在全膝关节置换术中比较低接触压和压配合式髁突旋转平台活动型假体：一项前瞻性随机研究。

Comparison of the low contact stress and press fit condylar rotating-platform mobile-bearing prostheses in total knee arthroplasty: a prospective randomized study.

机构信息

The Joint Replacement Center of Korea, Ewha Womans University School of Medicine, Seoul, South Korea.

出版信息

J Bone Joint Surg Am. 2011 Jun 1;93(11):1001-7. doi: 10.2106/JBJS.J.00445.

DOI:10.2106/JBJS.J.00445

PMID:21655893

Abstract

BACKGROUND

To our knowledge, no study to date has compared the clinical results of posterior cruciate-sacrificing mobile-bearing total knee replacements with those of posterior-stabilized mobile-bearing total knee replacements in the same patients. The purpose of the present study was to compare the clinical and radiographic results of these two designs. We hypothesized that the results would be better for knees treated with the posterior-stabilized mobile-bearing prosthesis.

METHODS

The present study consisted of a consecutive series of 107 female patients (mean age, 66.8 years) who underwent bilateral simultaneous total knee arthroplasty at the same surgical setting. All of these patients received a posterior cruciate-sacrificing mobile-bearing prosthesis in one knee and a posterior-stabilized mobile-bearing prosthesis in the contralateral knee. At the time of each follow-up (mean, 7.4 years; range, seven to 7.6 years), the patients were assessed clinically.

RESULTS

The mean postoperative Knee Society knee score (96 compared with 97 points) and Hospital for Special Surgery knee score (93 compared with 94 points) were similar between the two groups. At the time of the latest follow-up, the average range of motion was 127.7° (range, 70° to 150°) in the knees with a posterior cruciate-sacrificing mobile-bearing prosthesis and 132.4° (range, 90° to 150°) in the knees with a posterior-stabilized mobile-bearing prosthesis. With a margin of error of the manual measurement of 5°, this difference was not significant. The estimated survival rate was 97.2% (95% confidence interval, 91% to 99%) at seven years in the posterior-cruciate sacrificing mobile-bearing prosthesis group and 98.1% (95% confidence interval, 92% to 99%) at seven years in the posterior-stabilized mobile-bearing prosthesis group.

CONCLUSIONS

After a minimum duration of follow-up of seven years, we found no significant differences between the two groups with regard to the clinical and radiographic results, including knee range of motion.

摘要

背景

据我们所知，目前尚无研究比较过同种患者中后交叉韧带切除型活动平台膝关节假体与后稳定型活动平台膝关节假体的临床结果。本研究旨在比较这两种设计的临床和影像学结果。我们假设后稳定型活动平台假体治疗的膝关节结果会更好。

方法

本研究为连续系列研究，共纳入 107 例女性患者（平均年龄 66.8 岁），这些患者在同一手术环境下同时接受双侧全膝关节置换术。所有患者一侧膝关节采用后交叉韧带切除型活动平台假体，对侧膝关节采用后稳定型活动平台假体。每次随访时（平均随访 7.4 年，7~7.6 年），均对患者进行临床评估。

结果

两组患者术后膝关节美国特种外科医院（HSS）膝关节评分（分别为 96 分和 97 分）和 Knee Society 膝关节评分（分别为 93 分和 94 分）相似。末次随访时，后交叉韧带切除型活动平台假体组膝关节的平均活动度为 127.7°（70°~~150°），后稳定型活动平台假体组为 132.4°（90°~~150°）。考虑到手工测量的误差为 5°，这种差异没有统计学意义。后交叉韧带切除型活动平台假体组的 7 年估计生存率为 97.2%（95%置信区间：91%~~99%），后稳定型活动平台假体组为 98.1%（95%置信区间：92%~~99%）。