Fuchs Susanne, Sandmann Christian, Gerdemann Georg, Skwara Adrian, Tibesku Carsten O, Bottner Friedrich
Department of Orthopedics, University Hospital Münster, Albert-Schweitzer-Strasse 33, 48149, Münster, Germany.
Knee Surg Sports Traumatol Arthrosc. 2004 Mar;12(2):140-3. doi: 10.1007/s00167-003-0401-8. Epub 2003 Aug 21.
This study compared the overall outcome after salvage revision total knee arthroplasty using hinged and nonhinged designs. We followed 26 total knee arthroplasties for an average of 20.4 months. The average age was 68.5 years. All patients had a salvage situation secondary to excessive bone loss, enlarged flexion gap, collateral ligament insufficiency, or extensor mechanism insufficiency. Ten patients received a hinged implant after an average of 2.8 prior total knee replacements. Sixteen patients received nonhinged constrained implants after an average of 3.4 prior total knee replacements. The outcome was evaluated using the Hospital for Special Surgery Score (HSS), the Knee Society Score (KSS), the Visual Analogue Scale for pain (VAS), the Tegner Activity Score, the Patella Score, and the Short Form-36 Health Survey (SF-36). There was a statistically significant difference in flexion range of motion between hinged and nonhinged designs (96.5 degrees vs. 107.5 degrees ) but not in HSS, KSS, VAS, Tegner Activity Score, or Patella Score. Patients with hinged and nonhinged prostheses had significantly lower scores than an age-matched normal population in physical functioning, role limitations, and bodily pain on the SF-36 survey. However, patients with a hinged implant had no statistically significant difference compared to controls in the mental component summary. In salvage total knee arthroplasty the implant design does not significantly affect the overall functional outcome. However, patients with a hinged implant had significant better scores in the mental components of the SF36 quality-of-life assessment.
本研究比较了采用铰链式和非铰链式设计的挽救性翻修全膝关节置换术后的总体结果。我们对26例全膝关节置换术患者进行了平均20.4个月的随访。平均年龄为68.5岁。所有患者均因骨量过度丢失、屈曲间隙增大、侧副韧带功能不全或伸肌机制功能不全而处于挽救情况。10例患者在平均2.8次先前全膝关节置换术后接受了铰链式植入物。16例患者在平均3.4次先前全膝关节置换术后接受了非铰链式限制性植入物。使用特种外科医院评分（HSS）、膝关节协会评分（KSS）、疼痛视觉模拟量表（VAS）、特格纳活动评分、髌骨评分和简短健康调查问卷36（SF-36）对结果进行评估。铰链式和非铰链式设计在屈曲活动度方面存在统计学显著差异（96.5度对107.5度），但在HSS、KSS、VAS、特格纳活动评分或髌骨评分方面无差异。在SF-36调查中，使用铰链式和非铰链式假体的患者在身体功能、角色限制和身体疼痛方面的得分显著低于年龄匹配的正常人群。然而，铰链式植入物患者在精神健康综合评分方面与对照组相比无统计学显著差异。在挽救性全膝关节置换术中，植入物设计对总体功能结果无显著影响。然而，在SF36生活质量评估的精神健康方面，铰链式植入物患者的得分显著更高。
