摘要
目的比较间隙平衡技术与测量截骨技术在内翻膝骨性关节炎(KOA)患者全膝关节置换术(TKA)中的应用效果。方法选择2015年1月至2018年1月中国人民解放军陆军第八十三集团军医院收治的60例内翻KOA患者为研究对象,根据治疗方法将患者分为测量截骨组和间隙平衡组,每组30例。间隙平衡组患者采用间隙平衡技术,测量截骨组患者采用测量截骨技术。记录2组患者的手术时间、切口长度、术中出血量、住院时间。术前、术后14 d及术后6、12、36个月采用视觉模拟评分法(VAS)评估患者的膝关节疼痛程度,采用美国纽约特种外科医院(HSS)膝关节评分量表评估患者的膝关节功能。术后3 d,2组患者均于伸直、屈曲90°位行内、外翻应力下X线检查,并测量内、外翻应力下胫股关节角。结果间隙平衡组患者的手术时间显著短于测量截骨组,术中出血量显著少于测量截骨组(P<0.05);2组患者的切口长度和住院时间比较差异无统计学意义(P>0.05)。术前、术后14 d、术后6个月,2组患者的膝关节VAS评分比较差异无统计学意义(P>0.05);术后12、36个月,间隙平衡组患者的膝关节VAS评分显著低于测量截骨组(P<0.05);术前、术后14 d及术后6、12、36个月,测量截骨组和间隙平衡组患者的膝关节VAS评分均呈显著降低趋势(F=1.639、445.483,P<0.05)。术前,2组患者的HSS评分比较差异无统计学意义(P>0.05);术后14 d及术后6、12、36个月,间隙平衡组患者的HSS评分显著高于测量截骨组(P<0.05);术前、术后14 d及术后6、12、36个月,测量截骨组和间隙平衡组患者的膝关节HSS评分均呈显著升高趋势(F=29.084、1953.133,P<0.05)。术后3 d,膝关节伸直位时,2组患者内翻应力、外翻应力下的胫骨关节角比较差异无统计学意义(P>0.05);屈膝90°位时,间隙平衡组患者的内翻应力、外翻应力下的胫骨关节角均显著小于测量截骨组(P<0.05)。结论相较于测量截骨技术,内翻KOA患者TKA术中采用间隙平衡技术可缩短手术时间并减少术中出血量,对患者的膝关节功能及稳定性改善效果更明显,且对患者的膝关节疼痛的远期缓解效果更好。
Objective To compare the effect of space balance technique and measuring osteotomy technique in total knee arthroplasty(TKA)for patients with varus knee osteoarthritis(KOA).Methods A total of 60 patients with varus KOA admitted to the 83^(rd) Army Hospital of Chinese PLA from January 2015 to January 2018 were selected as the research objects.According to the treatment methods,the patients were divided into the measurement osteotomy group and the space balance osteotomy group,with 30 patients in each group.The patients in the space balance osteotomy group were underwent the space balance technique,and the patients in the measurement osteotomy group were underwent the measuring osteotomy technique.The operation time,incision length,intraoperative blood loss and hospitalization time of patiens in the two groups were recorded.Before operation,14 days after operation and 6,12,36 months after operation,the pain degree of patients′knee joints was evaluated by visual analogue scale(VAS),and the knee joint function of patients was evaluated by the knee joint rating scale of New York hospital for special surgery(HSS).Three days after operation,the patients in the two groups were underwent X-ray examination under varus and valgus stress at the straightening and buckling at 90°position,and the tibiofemoral joint angle under varus and valgus stress was measured.Results The operation time of patients in the space balance osteotomy group was significantly shorter than that in the measurement osteotomy group,and the intraoperative blood loss was significantly less than that in the measurement osteotomy group(P<0.05);there was no significant difference in the incision length and hospitalization time of patiens between the two groups(P>0.05).There was no significant difference in the VAS score of knee joint of patients between the two groups before operation,14 days after operation and 6 months after operation(P>0.05);at 12 and 36 months after operation,the VAS score of knee joint in the space balance osteotomy group was significantly lower than that in the measurement osteotomy group(P<0.05);before operation,14 days after operation,and 6,12,36 months after operation,there were significant downward trends in the VAS score of knee joint of patients in the measurement osteotomy group and the space balance osteotomy group(F=1.639,445.483;P<0.05).Before operation,there was no significant difference in the HSS scores of patients between the two groups(P>0.05);at 14 days and 6,12,36 months after operation,the HSS score of patients in the space balance osteotomy group was significantly higher than that in the measurement osteotomy group(P<0.05);before operation,14 days after operation and 6,12,36 months after operation,there were significant upward trends in the HSS scores of knee joint of patients in the measurement osteotomy group and the space balance osteotomy group(F=29.084,1953.133;P<0.05).Three days after operation,there was no significant difference in the tibial joint angle under varus stress and valgus stress in knee joint straight position between the two groups(P>0.05);at knee flexion 90°position,the tibial joint angle under varus stress and valgus stress of patiens in the space balance osteotomy group was significantly smaller than that in the measuring osteotomy group(P<0.05).Conclusion Compared with the measuring osteotomy technique,the use of space balance technique in TKA of varus KOA patients can shorten the operation time and reduce the amount of intraoperative bleeding,more significantly improve the function and stability of knee joint,and have better long-term relief effect on the patients′knee joint pain.
作者
胡泽森
夏磊
郝非凡
张旭辉
HU Zesen;XIA Lei;HAO Feifan;ZHANG Xuhui(Graduate School of Xinxiang Medical University,Xinxiang 453003,Henan Province,China;The First Department of Orthopedics,the 83 rd Army Hospital of Chinese PLA,Xinxiang 453001,Henan Province,China)
出处
《新乡医学院学报》
CAS
2022年第12期1145-1149,1154,共6页
Journal of Xinxiang Medical University
基金
新乡市科技攻关计划项目(编号:GG2020052)。
关键词
内翻膝骨性关节炎
全膝关节置换术
测量截骨技术
间隙平衡技术
varus knee osteoarthritis
total knee arthroplasty
space balance technique
measuring osteotomy technique
