股骨前髁厚度改变对全膝置换术后活动度的影响△

Influence of anterior condyle height variation on knee range of motion after total knee replacement

摘要:

[目的]探讨全膝关节置换术后股骨前髁厚度(anterior condyle height, ACH)改变对术后膝关节活动度(range of mo- tion, ROM) 的影响。[方法] 回顾性分析 2018 年 10 月—2020 年 1 月本院收治的因膝关节骨关节炎行初次单侧全膝关节置换术，并随访 12 个月以上的 72 例患者的临床资料。记录患者一般资料、ROM、KSS 评分，以及影像测量 ACH。采用单因素 Pearson 相关分析和多元逐步回归分析探讨影响末次随访时 ROM 的因素。[结果] 按 ACH 变化值 (术后 ACH-术前 ACH)，将患者分为三组，减薄组＜-3 mm 组，无改变组-3~3 mm，增厚组≥3 mm 组。术前三组 ROM 的差异无统计学意义 (P＞0.05)，末次随访时，ROM 由大至小依次为减薄组＞无改变组＞增厚组，差异有统计学意义(P＜0.05)。术前三组 KSS 临床评分的差异无统计学意义(P＞0.05)，末次随访时，KSS 临床评分由大至小依次为减薄组＞无改变组＞增厚组，差异有统计学意义(P＜0.05)。单项因素相关分析表明：末次随访 ROM 与 ACH 变化值呈显著负相关 (P＜0.05)，末次随访 ROM 与 KSS 临床评分呈显著正相关 (P＜0.05)。多元回归分析表明：末次随访时 ROM 与术前 ROM 呈显著正相关(B=0.317，P=0.021)，与 ACH 变化值呈显著负相关(B=-2.673，P＜0.001)。[结论]ACH 变化值与术后 ROM 有密切关系。

Abstract:

[Objective] To explore the influence of variation of anterior condyle height (ACH) on knee flexion-extension range of mo- tion (ROM) after total knee replacement. [Methods] A retrospective study was performed on 72 patients who underwent primary unilateral total knee replacement for knee osteoarthritis in our hospital from October 2018 to January 2020, and followed up for more than 12 months. The general information, ROM, KSS clinical and functional scores, as well as radiographically measured ACH were recorded. Univariate Pearson correlation analysis and multiple stepwise regression analysis were used to explore the factors affecting ROM at the last follow-up. [Results] Patients were divided into three groups according to ACH variation (postoperative ACH minus preoperative ACH), the thinning group with ACH variation ＜-3mm, the unchanged group with -3~3 mm, the thickening group ≥3mm group. Although there was no a signifi- cant difference in the ROM before operation among the three groups (P＞0.05) , the ROM at the latest follow-up was ranked in descending order of the thinning group ＞ the unchanged group ＞ the thickening group, with a statistically significant difference among them (P＜0.05) . There was no a significant difference in preoperative KSS clinical scores among the three groups (P＞0.05) , however, the ROM at the latest follow-up in descending order was of the thinning group ＞the unchanged group ＞ the thickening group, which was statistically significant (P＜0.05). In term of Pearson correlation analysis, the ROM at the latest follow-up was negatively correlated with ACH variation (P＜0.05) , whereas the former was significantly positively correlated with KSS clinical score at the last follow-up (P＜0.05) . As results of multiple re- gression analysis, the ROM at the last follow-up was positively correlated with the ROM preoperatively (B=0.317, P=0.021) , whereas nega- tively correlated with ACH variation (B=-2.673, P＜0.001) . [Conclusion] ACH variation is closely related to ROM after operation.