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全膝关节置换术中关节后方复合松解对关节间隙和术后活动度的影响

Effect of extended release of posterior clearance on flexion clearence and range of motion of the knee in total knee arthroplasty

摘要:

目的 研究全膝关节置换术(TKA)中关节后方复合松解对术中关节间隙变化及术后活动度的改善情况.方法 2010年3月至2012年3月随机选取120例符合研究条件的行单侧TKA的膝骨性关节炎患者,其中男性46例,女性74例;年龄49~ 75岁,平均63.6岁.以抽取密闭信封的形式将患者分为试验组和对照组各60例.术中在截骨完成后,试验组进行关节后方复合松解,释放后方空间,对照组仅行常规的后髁增生骨的清理.比较两组伸、屈膝间隙的情况、术后主动屈膝90°及120°所需时间和随访3个月时的最大屈膝角度,两组数据比较采用双侧配对t检验.结果 术中伸膝间隙试验组为(18.9±1.5)mm,对照组为(17.9±1.6)mm,差异有统计学意义(t=3.53,P<0.01);术中屈膝间隙试验组为(20.7±1.8)mm,对照组为(20.2±1.9)mm,差异无统计学意义(t =1.48,P>0.05).试验组术后主动屈膝90°(t=10.2399,P<0.01)及120°(t=11.142,P<0.01)所需时间和随访3个月时的最大屈膝角度(t=4.4255,P<0.01)均显著优于对照组.患者随访时间3~24个月,平均14.6个月,随访期内均无股骨假体组件松动.结论 复合松解释放膝关节后方空间有助于改善TKA术中伸膝间隙和术后膝关节活动度功能锻炼,而对术中屈膝间隙无明显改善.

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abstracts:

Objective To observe the change of clearance and range of joint improved situation during total knee arthroplasty(TKA)by operating extended release manipulation of the posterior knee clearance.Methods A total of 120 patients with knee osteoarthritis undergoing unilateral TKA from March 2010 to March 2012 were equally randomized prospectively assigned to the experimental group and control group,each 60 cases.There were 46 male and 74 female patients,the mean age was 63.6 years(range from 49 to 75 years).After the osteotomy of the tibia and the femoral condyle and before the release of soft tissue intraoperation,patients in experimental group were taken the extended release manipulation of the posterior knee clearence while the control group were cleaned the osteophyte of the posterior condyle only,2-sided paired t test was used to compare the clearence intraoperation and the time to flexion angle of 90°and 120° and the maximum angle after 3 months' follow-up.Results There was no significant difference of the index between the experimental group and control group(P > 0.05).Between experimental group and control group,the difference was significant in extention clearance((18.9 ± 1.5)mm vs.(17.9 ± 1.6)mm,t =3.53,P <0.01)intraoperation,and no significant difference in flexion clearance((20.7 ± 1.8)mm vs.(20.2 ± 1.9)mm,t =1.48,P > 0.05).It took longer time for the knee flexion range of motion to 90 °(t =10.2399,P < 0.01)or 120°(t =11.142,P < 0.01)of the control group than that of the experimental group,and the difference of the maximum range of motion between experimental group and control group was significant statistically at the 3-months follow-up(t =4.4255,P < 0.01).All the patients were followed up for 3-24 months,average of 14.6 months,no femoral component loosening happened.Conclusions Extended release of the posterior knee clearance benefits the knee extension clearence intraoperation and functional exercise of range of motion postoperation,while it is no meaning to the flexion clearence.

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