[使用Beznoska S.V.L. 植入物进行全膝关节置换术：短期结果]

Stárek M, Stehlík J, Held M

Ortopedické oddelení Nemocnice Ceské Budejovice, a. s.

Acta Chir Orthop Traumatol Cech. 2004;71(6):352-9.

PURPOSE OF THE STUDY

To present and evaluate short-term clinical results of total knee arthroplasty using the Beznoska S. V. L. implant and to compare them with the results of other authors.

MATERIAL

In the period from April 1997 to October 2002, 197 total knee replacements with a S. V. L. implant were carried out of these, 164 implants were evaluated in 146 patients. This group comprised 116 women (78 %) and 48 men (22 %), with an average age of 73.6 years (range, 63 to 83) at the time of surgery. The patients were evaluated on average at 4.3 years (range, 1.5 to 6.5) after surgery. Indications for replacement were primary knee arthritis in 151, rheumatoid arthritis in nine, secondary post-traumatic arthritis in two and conditions following tibial osteotomy in two cases.

METHODS

The results were evaluated using the Knee Society Clinical Rating System which consists of three parts: Knee Score (100 points), Knee Function Score (100 points) and Categorical Score (allocating patients to three groups according to function deficiencies of other joints). X-ray images were examined for implant position, the presence of radiolucent lines and patellar position, and assessed on the basis of the Knee Society Total Knee Arthroplasty Roentgenographic and Scoring System.

RESULTS

No or mild pain in the treated joint was reported by 90.2 % of the patients. Severe pain was not recorded at all. The average maximal range of flexion increased from 94 degrees preoperatively to 104 degrees post-operatively. The range of motion more than 90 degrees and that of more than 100 degrees were recorded in 96 % and 76.8 % of the operated-on knees, respectively. An anteroposterior mild instability of 5 to 10 mm was objectively found in nine knees (5.5 %) a medial laxity of 6 to 9 degrees was detected in 36 knees (22 %) and that of 10 to 15 degrees only in one patient. Severe instability was not recorded. The leg axis achieved after surgery was on average 6.4 degrees valgus, compared to 5.5 degrees varus before surgery. The total Knee Score was 85.1 points (range, 53 to 100), with excellent or good outcomes in 151 knee replacements (92 %). Six patients (4.6 %) reported failure to walk a distance of more than 500 m on an even terrain, six (4.6 %) could not manage the stairs and five (3 %) required a permanent use of two crutches or a walking frame. The average function score, which also included the effect of concomitant diseases of other joints, was 64.9 points (range, 40 to 100), with excellent or very good outcomes being achieved in 64 implants (39 %). On X-ray examination of implant position in anteroposterior projection, the average valgus angle of the femoral component was 94.8 degrees (range, 92 to 100) and the tibial angle was 90.3 degrees (range, 85 to 94). In lateral projection the flexion angle of the femoral component was 2.5 degrees (-1 to 6) and the average dorsal tilt of the tibia was 3 degrees. Distinct radiolucent lines up to 1 mm in width were seen in the femoral component in 10 (6 %) cases and in the tibial component in 27 (16.5 %) cases, this occurred in zones 1, 2 or 4. Wider lines of 2 mm were present in both components in 6 (3 %) cases. Radiolucent lines were recorded in 43 (26 %) implants. The patella examined in axial projection was correctly centered in 140 (85 %) total knee replacements. Eleven patients reported femoropatellar problems and, in three of them, patella replacement was subsequently performed. No aseptic loosening occurred and one deep infection (0.6 %) was treated by a two-stage reimplantation.

DISCUSSION

Excellent to very good outcomes, with an average Knee Score of 85.1 points, were achieved in 92 % of the implants. The total outcome characterized by an average Functional Score of 64.9 points was related to a higher average age of our patients and a high proportion of patients with diseases of other joints, which interfered with overall mobility and self-sufficiency. The results of implant position evaluation, based on X-ray examination, showed good values, which testifies to the use of an appropriate surgical technique and accuracy of the instrumentation applied. The occurrence of radiolucent lines was low, as was the number of complications. Our results are comparable with those reported in the literature.

CONCLUSIONS

Our short-term evaluation shows that the S. V. L. implant is fully useful for total knee replacement in patients of higher age categories.

研究目的

介绍并评估使用Beznoska S.V.L.植入物进行全膝关节置换术的短期临床结果，并与其他作者的结果进行比较。

材料

在1997年4月至2002年10月期间，共进行了197例使用S.V.L.植入物的全膝关节置换术，其中146例患者的164个植入物接受了评估。该组包括116名女性（78%）和48名男性（22%），手术时的平均年龄为73.6岁（范围63至83岁）。患者术后平均随访4.3年（范围1.5至6.5年）。置换的适应证包括原发性膝关节炎151例、类风湿关节炎9例、继发性创伤后关节炎2例以及胫骨截骨术后情况2例。

方法

使用膝关节协会临床评分系统评估结果，该系统由三部分组成：膝关节评分（100分）、膝关节功能评分（100分）和分类评分（根据其他关节功能缺陷将患者分为三组）。对X线图像检查植入物位置、透光线的存在情况和髌骨位置，并根据膝关节协会全膝关节置换术X线和评分系统进行评估。

结果

90.2%的患者报告治疗关节无疼痛或轻度疼痛。未记录到严重疼痛。平均最大屈曲范围从术前的94度增加到术后的104度。手术膝关节中，屈曲超过90度和超过100度的范围分别记录在96%和76.8%的病例中。客观发现9个膝关节（5.5%）存在5至10毫米的前后轻度不稳定，36个膝关节（22%）检测到内侧松弛6至9度，仅1例患者内侧松弛10至15度。未记录到严重不稳定。术后获得的下肢力线平均外翻6.4度，术前为内翻5.5度。膝关节总评分为85.1分（范围53至100分），151例膝关节置换（92%）结果为优或良。6例患者（4.6%）报告在平坦地面上行走超过500米失败，6例（4.6%）无法上下楼梯，5例（3%）需要长期使用双拐或助行架。平均功能评分（也包括其他关节伴发疾病的影响）为64.9分（范围40至100分），64个植入物（39%）结果为优或非常好。在前后位X线检查植入物位置时，股骨部件的平均外翻角度为94.8度（范围92至100度），胫骨角度为90.3度（范围85至94度）。在侧位，股骨部件的屈曲角度为2.5度（-1至6度），胫骨的平均背倾为3度。在10例（6%）股骨部件和27例（16.5%）胫骨部件中可见宽度达1毫米的明显透光线，发生在1、2或4区。6例（3%）两个部件均出现2毫米宽的更宽透光线。43个（26%）植入物记录到透光线。在140例（85%）全膝关节置换术中，轴位检查的髌骨位置正确居中。11例患者报告有髌股问题，其中3例随后进行了髌骨置换。未发生无菌性松动，1例深部感染（0.6%）通过二期再植入进行治疗。

讨论

92%的植入物取得了优至非常好的结果，膝关节平均评分为85.1分。以平均功能评分为64.9分为特征的总体结果与我们患者的平均年龄较高以及其他关节疾病患者比例较高有关，这影响了整体活动能力和自理能力。基于X线检查的植入物位置评估结果显示良好，这证明了采用了合适的手术技术和所用器械的准确性。透光线的发生率较低，并发症数量也较少。我们的结果与文献报道的结果相当。