初次全膝置换前稳定与后交叉保留垫片的比较△（开放获取）

Anterior stabilized insert versus cruciate retaining counterpart for primary total knee arthroplasty (OA)

摘要:

[目的]比较初次全膝关节置换术中使用前稳定型胫骨垫片与后交叉韧带保留型垫片的中期临床效果。[方法]回顾性分析 2016 年 1 月—2017 年 1 月因膝关节骨性关节炎使用 Vanguard 膝关节假体行单侧初次全膝关节置换术的 116 例 （116 膝） 患者的临床资料。根据术前医患沟通结果，65 例使用前稳定型垫片 （AS 组），51 例使用后交叉保留型垫片 （CR 组），比较两组患者围手术期、随访及影像资料。[结果] 两组患者均顺利完成手术，两组围手术期指标的差异均无统计学意义 （P＞ 0.05）。平均随访时间（7.0±0.1）年。与术前相比，末次随访时两组 VAS 评分、HSS 评分、KSS 临床功能评分、膝关节 ROM 均显著改善（P＜0.05），相同时间点，两组间上述指标比较差异均无统计学意义（P＞0.05）。末次随访时两组 FJS 评分的差异无统计学意义（P＞0.05）。影像方面，与术后即刻相比，末次随访时两组患者股胫角（femorotibial angle, FTA）、髋膝踝角（hip-knee-ankle angle, HKAA)、股骨内翻-外翻角（femoral varus-valgus angle, FVVA）、股骨矢状角（femoral sagittal angle, FSA）、胫骨内翻-外翻角 （tibial varus-valgus angle, TVVA）、胫骨后倾角 （posterior tibial slope angle, PTSA）、后髁偏移率 （posterior condylar offset ratio, PCOR）和 Insall-Salvati 指数均无显著变化（P＞0.05）。术后即刻和末次随访时，AS 组 PTSA 角 [(2.2±1.5)° vs (6.1±1.4)°, P＜0.001； (2.2±1.4)° vs (6.1±1.4)°, P＜0.001] 显著小于 CR 组，其他影像指标两组间差异均无统计学意义（P＞0.05）。[结论]初次全膝关节置换术中应用 AS 垫片术后中期临床结果及影像学结果良好，与 CR 垫片相比无显著差异。在临床具体治疗过程中，手术医师可根据具体情况灵活选择。

Abstract:

[Objective] To compare the mid-term clinical outcomes of anterior stabilized insert versus cruciate retaining insert in primary total knee arthroplasty. [Methods] A retrospective study was conducted on 116 patients (116 knees) who underwent unilateral primary total knee arthroplasty with Vanguard knee prosthesis for knee osteoarthritis from January 2016 to January 2017. According to the preoperative doctor-patient communication, 65 patients received anterior stabilized insert (the AS group), while other 51 patients had cruciate retaining insert used (the CR group). The documents regarding perioperative period, follow-up and images were compared between the two groups. [Results] All patients in both groups had corresponding TKA performed successfully with no statistical significance in perioperative parameters between the two groups (P>0.05). The VAS, HSS, and KSS scores, as well as knee ROM in both groups were significantly improved at the latest follow-up lasted for (7.0±0.1) years in a mean compared with those preoperatively (P<0.05), which were not statistical significant between the two groups at any time points accordingly (P>0.05). In addition. there was no significant difference in FJS scores between the two groups at the last follow-up (P>0.05). Radiographically, the femorotibial angle (FTA), hip knee ankle angle (HKAA), femoral varus-valgus angle (FVVA), femoral sagittal angle (FSA), tibial varus-valgus angle (TVVA), posterior tibial slope angle (PTSA), posterior condylar offset ratio (PCOR) and Insall-Salvati index remained unchanged at the latest follow-up compared with those immediately after surgery (P> 0.05). The AS group had significantly less PTSA than the CR group immediately postoperatively and at the latest follow-up [(2.2±1.5)° vs (6.1±1.4)°, P<0.001; (2.2±1.4)° vs (6.1±1.4)°, P<0.001], despite of the fact that no significant difference in other imaging indicators were noted between the two groups (P>0.05). [Conclusion] The midterm clinical and imaging consequences of AS insert used in primary total knee arthroplasty are good, and not significantly different compared with CR insert. In the clinical setting, the surgeon might choose the inserts flexibly according to the specific situation.