后稳定全膝置换衬垫安放次序的影响

Influence of insert placement sequence in posterior-stabilized total knee arthroplasty

摘要:

[目的] 探讨后稳定型全膝关节置换术 （posterior-stabilized total knee arthroplasty, PS-TKA） 衬垫安放次序的影响。 [方法] 2021 年 1 月—2021 年 10 月本院骨科收治的初次 TKA 患者 93 例，随机分为先安组 47 膝和后安组 46 膝，比较两组临床与影像资料。[结果]先安组的手术时间显著少于后安组 [(49.1±3.8) min vs (55.3±4.2) min, P＜0.001]，两组切口长度、术中失血量、术后下地时间、切口愈合情况的差异均无统计学意义（P＞0.05）。与术前相比，两组患者出院时 VAS 评分、HSS 评分、膝 ROM 均显著改善（P＜0.05）。出院时，先安组 HSS 评分 [(75.3±5.9) vs (72.2±5.6), P=0.011] 显著优于后安组。影像方面，与术前相比，两组患者术后髋-膝-踝角（hip-knee-ankle angle, HKA）、胫骨近端内侧角（medial proximal tibial angle, MPTA）、股骨机械轴远端外侧角（mechanical lateral distal femoral angle, mLDFA）均显著增加（P＜0.05）。术前两组间上述影像指标的差异均无统计学意义（P＞0.05)，术后先安组的 mLDFA 显著大于后安组 [(91.1±1.1) ° vs (90.6±1.3) °, P=0.011]。[结论]后稳定型全膝关节置换术中优先装配衬垫能够减少手术操作步骤，缩短手术时间，有利于关节功能恢复。

Abstract:

[Objective] To explore the effect of insert placement sequence in posterior-stabilized total knee arthroplasty (PS-TKA). [Methods] From January 2021 to October 2021, a total 93 patients who were undergoing initial unilateral PS-TKA in our hospital were randomly divided into two groups. Of them, 47 knees had the insert placed firstly, while other 46 knee group had insert placed secondarily. The documents regarding to perioperative period and images of the two groups were compared. [Results] The firstly group proved significantly shorter operation time than the secondarily group [(49.1±3.8) min vs (55.3±4.2) min, P＜0.001], althogh there were no significant differences in incision length, intraoperative blood loss, postoperative walking time and incision healing between the two groups (P＞0.05). The VAS, HSS scores and knee ROM significantly improved in both groups at discharge compared with those preoperatively (P＜0.05). At discharge, the firstly group was significantly better than the secondarily group in term of HSS score [(75.3±5.9) vs (72.2±5.6), P=0.011]. With respect of imaging, the postoperative Hip-knee ankle angle (HKA), medial proximal tibial angle (MPTA) and mechanical lateral distal femoral angle (mLDFA) significantly increased in both groups compared with those preoperatively (P＜0.05). Despite of insignificant differences in the above imaging indexes between the two groups before operation (P＞0.05), the firstly group got significantly greater mLDFA than the secondarily group postoperatively [(91.1±1.1)° vs (90.6±1.3)°, P=0.011]. [Conclusion] In PS-TKA, the insert placed firstly does reduce the operation steps and shorten the operation time, which is conducive to the recovery of joint function in this study.