交叉韧带保留与后稳定型假体全膝置换早期比较△

Comparison of short-term outcomes of cruciate retaining versus posterior stabilized total knee arthroplasty

摘要:

［目的］ 比较后交叉韧带保留 （cruciate retaining, CR） 与后稳定 （posterior stabilized, PS） 型全膝关节置换 （total knee arthroplasty, TKA）术治疗中重度膝骨性关节炎（knee osteoarthritis, KOA）的早期疗效。［方法］回顾性分析 2015 年 1 月— 2017 年 12 月 142 例 （142 膝） 因中重度单侧 KOA 行 TKA 患者的临床资料。依据术前医患沟通结果，85 例 （85 膝） 采用 CR 型 TKA，57 例（57 膝）采用 PS 型 TKA。比较两组围手术期、随访及影像结果。［结果］两组患者均顺利完成手术，术中无神经、血管损伤等严重并发症。CR 组术中失血量、术中抽屉试验前后移动距离、术后引流量以及下地行走时间均显著优于 PS 组 （P<0.05）。两组患者随访 36 个月以上，CR 组恢复完全负重活动时间显著早于 PS 组 （P<0.05）。随时间推移，两组患者 VAS 评分显著降低 （P<0.05），而屈伸 ROM、AKSS 临床和 AKSS 功能评分以及 HSS 评分均显著增加 （P<0.05）。在术后 1 个月时， CR 组上述指标显著优于 PS 组 （P<0.05），但术后 6、36 个月时，两组上述指标的差异均无统计学意义 （P>0.05）。影像方面， 与术前相比，术后两组患者 FTA 减少，而 MPTA 均显著增加 （P<0.05），相应时间点两组患者 FTA、MPTA 差异均无统计学意义 （P>0.05）。术后 6、36 个月，CR 组的 PTS 显著小于 PS 组 （P<0.05）。［结论］ CR 和 PS 假体 TKA 均可有效治疗 KOA，相比之下，CR 组手术创伤小，功能恢复快。但两种假体远期疗效比较还需长期随访加以验证。

Abstract:

[Objective] To compare the short-term outcomes of cruciate retaining (CR) versus posterior stabilized (PS) total knee arthro- plasty (TKA) for moderate and severe knee osteoarthritis (KOA) . [Methods] A retrospective study was done on 142 patients (142 knees) who underwent TKA for moderate and severe unilateral KOA from January 2015 to December 2017. According to preoperative doctor-pa- tient communication, 85 patients (85 knees) received CR-TKA, while the remaining 57 patients (57 knees) received PS -TKA. The periop- erative, follow-up and imaging documents were compared between the two groups. [Results] All the patients in both groups had operation completed successfully without neurovascular injuries and other serious complications. The CR group proved significantly superior to the PS group in terms of intraoperative blood loss, displacement measured in intraoperative anterior drawer test, postoperative drainage and walking time postoperatively (P＜0.05) . The patients in both groups were followed up for more than 36 months, and the CR group resumed full weight-bearing activity significantly earlier than the PS group (P＜0.05) . The VAS scores decreased significantly (P＜0.05) , while flex- ion- extension ROM, AKSS clinical and functional scores, as well as HSS scores significantly increased over time in both groups (P＜0.05) , which in the CR group were significantly superior to those in the PS group at 1 month after surgery (P＜0.05) , whereas become not statisti- cally significant between them at 6 and 36 months postoperatively (P＞0.05) . With respect to radiographs, the femorotibial angle (FTA) de- creased significantly (P＜0.05) , while the medial proximal tibial angle (MPTA) increased significantly postoperatively in both groups com- pared with those preoperatively (P＜0.05) , with no significant differences between the two group at any matching time points (P＞0.05) . How- ever, the CR group had significantly less posterior tibial slope (PTS) than the PS group at 6 and 36 months after operation (P＜0.05) . [Conclusion] Both CR and PS prostheses for TKA do effectively treat KOA. By contrast, the CR prosthesis takes benefits of less surgical trauma and faster functional recovery, however, long-term follow-up is still needed to compare the efficacy of the two prostheses.