【摘要】 目的观察全膝关节置换术(TKA)后关节线(JL)位置改变,探讨其与膝关节临床功能的关系。方法接受单侧TKA治疗的膝骨关节炎患者89例(89膝),手术均采用GENESISⅡ后稳定型假体。分别测量手术前后JL位置,计算JL位置改变程度;评估手术前后膝关节KSS评分、膝关节功能KSS评分、Feller髌骨评分,分析TKA后JL改变范围与临床功能评分的关系。结果术后随访假体生存率为100%(89/89),膝关节正位及侧位X线片均未显示影像学松动,膝关节KSS评分、功能评分、活动度及Feller髌骨评分均较术前增加(P均<0.01);手术前后JL改变≤4 mm患者术后膝关节KSS评分、功能评分、活动度及Feller髌骨评分均高于JL改变>4 mm患者(P<0.05或<0.01)。JL改变≤4 mm患者Feller髌骨评分与JL改变程度没有相关性(r=-0.162,P=0.205),JL改变>4 mm患者Feller髌骨评分与JL改变程度呈负相关(r=-0.724,P=0.000)。结论采用后稳定型膝关节假体的初次TKA患者术后JL改变>4 mm对于膝关节功能有影响,JL改变程度与伸膝装置功能呈负相关。更多还原

【Abstract】 Objective To observe the changes of the knee joint line position after total knee arthroplasty( TKA),and to investigate the relationship with the clinical features. Methods Eighty-nine patients who received TKA were selected randomly. Posterior stabilized prosthesis( GENESISⅡ) was used in all patients. According to the method recommended by Hofmann,the distance between adductor tubercle of femur and distal line of femoral condylar which represented the joint line position was recorded. Pre-and post-operative knee joint line was measured,and the changes of pre-and post-operative knee joint line were calculated. The KSS and Feller scores were used to assess pre-and post-operative knee and knee extension apparatus function. The correlations between the changes of joint line and Feller scores were analyzed. Results The implant survival rate was 100%( 89 /89) during the postoperative follow-up. The anteroposterior and lateral X-ray of knee did not show radiographic loosening,and the knee KSS,function,mobility and Feller patellar scores increased as compared with that preoperative( all P < 0. 01). The knee KSS,function,mobility and Feller patellar scores were higher in the patients whose JL level changes ≤4 mm than those whose JL > 4 mm( P < 0. 05 or P < 0. 01). The Feller patellar scores in patients whose JL changes ≤4 mm was not related with the altitude of changed JL( r =- 0. 162,P = 0. 205); while the Feller patellar scores in patients whose JL changes > 4 mm was negatively correlated with the altitude of changed JL( r =-0. 724,P = 0. 000). Conclusions The joint line changed within 4 mm in patients who underwent TKA for the first time by using posterior stabilized prosthesis may result in a better knee joint function after TKA. The joint line change is negatively correlated with knee extension apparatus function.更多还原