Anouchi Y S, McShane M, Kelly F, Elting J, Stiehl J
Ortho Surgery, Ohio Permanente Med Group, Cleveland, USA.
Clin Orthop Relat Res. 1996 Oct(331):87-92. doi: 10.1097/00003086-199610000-00012.
This is a multicenter prospective clinical study using a modified Knee Society scoring system which evaluated the effect of age, gender, weight, preoperative range of motion and knee score, previous surgery, and modification of the posterior femoral condyle geometry on postoperative range of motion. The primary outcome variable was change in flexion. The data were collected from 5 surgeons using a single total knee system. The current study has 621 patients enrolled, of which 282 total knee replacements have followup of 12 months and 86 have followup of 24 months. Multivariate analysis was used to evaluate the data. The variables listed were examined as to their relationship to changes in flexion. Patients were divided into 3 groups: preoperative flexion less than 90 degrees, 91 degrees to 105 degrees, and greater than 105 degrees. When comparing the patients with preoperative motion less than 90 degrees to those with motion greater than 105 degrees, the first group improved 26 degrees more than the latter. They also improved 12 degrees more than the midrange group. The midrange group improved 14 degrees more than the upper range group. These values are all adjusted to eliminate differences due to the other variables. None of the other variables showed a significant correlation with the flexion outcome. To analyze the knee score, the group was also divided into 3 groups: preoperative score less than 27, 28 to 40, and greater than 40. The preoperative knee score was the best predictor of the postoperative knee score. The patients with preoperative knee scores below 27 improved 16 points more than those in the 27 to 40 range and 33 points greater than the greater than 40 group. To analyze functional evaluation, the patients were divided into 3 groups based on preoperative score: less than 40, 41 to 50, and greater than 50. Those in the less than 40 group improved 14 points more than the midrange group and 35 points more than the greater than 50 group. Analysis of delta range of motion and delta pain showed similar results. Age, weight, previous open surgical procedure, and altered femoral component contour, did not seem significantly correlated with changes in postoperative flexion. The best predictors of postoperative clinical results are the preoperative scores.
这是一项多中心前瞻性临床研究，采用改良的膝关节协会评分系统，评估年龄、性别、体重、术前活动范围和膝关节评分、既往手术以及股骨后髁几何形状改变对术后活动范围的影响。主要结局变量是屈曲度的变化。数据由5位外科医生使用单一全膝关节系统收集。本研究共纳入621例患者，其中282例全膝关节置换术患者有12个月的随访数据，86例有24个月的随访数据。采用多变量分析来评估数据。对列出的变量就其与屈曲度变化的关系进行了检查。患者被分为3组：术前屈曲度小于90度、91度至105度以及大于105度。将术前活动度小于90度的患者与大于105度的患者进行比较时，第一组比后者改善了26度。他们也比中间范围组多改善了12度。中间范围组比高范围组多改善了14度。这些值均经过调整以消除其他变量造成的差异。其他变量均未显示与屈曲结局有显著相关性。为分析膝关节评分，该组也被分为3组：术前评分小于27分、28至40分以及大于40分。术前膝关节评分是术后膝关节评分的最佳预测指标。术前膝关节评分低于27分的患者比27至40分范围的患者多改善16分，比大于40分的组多改善33分。为分析功能评估，根据术前评分将患者分为3组：小于40分、41至50分以及大于50分。小于40分的组比中间范围组多改善14分，比大于50分的组多改善35分。活动度变化量和疼痛变化量的分析显示了相似的结果。年龄、体重、既往开放手术以及股骨假体外形改变似乎与术后屈曲度变化无显著相关性。术后临床结果的最佳预测指标是术前评分。
