膝关节置换且获得术后5-10年随访的患者107例,拍摄应力位X射线片,以不同方法测量双侧膝关节冠状位松弛度。①方法A:以内外翻应力试验中膝关节内外侧开口距离变化值之和表示膝关节松弛度,A1组(≥0 mm且≤5 mm,n=23),A2组(> 5 mm且≤7 mm,n=38),A3组(> 7 mm且≤9 mm,n=24),A4组(> 9 mm,n=22);②方法B:以内外翻应力试验中膝关节内外翻角度之和表示膝关节松弛度,B1组(≥0°且≤4°,n=20),B2组(> 4°且≤6°,n=31),B3组(> 6°且≤9°,n=23),B4组(> 9°,n=33);③方法C:求出方法A中双膝关节间松弛度的差值来表示双膝关节间松弛度差异,C1组(≤-5 mm,n=22),C2组(> -5 mm且≤-1 mm,n=33),C3组(> -1 mm且≤1 mm,n=32),C4组(> 1 mm,n=20);④方法D:求出方法B中双膝关节间松弛度的差值来表示双膝关节间松弛度差异,D1组(≤-3°,n=27),D2组(> -3°且≤0°,n=33),D3组(> 0°且≤3.5°,n=27),D4组(> 3.5°,n=20)。根据OKS评分及改良Lysholm评分评估膝关节功能,找出患者满意度最高的软组织松弛度范围。通过比较A、B两种方法的灵敏度和特异度得出在此次随访中测量效能更好的测量方法,通过分析C、D两种方法的结果解释双膝关节间松弛度差异对患者满意度的影响。
结果与结论:①方法A中各组间OKS评分、改良Lysholm评分比较差异均有显著性意义(P < 0.05),功能最佳的范围是5-9 mm;方法B中各组间OKS评分、改良Lysholm评分比较差异均有显著性意义(P < 0.05),功能最佳的范围为4°-9°;方法C中各组间OKS评分、改良Lysholm评分比较差异无显著性意义(P > 0.05);方法D中各组间OKS评分、改良Lysholm评分比较差异有显著性意义(P < 0.05),功能最佳的范围-3°-3.5°;②方法A的灵敏度略低于方法B,但特异度高于方法B;③结果表明,全膝关节置换后5-10年患者满意度最高的膝关节松弛度范围以角度测量时为4°-9°,以长度测量时为5-9 mm;以长度和角度测量膝关节冠状位松弛度的效能相仿;当以角度表示双膝关节间松弛度时,角度差异越小患者满意度越高,差异显著时术侧膝关节松弛度大于对侧的患者满意度更差;以长度表示双膝关节间松弛度差异的效果不佳。

https://orcid.org/0000-0002-5724-4458 (夏培格) 

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

关键词: 骨性关节炎, 全膝关节置换, 膝关节韧带松弛度, 软组织平衡, 膝关节功能评分, 满意度, 假体置入, 骨科植入物

Abstract: BACKGROUND: Appropriate soft tissue laxity is required for a successful total knee arthroplasty; however, different patients present with different soft tissue changes after surgery.  
OBJECTIVE: To investigate the effect of knee ligamentous laxity on patient satisfaction during medium and long-term follow-up after total knee arthroplasty, and to preliminarily test the effectiveness of measuring knee ligamentous laxity based on length measurement.
METHODS:  A total of 107 patients who underwent total knee arthroplasty in the First Affiliated Hospital of Zhengzhou University and had been followed up for 5-10 years after surgery were selected. Stress X-rays were taken in each patient, and the coronal laxity of the bilateral knee joints was measured by different methods. Method A: The knee joint laxity was expressed by the sum of the changes in the distance between the medial and lateral openings of the knee joint in the varus and valgus stress test: A1 group (≥ 0 mm and ≤ 5 mm, n=23), A2 group (> 5 mm and ≤ 7 mm, n=38), A3 group (> 7mm and ≤ 9 mm, n=24), and A4 group (> 9 mm, n=22). Method B: The knee joint laxity was expressed by the sum of the knee joint varus and valgus angles in the varus and valgus stress test: B1 group (≥ 0° and ≤ 4°, n=20), B2 group (> 4° and ≤ 6°, n=31), B3 group (> 6° and ≤ 9°, n=23), and B4 group (> 9°, n=33). Method C: The difference in laxity between the knee joints described in Method A was calculated to indicate the difference in laxity between the bilateral knee joints: C1 group (≤ -5 mm, n=22), C2 group (> -5 mm and ≤ -1 mm, n=33), C3 group (> -1 mm and ≤ 1 mm, n=32), and C4 group (> 1 mm, n=20). Method D: The difference in the laxity between the knee joints in Method B was calculated to indicate the difference in laxity between the knee joints: D1 group (≤ -3°, n=27), D2 group (> -3° and ≤ 0°, n=33), D3 group (> 0° and ≤ 3.5°, n=27), and D4 group (> 3.5°, n=20). The Oxford knee score and the modified Lysholm score were used for knee function assessment, to find out the soft tissue laxity range with the highest patient satisfaction. By comparing the sensitivity and specificity of Methods A and B, we could get a better measurement method in this follow-up. By analyzing the results of Methods C and D, the influence of difference in laxity between the bilateral knee joints on patient satisfaction could be explained.  
RESULTS AND CONCLUSION: In Method A, there were significant differences in Oxford knee scores and modified Lysholm scores among groups (P < 0.05), and the range of the best function was 5-9 mm. In Method B, there were significant differences in Oxford knee scores and modified Lysholm scores among groups (P < 0.05), and the range of the best function was 4°-9°. In Method C, there was no significant difference in Oxford knee scores and modified Lysholm scores among groups (P > 0.05). In Method D, there were significant differences in the Oxford knee scores and the modified Lysholm scores (P < 0.05), and the range of the best function was -3°-3.5°. The sensitivity in Method A was slightly lower than that in the Method B, but the specificity was higher than that in Method B. These findings indicate that the range of knee joint laxity with the highest patient satisfaction in 5-10 years after total knee arthroplasty is 4°-9° when measured by angle, and 5-9 mm when measured by length. Length and angle measurements have similar effectiveness in measuring the coronal laxity of the knee joint. When the knee joint laxity is expressed in angle, the smaller the angle difference, the higher the patient’s satisfaction. When the difference is significant, the satisfaction of patients whose knee joint laxity on the surgical side is higher than that on the contralateral side is worse. When the knee joint laxity is expressed in length, the difference in laxity between the bilateral knee joints is not well denoted.

Key words: osteoarthritis, total knee arthroplasty, knee ligamentous laxity, soft tissue balance, knee joint function score, satisfaction, implantation of prosthesis, orthopedic implant

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