CR假体与PS假体对全膝关节置换术疗效的影响

doi:10.3969/j.issn.1007-3205.2021.01.010

摘要/Abstract

摘要： cruciate substituting,PS)假体全膝关节置换术(total knee arthroplasty,TKA)效果。
方法选择膝关节骨性关节炎患者80例，均行单侧TKA术，其中40例患者采用CR型假体为CR组，40例患者采用PS假体为PS组。比较2组手术时间、术中出血量、引流量，记录术后1、3个月美国纽约特种外科医院膝关节评分(hospital for special surgery knee score,HSS)、膝关节活动度，术后3、7 d膝关节活动度及视觉模拟评分（visual analog scale,VAS）；记录术后血红蛋白(hemoglobin,HB)下降量以及术后皮下淤斑、关节肿胀、下肢静脉血栓形成等并发症发生情况；随访6个月，采用麦克马斯特大学骨关节炎指数评分(western ontario McMaster university osteoarthritis index,WOMAC)评估患者满意度。
结果 CR组术后HB下降量较PS组减少，差异有统计学意义（P＜0.05）；2组手术时间、术前HB、术后引流量比较差异均无统计学意义（P＞0.05）；CR组VAS评分低于PS组（P＜0.05），2组在组间、时点间差异有统计学意义（P＜0.05），在组间·时点间交互作用差异无统计学意义（P＞0.05）；CR组、PS组术前膝关节活动度、HSS评分比较差异无统计学意义（P＞0.05），CR组术后6个月膝关节活动度小于PS组（P＜0.05），HSS评分与PS组比较差异无统计学意义（P＞0.05）；CR组皮下淤斑、关节肿胀发生率低于PS组（P＜0.05），切口愈合不良、下肢静脉血栓发生率与PS组比较差异无统计学意义（P＞0.05）；术后6个月，CR组患者满意度（87.5%）高于PS组（67.5%）（P＜0.05）。
结论 CR假体可保留本体感觉，减少患者失血量，有助于减轻疼痛，降低术后并发张发生，PS假体在改善膝关节活动度上更具有优势。临床应用时，应严格把握适应证，并综合医师的操作技能水平来选择假体类型。

关键词: 关节成形术, 置换, 膝；骨关节炎；后交叉韧带

Abstract: Objective To investigate the effect of posterior cruciate ligament retaining(CR) and posterior cruciate substituting(PS) total knee arthroplasty(TKA).
Methods A total of 80 patients with knee osteoarthritis(KOA) underwent unilateral TKA, including 40 patients with CR-type prosthesis as CR group, and 40 patients with the PS prosthesis as the PS group. The duration of operation, intraoperative blood loss and drainage volume of the two groups were compared. The hospital for special surgery knee score(HSS) and knee joint activity were recorded at 1 and 3 months after operation. Knee activity and visual analog scale(VAS) at 3 and 7 d after operation were recorded; postoperative hemoglobin(HB) decline and postoperative subcutaneous ecchymosis, joint swelling, lower extremity venous thrombosis and other complications were recorded. They were followed up for six months, and the patient satisfaction was assessed using the Western Ontario McMaster university osteoarthritis index(WOMAC).
Results The decrease of HB in the CR group was significantly lower than that in the PS group after operation(P＜0.05). There was no significant difference in the duration of operation, preoperative HB and postoperative drainage between the two groups(P＞0.05). The VAS score of the CR group was lower than that of the PS group(P＜0.05). There was significant difference of VAS score between the two groups and different time points(P＜0.05), and the difference of interaction between groups, time points and time points between groups were not statistically significant(P＞0.05). There was no significant difference in the knee joint activity of the CR group and the PS group before operation, as well as in in HSS scores between two groups(P＞0.05). The knee joint activity in the CR group was less than that in the PS group at 6 months after operation(P＜0.05), and there was no significant difference in the HSS score as compared with the PS group(P＞0.05). The incidence of subcutaneous ecchymosis and joint swelling in the CR group was lower than that in the PS group(P＜0.05). There was no significant difference in the rate of incision healing and the incidence of venous thrombosis in the lower extremity compared with the PS group(P＞0.05). At 6 months after operation, the satisfaction rate of patients in the CR group(87.5%) was higher than that in the PS group(67.5%)(P＜0.05).
Conclusion CR prosthesis can retain the proprioception, reduce the amount of blood loss, pain and postoperative complications. PS prosthesis is more advantageous in improving knee joint mobility. In clinical application, the indications should be strictly controlled, and the level of prosthesis should be selected by the comprehensive skill level of the physician.

Key words: arthroplasty, replacement, knee, osteoarthritis, posterior cruciate ligament

李萍, 柴恺. CR假体与PS假体对全膝关节置换术疗效的影响[J]. 河北医科大学学报, 2021, 42(1): 42-76.

LI Ping, CHAI Kai. Effect of CR prosthesis and PS prosthesis on the outcome of total knee arthroplasty[J]. Journal of Hebei Medical University, 2021, 42(1): 42-76.

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CR假体与PS假体对全膝关节置换术疗效的影响

Effect of CR prosthesis and PS prosthesis on the outcome of total knee arthroplasty

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