在韧带平衡型全膝关节置换术中，固定平台较活动平台具有更好的长期生存率。
Superior long-term survival for fixed bearing compared with mobile bearing in ligament-balanced total knee arthroplasty.
机构信息
Sint Maartenskliniek, Nijmegen, The Netherlands.
Orthopädische Klinik orthosiloah Bern-Gümligen, Bern, Switzerland.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2018 May;26(5):1524-1531. doi: 10.1007/s00167-017-4542-6. Epub 2017 Apr 7.
PURPOSE
Only few long-term data on ligament-balanced cruciate-retaining total knee arthroplasty (CR TKA) are currently available. Either a mobile- or fixed-bearing insert can be chosen, which showed good mid-term outcome and few complications and revisions. This multi-centre retrospective cross-sectional cohort study investigated the 12-year results of primary TKA using a balancing gap technique and compared survival and clinical outcome between fixed and mobile inserts.
METHODS
In this retrospective cross-sectional cohort study, 557 cases of three clinics (2 Swiss, 1 Dutch) operated between 1998 and 2003 with the first series of a TKA implanted with a balanced gap technique (433 (77.7%) fixed, 124 (22.3%) mobile (anterior-posterior gliding (7-9 mm) and rotational (15°) degrees of freedom) inserts) were included for survival analysis (Kaplan-Meier, by insert type). At the 12-year follow-up (FU) examination of 189 cases, range of motion, knee society score (KSS), numeric rating scale (NRS) for pain and satisfaction were determined and radiographs were evaluated by median tests, by insert type.
RESULTS
Of 521 cases available for analysis, 28 (5.4%; 11 fixed, 17 mobile bearing) were revised. Mean cumulative survival after 12.4 years was 97.0% (95% CI 94.7-98.4) for fixed bearings and 85.4% (95% CI 77.5-90.7) after 12.2 years for mobile bearings, p < 0.0001. Patients' mean age at 11.0 years FU (n = 189) was 78.0 (range 54.5-97.3) years. Mean total KSS was 157.8 (24-200) points, and mean passive flexion was 114° (45-150); no clinical score differed significantly between fixed and mobile bearings.
CONCLUSION
This study showed a superior survival for fixed bearing compared with mobile bearing in a CR TKA using a ligament-balanced technique after more than 12 years. Clinical outcomes are excellent to good after long-term follow-up, and similar for fixed and mobile bearing.
LEVEL OF EVIDENCE
Therapeutic studies-retrospective cohort study, Level III.
目的
目前仅有少量关于韧带平衡型保留后交叉韧带的全膝关节置换术（CR TKA）的长期数据。可以选择活动或固定衬垫，它们都显示出良好的中期结果和较少的并发症和翻修。这项多中心回顾性交叉队列研究调查了使用平衡间隙技术的初次 TKA 的 12 年结果，并比较了固定和活动衬垫的生存率和临床结果。
方法
在这项回顾性交叉队列研究中，纳入了 1998 年至 2003 年间三个诊所（2 个瑞士，1 个荷兰）的 557 例病例，这些病例采用平衡间隙技术进行初次 TKA 手术（433 例为固定衬垫（77.7%），124 例为活动衬垫（前-后滑动（7-9mm）和旋转（15°）自由度））。通过植入物类型进行生存分析（Kaplan-Meier）。在 189 例患者的 12 年随访（FU）检查中，评估了运动范围、膝关节学会评分（KSS）、疼痛数字评分量表（NRS）和满意度，并通过中位数检验评估了放射学结果，通过植入物类型进行比较。
结果
在可分析的 521 例病例中，28 例（5.4%；11 例固定，17 例活动衬垫）进行了翻修。固定衬垫的 12.4 年后累积生存率为 97.0%（95%CI 94.7-98.4），活动衬垫的 12.2 年后生存率为 85.4%（95%CI 77.5-90.7），p<0.0001。189 例患者在 11.0 年 FU 时的平均年龄为 78.0 岁（范围 54.5-97.3）。平均总 KSS 为 157.8 分（24-200），平均被动屈曲为 114°（45-150）；固定和活动衬垫的临床评分无显著差异。
结论
这项研究表明，在使用韧带平衡技术的 CR TKA 中，固定衬垫的生存率优于活动衬垫，超过 12 年后仍然如此。长期随访后，临床结果优异或良好，固定和活动衬垫相似。
证据水平
治疗研究-回顾性队列研究，III 级。
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