应用GenesisⅡPS型假体行全膝关节置换术的中期疗效
摘要
目的
对采用GenesisⅡ(Smith-Nephew,USA) PS型假体行全膝关节置换术的中期临床和X线疗效进行回顾性研究，分析可能影响疗效的假体设计特征因素，为临床医师选择假体提供依据。
方法
2001年12月～2008年10月，按纳入和排除标准纳入本研究的患者共126例（135膝），其中7例（8膝）患者因其他原因死亡，10例（13膝）失访。最终获得完整随访的患者共107例（114膝），其中7例行双侧一期TKA，平均年龄65.0±9.2岁，平均体重指数（BMI）26.0±1.0，术前诊断：退变性骨性关节炎97例（103膝），类风湿性关节炎3例（4膝），创伤性关节炎7例（7膝）。术前平均膝关节评分为47.8±6.1分，平均功能评分为49.1±10.7分，其中平均疼痛评分为11.0±3.3分，平均膝关节活动度为86.8±14.9度，平均Feller髌骨评分为18.6±3.6分。假体均采用骨水泥固定，除1例因髌骨骨折内固定术后畸形愈合行髌骨置换外，其余病例均未行髌骨置换术。
结果平均随访时间6.4年（3～9年）。无1例感染、脱位，神经血管损伤并发症。2例（2膝）并发术中骨折（股骨外髁后方），10膝有轻度膝前痛。无一例因假体松动或其它原因需行翻修术。
1.临床疗效：
单侧TKA者，术后第2天开始下地行走，双侧TKA者，下地行走时间推迟至术后7～10天。手术后半年，平均膝关节评分和功能评分分别为85.5±9.6分和80.7±12.7分，其中平均疼痛评分为39.9±8.6分，关节活动度为104.7±9.6度，平均Feller髌骨评分为26.4±2.3分，均较术前获得明显改善（P<0.05）。在随访末期，平均膝关节评分和功能评分进一步改善至91.6±4.9分和89.0±8.1分，其中平均疼痛评分为45.1±5.7分，关节活动度为114.2±7.5度，平均Feller髌骨评分为26.4±2.3分，均较术前及术后半年均明显改善（P<0.05）。患者整体满意率为90.4%。
2.影像学评估：术后正位片上测量的股骨角（α）和胫骨角（β）分别为96±0.9°和90±1.1°，侧位片上测量的平台后倾角（σ）和股骨屈曲角（γ）分别为85.5±0.7°和1.6±0.7°。胫骨平台在冠状和矢状位上的覆盖率分别为95.5±2.4%和98.9±1.1%。所有病例术后及随访末期的X线片均未显示有任何假体周围的骨溶解、X线透亮线或假体松动迹象。
结论
1.采用GenesisⅡ PS型假体行膝关节置换术，可有效缓解膝关节疼痛，改善膝关节功能，术后恢复快，并发症少，中期疗效满意，但尚需进一步观察远期疗效。2.GenesisⅡ PS型假体设计合理，是目前人工膝关节置换较理想的假体选择。
Objective: The purpose of the current retrospective follow-up study was to report themidterm clinical and X-ray results of primary total knee arthroplasty using GenesisⅡposterior-stabilized (PS) prosthesis. To analysis the possible affect factors of design features ofprosthesis and sex, and to provide the basis in prosthesis selecting.
Methods: One hundred and twenty-six(135knees) consecutive patients performedtotal knee arthroplasty using Genesis Ⅱ PS prosthesis between December2001and October2008.7patients(8knees)died for other reasons,10patients(13knees) were lost tofollow-up.107consecutive patients(114knees) were followed by a mean of6.4years(range,3-9years) after surgery. In seven patients, bilateral total knee arthroplastywere performed.The mean BMI was26.0±1.0.Preoperative diagnoses includedosteoarthritis in97patients(103knees), rheumatoid arthritis in3patients (4knees),traumatic arthritis in7patients (7knees). Preoperative mean KSS was47.8±6.1points,mean function scores was49.1±10.8points, mean Feller patellar score was18.6±3.6points,the mean range of motion was86.8±14.9°. All components were cemented. No patella wasresurfaced, but1knee resurfaced for postoperative malunion of patella fracture fixation.
Results: No infection, dislocation, or neurovascular injury occurred, but2kneesoccurred interoperative posteriorlateral femoral condyle fractures, and anterior knee painoccurred in10knees. No components were radiographically loose. No revision surgerieswere performed. At the half year past surgery, the KSS averaged85.5±9.6points, themean function scores was80.7±12.7points, the mean Feller patellar score was26.4±2.3points, the mean range of motion was104.7±9.6°, which were increased significantlycompared with those before surgery(P<0.05). At latest follow-up, the KSS averaged 91.6±4.9points, the mean function scores was89.0±8.1points, the mean Feller patellarscore was27.8±2.2points, the mean range of motion was114.2±7.5°, which wereincreased significantly compared with those before surgery and half year pastsurgery(P<0.05).90.2%of the knees were satisfied. The mean femoral angle was96±0.9°,the mean tibial angle was90±1.1°,the mean tibial posterior slope was85.5±0.7°, and themean femoral flexion angle was1.6±0.7°. Mean tibial coverage was95.5±2.4%in thecoronal plane and98.9±1.1%in the sagittal plane.
Conclusion: Midterm results of primary total knee arthroplasty using Genesis ⅡPSprosthesis was excellent, but further observation is needed. Reasonable design makesGenesis Ⅱ PS prosthesis become an ideal choice.
对采用GenesisⅡ(Smith-Nephew,USA) PS型假体行全膝关节置换术的中期临床和X线疗效进行回顾性研究，分析可能影响疗效的假体设计特征因素，为临床医师选择假体提供依据。
方法
2001年12月～2008年10月，按纳入和排除标准纳入本研究的患者共126例（135膝），其中7例（8膝）患者因其他原因死亡，10例（13膝）失访。最终获得完整随访的患者共107例（114膝），其中7例行双侧一期TKA，平均年龄65.0±9.2岁，平均体重指数（BMI）26.0±1.0，术前诊断：退变性骨性关节炎97例（103膝），类风湿性关节炎3例（4膝），创伤性关节炎7例（7膝）。术前平均膝关节评分为47.8±6.1分，平均功能评分为49.1±10.7分，其中平均疼痛评分为11.0±3.3分，平均膝关节活动度为86.8±14.9度，平均Feller髌骨评分为18.6±3.6分。假体均采用骨水泥固定，除1例因髌骨骨折内固定术后畸形愈合行髌骨置换外，其余病例均未行髌骨置换术。
结果平均随访时间6.4年（3～9年）。无1例感染、脱位，神经血管损伤并发症。2例（2膝）并发术中骨折（股骨外髁后方），10膝有轻度膝前痛。无一例因假体松动或其它原因需行翻修术。
1.临床疗效：
单侧TKA者，术后第2天开始下地行走，双侧TKA者，下地行走时间推迟至术后7～10天。手术后半年，平均膝关节评分和功能评分分别为85.5±9.6分和80.7±12.7分，其中平均疼痛评分为39.9±8.6分，关节活动度为104.7±9.6度，平均Feller髌骨评分为26.4±2.3分，均较术前获得明显改善（P<0.05）。在随访末期，平均膝关节评分和功能评分进一步改善至91.6±4.9分和89.0±8.1分，其中平均疼痛评分为45.1±5.7分，关节活动度为114.2±7.5度，平均Feller髌骨评分为26.4±2.3分，均较术前及术后半年均明显改善（P<0.05）。患者整体满意率为90.4%。
2.影像学评估：术后正位片上测量的股骨角（α）和胫骨角（β）分别为96±0.9°和90±1.1°，侧位片上测量的平台后倾角（σ）和股骨屈曲角（γ）分别为85.5±0.7°和1.6±0.7°。胫骨平台在冠状和矢状位上的覆盖率分别为95.5±2.4%和98.9±1.1%。所有病例术后及随访末期的X线片均未显示有任何假体周围的骨溶解、X线透亮线或假体松动迹象。
结论
1.采用GenesisⅡ PS型假体行膝关节置换术，可有效缓解膝关节疼痛，改善膝关节功能，术后恢复快，并发症少，中期疗效满意，但尚需进一步观察远期疗效。2.GenesisⅡ PS型假体设计合理，是目前人工膝关节置换较理想的假体选择。
Objective: The purpose of the current retrospective follow-up study was to report themidterm clinical and X-ray results of primary total knee arthroplasty using GenesisⅡposterior-stabilized (PS) prosthesis. To analysis the possible affect factors of design features ofprosthesis and sex, and to provide the basis in prosthesis selecting.
Methods: One hundred and twenty-six(135knees) consecutive patients performedtotal knee arthroplasty using Genesis Ⅱ PS prosthesis between December2001and October2008.7patients(8knees)died for other reasons,10patients(13knees) were lost tofollow-up.107consecutive patients(114knees) were followed by a mean of6.4years(range,3-9years) after surgery. In seven patients, bilateral total knee arthroplastywere performed.The mean BMI was26.0±1.0.Preoperative diagnoses includedosteoarthritis in97patients(103knees), rheumatoid arthritis in3patients (4knees),traumatic arthritis in7patients (7knees). Preoperative mean KSS was47.8±6.1points,mean function scores was49.1±10.8points, mean Feller patellar score was18.6±3.6points,the mean range of motion was86.8±14.9°. All components were cemented. No patella wasresurfaced, but1knee resurfaced for postoperative malunion of patella fracture fixation.
Results: No infection, dislocation, or neurovascular injury occurred, but2kneesoccurred interoperative posteriorlateral femoral condyle fractures, and anterior knee painoccurred in10knees. No components were radiographically loose. No revision surgerieswere performed. At the half year past surgery, the KSS averaged85.5±9.6points, themean function scores was80.7±12.7points, the mean Feller patellar score was26.4±2.3points, the mean range of motion was104.7±9.6°, which were increased significantlycompared with those before surgery(P<0.05). At latest follow-up, the KSS averaged 91.6±4.9points, the mean function scores was89.0±8.1points, the mean Feller patellarscore was27.8±2.2points, the mean range of motion was114.2±7.5°, which wereincreased significantly compared with those before surgery and half year pastsurgery(P<0.05).90.2%of the knees were satisfied. The mean femoral angle was96±0.9°,the mean tibial angle was90±1.1°,the mean tibial posterior slope was85.5±0.7°, and themean femoral flexion angle was1.6±0.7°. Mean tibial coverage was95.5±2.4%in thecoronal plane and98.9±1.1%in the sagittal plane.
Conclusion: Midterm results of primary total knee arthroplasty using Genesis ⅡPSprosthesis was excellent, but further observation is needed. Reasonable design makesGenesis Ⅱ PS prosthesis become an ideal choice.
引文
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