两种假体组合全膝关节翻修的比较△（开放获取）

(Open Access) Comparison of total knee revision with two prosthetic combinations

摘要:

[目的]比较膝关节翻修术（totalkneerevision, TKR）使用 Sleeve 系统与髁限制性假体（constrained condylar knee, CCK）结合垫块的临床疗效。[方法]回顾性分析2017年3月—2020年11月53例在本院行TKR患者的临床资料，根据术前骨缺损情况，结合术前规划及医患沟通结果，22例采用Sleeve系统（Sleeve组），31例采用CCK结合垫块（CCK组）。比较两组围手术期、随访及影像资料。[结果]两组患者均顺利完成手术，Sleeve组骨缺损显著大于CCK组[(1.8±0.7)cmvs(1.0±0.4) cm, P＜0.001]，但是，前者垫片厚度显著小于后者[(11.2±4.2)mmvs(14.4±5.8) mm, P=0.032]。两组手术时间等围手术期指标差异均无统计学意义（P＞0.05），Sleeve 组的总治疗费显著多于CCK组[(11.6±2.3)万元vs(9.9±2.5) 万元, P=0.015]。随访时间平均 （36.0±3.5）个月，术后随时间推移，两组VAS评分、KSS临床及功能评分、OKS评分、膝伸-屈ROM均显著改善（P＜0.05）。 术前Sleeve 组的OKS评分[(44.3±10.3) vs (38.2±8.6), P=0.023] 显著差于 CCK 组，但是，术后 1 个月及末次随访时，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，末次随访时两组HKA、MAD均显著改善（P＜0.05），关节线高度无显著变化（P＞0.05）。末次随访时，Sleeve组的关节线高度显著小于CCK组[(20.4±6.0)mmvs(23.4±4.7)mm,P=0.047]。[结论]2种假体组合均可获得优异的临床疗效、良好的下肢力线以及假体稳定性。Sleeve在恢复关节线高度、修复更大骨缺损方面更有优势，但需警惕术中骨折发生。

Abstract:

[Objective] To compare the clinical efficacy of total knee revision (TKR) using Sleeve system versus constrained condylar knee (CCK) combined with augment. [Methods] A retrospective study was done on 53 patients who received TKR in our hospital from March 2017 to November 2020. According to preoperative bone defects, combined with preoperative planning and surgeon-patient communication, 22 patients had TKR performed with Sleeve system (Sleeve group), while other 31 patients were treated with CCK combined with augment (CCK group). The perioperative, follow-up and imaging data of the two groups were compared. [Results] All patients in both groups had TKR performed smoothly, and the Sleeve group had significantly longer bone defect than the CCK group [(1.8±0.7) cm vs (1.0± 0.4) cm, P＜0.001], while the former had significantly thinner pad used less than the latter [(11.2±4.2) mm vs (14.4±5.8) mm, P=0.032]. There was no statistical significance in perioperative items, such as operation time, between the two groups (P＞0.05). The Sleeve group spent significantly higher medical fee than the CCK group [(11.6±2.3) 10 k yuan vs (9.9±2.5) 10 k yuan, P=0.015]. With time of follow-up period lasted for a mean of (36.0±3.5) months, the VAS scores, KSS clinical and functional scores, OKS scores and knee extension-flexion ROM in both groups significantly improved (P＜0.05). Although the Sleeve group was significantly inferior to the CCK group in term of preoperative OKS scores [(44.3±10.3) vs (38.2±8.6), P=0.023], but there was no significant difference in the abovesaid score between the two groups at 1 month after surgery and the last follow-up (P＞0.05). As for imaging, the hip-knee-ankle angle (HKA ) and mechanical axis deviation (MAD) significantly improved in both groups at the last follow-up (P＜0.05), but there was no significant change in joint line height (P＞0.05). However, the Sleeve group had significantly lower joint line height than that of CCK group at the last follow-up [(20.4±6.0) mm vs (23.4±4.7) mm, P=0.047]. [Conclusion] Both the prosthetic combinations achieve excellent clinical consequence, with good lower limb alignment and stable knee. The Sleeve has advantages in restoring joint line height and repairing larger bone defects, but intraoperative frac-tures must be vigilant.