改良混合固位技术可减轻翻修全膝关节置换术后柄尖疼痛，提高患者满意度。

Modified hybrid cementing technique reduces stem tip pain and improves patient's satisfaction after revision total knee arthroplasty.

机构信息

Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.

Department of Orthopaedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021, Tongil Ro, Eunpyeong-gu, Seoul, 03312, Republic of Korea.

出版信息

J Orthop Surg Res. 2020 Sep 9;15(1):393. doi: 10.1186/s13018-020-01921-1.

DOI:10.1186/s13018-020-01921-1

PMID:32907611

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7487825/

Abstract

BACKGROUND

There have been no studies comparing patient-reported outcome measures including end-of-stem tip pain and patient satisfaction based on the use of cementing techniques in revision total knee arthroplasty (TKA). The purpose of this study was to compare end-of-stem tip pain and PROMs with hybrid and modified hybrid cementing techniques in revision TKAs.

METHOD

Sixty-two cases of revision TKA performed by a single surgeon were divided into two groups based on the cementing technique with a minimum follow-up of 2 years. Two types of cementing technique for femoral and tibial stems were used as follows: (1) a hybrid cementing technique (33 cases), in which cement was applied immediately distal to the modular junction of the stem and the component while the distal stem was press-fitted into the diaphysis without using cement; and (2) a modified hybrid cementing technique (29 cases), in which cement was applied to the tip of femoral and tibial stems. The thigh and shin were assessed for the end-of-stem tip pain. Patient satisfaction was evaluated based on the satisfaction items of New Knee Society Score.

RESULTS

Modified hybrid cementing significantly lowered the percentage of patients manifesting shin pain (3.4% vs. 24.2%, p = 0.029). Patients treated with the modified hybrid cementing technique showed a higher satisfaction rate (p = 0.003). Multivariate logistic regression analysis showed an increase in the odds of satisfaction 32.686-fold (p = 0.004) in patients without pain at the end-of-stem tip in the shin and 9.261-fold (p = 0.027) in patients treated with the modified hybrid cementing technique.

CONCLUSION

The modified hybrid cementing technique for fixation of long-stem in revision TKAs reduced the end-of-stem tip pain in the shin, leading to significantly higher satisfaction compared with the hybrid cementing technique after revision TKA.

LEVEL OF EVIDENCE

Level III.

摘要

背景

在翻修全膝关节置换术（TKA）中，比较基于不同骨水泥固定技术的患者报告结局指标（包括末端柄尖疼痛和患者满意度）的研究尚未见报道。本研究旨在比较翻修 TKA 中混合骨水泥固定技术和改良混合骨水泥固定技术的末端柄尖疼痛和 PROMs。

方法

62 例由同一位外科医生完成的翻修 TKA 病例，根据骨水泥固定技术分为两组，随访时间至少 2 年。两种股骨和胫骨柄骨水泥固定技术如下：（1）混合骨水泥固定技术（33 例），即在柄的模块化连接远端立即应用骨水泥，同时将远端柄压入骨干而不使用骨水泥；（2）改良混合骨水泥固定技术（29 例），在股骨和胫骨柄的末端应用骨水泥。评估股骨干和胫骨末端柄尖疼痛。基于新膝关节协会评分的满意度项目评估患者满意度。

结果

改良混合骨水泥固定技术显著降低了胫骨末端柄尖疼痛患者的比例（3.4%比 24.2%，p=0.029）。采用改良混合骨水泥固定技术的患者满意度更高（p=0.003）。多变量逻辑回归分析显示，胫骨末端柄尖无疼痛的患者满意度增加 32.686 倍（p=0.004），采用改良混合骨水泥固定技术的患者满意度增加 9.261 倍（p=0.027）。