CAJ | 학술논문

背景：虽然活动平台人工膝关节假体具有理论上的设计先进性以及体外运动学和磨损方面的优势，但临床效果是否优于固定平台假体目前尚不明确。目的：评估国人活动平台假体人工膝关节置换后的中期临床效果，为人工膝关节置换假体的选择提供临床依据。方法：纳入2006年12月至2009年6月于北京同仁医院采用旋转平台假体(PFC sigma RP)进行初次人工膝关节置换的膝关节骨关节炎和类风湿关节炎患者，对比观察患者置换前及置换后末次随访 KSS 评分、KSS功能评分、髌骨评分、膝前痛评、膝关节活动度、最大屈伸膝角度。记录患者置换后包括感染、髌骨弹响、聚乙烯垫片脱位、深静脉血栓等并发症情况。拍摄置换后标准的膝关节前后位、侧位及 Merchant 位 X 射线片，观察假体的力线、假体周围透亮区、髌骨脱位情况。将本组活动平台假体的随访结果与文献报道的固定平台假体人工膝关节置换的中期随访结果进行比较。结果与结论：最终共有31例45膝纳入试验，患者年龄(64.56±10.33)岁，随访时间3.9-7.6年。置换后末次随访时的各项评分、膝关节活动度及最大屈伸膝角度均较置换前明显改善，但与文献报道的固定平台置换后中期随访结果相当。未发现透亮线、假体松动、聚乙烯垫片脱出；虽然仅做了有限的髌外侧松解，所有患者均未出现髌骨脱位或半脱位；2例患者(2膝)出现髌骨弹响。提示活动平台膝关节置换后的中期临床效果满意。虽然仅做了有限的髌外侧松解，但没有发现髌骨脱位和半脱位，这可能是旋转平台设计上髌股关节方面优势的体现。
배경：수연활동평태인공슬관절가체구유이론상적설계선진성이급체외운동학화마손방면적우세，단림상효과시부우우고정평태가체목전상불명학。목적：평고국인활동평태가체인공슬관절치환후적중기림상효과，위인공슬관절치환가체적선택제공림상의거。방법：납입2006년12월지2009년6월우북경동인의원채용선전평태가체(PFC sigma RP)진행초차인공슬관절치환적슬관절골관절염화류풍습관절염환자，대비관찰환자치환전급치환후말차수방 KSS 평분、KSS공능평분、빈골평분、슬전통평、슬관절활동도、최대굴신슬각도。기록환자치환후포괄감염、빈골탄향、취을희점편탈위、심정맥혈전등병발증정황。박섭치환후표준적슬관절전후위、측위급 Merchant 위 X 사선편，관찰가체적력선、가체주위투량구、빈골탈위정황。장본조활동평태가체적수방결과여문헌보도적고정평태가체인공슬관절치환적중기수방결과진행비교。결과여결론：최종공유31례45슬납입시험，환자년령(64.56±10.33)세，수방시간3.9-7.6년。치환후말차수방시적각항평분、슬관절활동도급최대굴신슬각도균교치환전명현개선，단여문헌보도적고정평태치환후중기수방결과상당。미발현투량선、가체송동、취을희점편탈출；수연부주료유한적빈외측송해，소유환자균미출현빈골탈위혹반탈위；2례환자(2슬)출현빈골탄향。제시활동평태슬관절치환후적중기림상효과만의。수연부주료유한적빈외측송해，단몰유발현빈골탈위화반탈위，저가능시선전평태설계상빈고관절방면우세적체현。
BACKGROUND:Mobile-bearing prosthesis has advantages in theoretic design, in vitro kinematics and abrasion, but it remains unclear whether its clinical outcomes are better than fixed-bearing prosthesis at present. OBJECTIVE:To evaluate the medium-term results of total knee arthroplasty using mobile-bearing prosthesis to provide clinical evidence for the choice of prosthesis. METHODS:The patients who suffered from osteoarthritis or rheumatoid arthritis and underwent total knee arthroplasty with PFC Sigma RP in Beijing Tongren Hospital from December 2006 to June 2009 were included in this study. The postoperative Knee Society Score, Knee Society Score Function Score, Patel ar Score and the Pain Score, range of motion, maximun flexion and extension angle were col ected and compared with pre-operation. The complications, such as infection, patel a clicking, polyethylene insert dislocation, and deep vein thrombosis were recorded after replacement. The anterior-posterior, lateral and Merchant position X-ray images were taken to evaluate the tibiofemoral alignment, radiolucent lines, and patel ar dislocation. Then, the results of other medium-term fol ow-up researches were compared with fixed-bearing arthroplasty. RESULTS AND CONCLUSION:Final y, 31 patients (45 knees) were fol owed up. The average age was 64.56±10.33 years, and fol ow-up period was 3.9-7.6 years. The postoperative scores, range of motion, maximun flexion and extension angle were improved obviously, but there were no differences with other medium-term fol ow-up researches. No radiolucent lines, prosthetic loosening or polyethylene insert dislocation was found. Lateral patel ar release was done, but no patel ar dislocation or subluxation appeared in al patients. Two patients (2 knees) accompanied patel a clicking. Results indicated that the medium-term clinical result was satisfactory. No patel ar dislocation or subluxation was found, although only lateral patel ar release was done. This may be the superiority of mobile-bearing arthroplasty.