中国组织工程研究

中国组织工程研究 ›› 2021, Vol. 25 ›› Issue (9): 1362-1367.doi: 10.3969/j.issn.2095-4344.3761

• 人工假体Artificial prosthesis • 上一篇    下一篇

后交叉韧带替代型假体全膝关节置换术后屈曲受限的影响因素

肖国庆，刘选泽，严钰皓，钟喜红   

  1. 成都医学院第二附属医院/核工业四一六医院骨科，四川省成都市   610051
  • 收稿日期:2020-02-10 修回日期:2020-02-14 接受日期:2020-05-13 出版日期:2021-03-28 发布日期:2020-12-15
  • 通讯作者: 钟喜红，主任医师，成都医学院第二附属医院/核工业四一六医院骨科，四川省成都市 610051
  • 作者简介:肖国庆，男，1981年生，四川省绵阳市人，硕士，副主任医师，主要从事关节外科的研究。

Influencing factors of knee flexion limitation after total knee arthroplasty with posterior stabilized prostheses

Xiao Guoqing, Liu Xuanze, Yan Yuhao, Zhong Xihong   

  1. Department of Orthopedics, Second Affiliated Hospital of Chengdu Medical College/Nuclear Industry 416 Hospital, Chengdu 610051, Sichuan Province, China
  • Received:2020-02-10 Revised:2020-02-14 Accepted:2020-05-13 Online:2021-03-28 Published:2020-12-15
  • Contact: Zhong Xihong, Chief physician, Department of Orthopedics, Second Affiliated Hospital of Chengdu Medical College/Nuclear Industry 416 Hospital, Chengdu 610051, Sichuan Province, China
  • About author:Xiao Guoqing, Master, Associate chief physician, Department of Orthopedics, Second Affiliated Hospital of Chengdu Medical College/Nuclear Industry 416 Hospital, Chengdu 610051, Sichuan Province, China

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摘要：

文题释义：
后交叉韧带替代型假体：全膝关节置换术中切除后交叉韧带，通过一个盒式结构的装置来代替后交叉韧带实现膝关节屈曲过程中的后滚机制。试验采用后交叉韧带替代型假体进行全膝关节置换，选择膝正中切口和内侧髌旁入路，松解支持带外翻髌骨后屈膝(髌骨只做修整不做置换)；凿除股骨髁边缘骨赘，切除脂肪垫和两侧半月板前角，切断前后交叉韧带和半月板后根止点进一步屈膝至110°(屈曲活动度≤45°的患者股四头肌腱可能需要斜切)。
膝关节屈曲受限：日常生活中膝关节所需要的最小屈曲活动度是 90°，全膝关节置换术后膝关节活动度不理想，<90°可认为屈曲受限。膝关节屈曲活动度受到全膝关节置换手术和非手术因素的影响。

背景：全膝关节置换术是保守治疗无效或晚期膝关节骨关节炎患者重要的治疗手段，但其手术效果和满意度仍有待提高。膝关节活动度是评价患者术后功能和满意度的重要参数。
目的：探讨后交叉韧带替代型假体全膝关节置换术后屈曲受限的影响因素。
方法：选择2010年1月至2018年12月成都医学院第二附属医院/核工业四一六医院收治的膝关节骨关节炎患者117例，其中男29例，女88例，均接受全膝关节置换术。术后随访6个月以上，对全膝关节置换术后屈曲受限的影响因素(手术因素：术后关节线高度变化、术后胫骨平台后倾角、股骨前髁偏距比率变化；非手术因素：年龄、体质量指数、术前HSS评分、术前关节活动度、术前目测类比评分、术后主动锻炼)进行单因素分析和Logistic回归分析，探讨全膝关节置换术后屈曲受限的独立影响因素。研究获得成都医学院第二附属医院/核工业四一六医院伦理委员会批准。
结果与结论：①单因素分析结果显示，患者的年龄、体质量指数、术前HSS评分、术前关节活动度、术前目测类比评分、术后主动锻炼、术后关节线高度变化对术后膝关节屈曲功能有显著影响(P均< 0.05)；②Logistic 回归分析：体质量指数[OR=0.131，95%CI(0.065，0.261)，P < 0.001]、术前HSS评分[OR=4.297，95%CI(2.139，8.634)，P < 0.001]、术前关节活动度[OR=10.612，95%CI(6.565，17.153)，P < 0.001]是全膝关节置换术后膝关节屈曲受限的非手术独立影响因素；术后关节线高度变化[OR=0.255，95%CI(0.167，0.387)，P < 0.001]是全膝关节置换术后膝关节屈曲受限的手术独立影响因素；体质量指数、术后关节线高度变化与全膝关节置换术后膝关节屈曲活动度呈显著负相关，术前HSS评分、术前关节活动度与全膝关节置换术后膝关节屈曲活动度呈显著正相关；③结果表明，后交叉韧带替代型假体全膝关节置换术后的屈曲功能与患者体质量指数、术前HSS评分、术前关节活动度、术后关节线高度变化存在显著相关性。
https://orcid.org/0000-0002-1086-3251 (肖国庆) 

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, 假体, 关节炎, 膝关节, 关节置换, 屈曲受限, 影响因素

Abstract: BACKGROUND: Total knee arthroplasty is an important treatment for patients with ineffective conservative treatment or terminal knee osteoarthritis, but its surgical effect and patients’ satisfaction still need to be improved. Range of motion is an important parameter to evaluate patients' postoperative function and satisfaction.   
OBJECTIVE: To investigate the influencing factors of knee flexion limitation after total knee arthroplasty with posterior stabilized prostheses. 
METHODS: From January 2010 to December 2018, 117 patients with knee osteoarthritis were treated in the Second Affiliated Hospital of Chengdu Medical College/Nuclear Industry 416 Hospital, including 29 males and 88 females, all of whom received total knee arthroplasty. After a follow-up of more than 6 months, single factor analysis and Logistic regression analysis were performed on the influencing factors (surgical factors: postoperative joint line height change, postoperative tibial plateau retroversion, femoral condyle offset ratio change; non-operative factors: age, body mass index, preoperative HSS score, preoperative joint range of motion, preoperative visual analogue scale score, and postoperative active exercise) of postoperative knee flexion limitation to identify the independent impact factors of flexion limitation after total knee arthroplasty. The reaserch was approved by the Ethics Committee of the Second Affiliated Hospital of Chengdu Medical College/Nuclear Industry 416 Hospital.  
RESULTS AND CONCLUSION: (1) Single factor analysis showed that the patient’s age, body mass index, preoperative HSS score, preoperative range of motion, preoperative visual analogure scale score, postoperative active exercise and postoperative joint line height change had a significant effect on postoperative knee flexion function (all P < 0.05). (2) Logistic regression analysis: body mass index [OR=0.131, 95%CI (0.065,0.261), P < 0.001], preoperative HSS score [OR=4.297, 95%CI (2.139,8.634), P < 0.001], and preoperative range of motion [OR=10.612, 95%CI (6.565,17.153), P < 0.001] were non-operative independent influencing factors for patients with limited knee flexion after total knee arthroplasty. postoperative joint line height change [OR=0.255, 95%CI(0.167,0.387), P < 0.001] was an independent surgical influencing factor for patients with limited knee flexion after total knee arthroplasty. Body mass index and postoperative joint line height change were negatively correlated with postoperative knee flexion function; and preoperative HSS score and preoperative range of motion were positively correlated with postoperative knee flexion function. (3) The results showed that knee flexion function after total knee arthroplasty with posterior stabilized prostheses had correlations with patient's body mass index, preoperative HSS score, preoperative range of motion and postoperative joint line height change. 

Key words: bone, prosthesis, arthritis, knee, arthroplasty, flexion limitation, influencing factor

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