CAJ | 학술논문

背景：小儿膝关节发育不良是一种先天性发育畸形，膝关节融合固定可以有效地消除疼痛，但是没有具有活动功能的关节。全膝关节置换其是一种安全有效的缓解疼痛、重建功能的方法。而随着人工全膝关节置换的不断发展，膝关节假体的类型也越来越多。目的：探讨不同假体重建方式对于小儿膝关节发育不良关节置换后疗效的影响。方法：膝关节发育不良患儿120例根据随机抽签原则分为治疗组与对照组，每组60例，均采用人工膝关节置换治疗，由同一组医师完成。对照组选择后稳定型固定平台假体，治疗组选择非限制性假体-后交叉韧带切除低接触压力旋转平台假体。观察两组患儿的手术时间、术中出血量、置换后住院时间及并发症发生情况。所有患儿出院后随访3个月，采用美国纽约特殊外科医院评分(Hospital for Special Surgery，HSS)及美国膝关节协会评分(American knee society knee score，KSS)进行膝关节功能评定。使用多元回归方法对可能影响随访时膝关节HSS评分的因素进行分析。结果与结论：两组患儿的手术时间、术中出血量与置换后住院时间对比差异均无显著性意义(P>0.05)。治疗组置换后的炎性反应、切口愈合不良、假体周围感染、关节僵硬等并发症总体发病率明显低于对照组(P <0.05)。随访3个月，治疗组的HSS评分、KSS临床评分与功能评分均明显高于对照组，差异有显著性意义(P <0.05)。以随访HSS评分>80分作为判定标准，多因素回归结果显示，年龄、假体类型、内翻畸形是影响膝关节置换预后的主要独立危险因素(P <0.05)。提示膝关节置换修复小儿膝关节发育不良有很好的预后效果，同时非限制性假体重建的应用能有效减少置换后并发症，改善膝关节功能。
배경：소인슬관절발육불량시일충선천성발육기형，슬관절융합고정가이유효지소제동통，단시몰유구유활동공능적관절。전슬관절치환기시일충안전유효적완해동통、중건공능적방법。이수착인공전슬관절치환적불단발전，슬관절가체적류형야월래월다。목적：탐토불동가체중건방식대우소인슬관절발육불량관절치환후료효적영향。방법：슬관절발육불량환인120례근거수궤추첨원칙분위치료조여대조조，매조60례，균채용인공슬관절치환치료，유동일조의사완성。대조조선택후은정형고정평태가체，치료조선택비한제성가체-후교차인대절제저접촉압력선전평태가체。관찰량조환인적수술시간、술중출혈량、치환후주원시간급병발증발생정황。소유환인출원후수방3개월，채용미국뉴약특수외과의원평분(Hospital for Special Surgery，HSS)급미국슬관절협회평분(American knee society knee score，KSS)진행슬관절공능평정。사용다원회귀방법대가능영향수방시슬관절HSS평분적인소진행분석。결과여결론：량조환인적수술시간、술중출혈량여치환후주원시간대비차이균무현저성의의(P>0.05)。치료조치환후적염성반응、절구유합불량、가체주위감염、관절강경등병발증총체발병솔명현저우대조조(P <0.05)。수방3개월，치료조적HSS평분、KSS림상평분여공능평분균명현고우대조조，차이유현저성의의(P <0.05)。이수방HSS평분>80분작위판정표준，다인소회귀결과현시，년령、가체류형、내번기형시영향슬관절치환예후적주요독립위험인소(P <0.05)。제시슬관절치환수복소인슬관절발육불량유흔호적예후효과，동시비한제성가체중건적응용능유효감소치환후병발증，개선슬관절공능。
BACKGROUND:Pediatric knee dysfunction is a congenital malformation. Fusion and fixation can effectively eliminate pain, but no joint has active function. Total knee arthroplasty is a safe and effective method to relieve pain and to rebuild its function. With the continuous development of total knee arthroplasty, the type of knee prostheses is more. OBJECTIVE: To study the efficacy of different reconstruction methods for children with stunted knee arthroplasty. METHODS:120 knee stunted children were equaly divided into treatment group and control group depended on the reconstruction, and then al children were given the artificial knee replacement surgery and were completed by the same group of physicians. In the control group, stable fixed platform prosthesis was selected. In the treatment group, the non-limiting prosthetic-posterior cruciate ligament resection of low contact pressure rotating platform prosthesis was given. Operative time, blood loss, postoperative hospital stay, and complications were observed in both groups. Al patients were folowed up for 3 months. Knee function was assessed by Hospital for Special Surgery and American knee society knee score. Multivariate regression analysis was used to analyze the possible factors affecting Hospital for Special Surgery score during folow up. RESULTS AND CONCLUSION: No significant difference in operative time, blood loss and postoperative hospital stay was compared in both groups (P> 0.05). The postoperative overal incidences of inflammatory response, wound healing, periprosthetic infection, and joint stiff were significantly lower in the treatment group than in the control group (P < 0.05). At 3-month folowed-up, Hospital for Special Surgery and American knee society knee score clinical score and functional score were significantly higher in the treatment group than in the control group (P < 0.05). Hospital for Special Surgery score > 80 served as a standard. Multivariate regression analysis results showed that age, type of prosthesis, and varus deformity were the major independent risk factors for affecting joint replacement (P< 0.05). Results indicate that knee arthroplasty for knee dysfunction obtained good prognostic effect. Simultaneously, the non-limiting application of prosthetic reconstruction can effectively reduce postoperative complications and improve knee function.