CR假体与PS假体治疗膝骨性关节炎的效果比较

doi:10.3969/j.issn.1006-5725.2024.09.012

摘要/Abstract

摘要：

目的比较CR假体与PS假体在人工膝关节置换术后应用效果。方法随机选取2021年6月至2022年6月在我科收治且符合选择标准的膝骨性关节炎患者64例，随机分为观察组和对照组（n = 32）。观察组使用CR假体实施TKA，对照组使用PS假体实施TKA。记录两组患者的手术时间、术后引流量、手术前后HGB差值、术后住院时间，术后7 d、14 d、45 d、3个月、1年膝关节ROM、VAS评分、HSS评分、膝关节最大前后向位移，并定期复查X线片。结果两组患者在手术时间、术后住院时间、VAS评分、膝关节最大前后向位移方面相当；和对照组相比，观察组术后引流量明显更少，差异有统计学意义（P < 0.05）；和对照组相比，观察组在HGB差值上明显更低，差异有统计学意义（P < 0.05）；手术之前两组患者ROM、HSS评分无明显差异，和观察组比较，术后7 d、14 d、45 d时对照组ROM以及HSS评分更高，差异有统计学意义（P < 0.05），术后3个月时，两组ROM、HSS评分相当，术后6个月、1年时观察组的ROM、HSS评分明显更高，差异有统计学意义（P < 0.05）。结论 CR假体在手术失血量和术后引流量方面优于PS假体，可以降低手术风险，两种假体在术后均可获得良好的膝关节稳定性，而PS假体早期临床效果较好，CR假体长期临床效果更优。

关键词: 膝关节, 膝骨性关节炎, 全膝关节表面置换术, PS假体, CR假体

Abstract:

Objective To compare the effect of posterior cruciate ligament retaining （CR） and posterior cruciate substituting （PS） prosthesis in knee arthroplasty. Methods 64 patients with knee osteoarthritis were admitted to our department from June 2021 to June 2022 and whom met the selection criteria were randomly selected and divided into observation group and control group （n = 32）. CR prosthesis was used in the observation group， and PS prosthesis was used in the control group. Operation time， postoperative drainage volume， difference of hemoglobin （HGB） before and after operation， postoperative hospital stay， postoperative range of motion at 7 d， 14 d， 45 d， 3 months and 1 year were recorded. ROM， visual analog pain Scale （VAS）， Hospital for special surgery （HSS） score， and maximum forward and backward displacement of knee joint and the regular radiographs were also recorded， too. Results The two groups were similar in terms of operation time， postoperative hospital stay， postoperative VAS score and maximum anterior and posterior displacement of knee joint， with P values greater than 0.05， which had no statistical significance. The postoperative drainage volume in the observation group was significantly less than that in the control group， with statistical significance （P < 0.05）. The HGB difference of observation group was significantly lower than that of control group， with statistical significance （P < 0.05）. There was no statistically significant difference in ROM and HSS scores between the two groups before surgery； the ROM and HSS scores of the control group at 7， 14 and 45 days after surgery was better than that of the observation group， with statistical significance （P < 0.05）； the ROM and HSS scores of the two groups at 3 months after surgery was not statistically significant. The ROM and HSS scores in the observation group was better than that in the control group at 6 months and 1 year after operation， and the difference was statistically significant （P < 0.05）. Conclusions CR prosthesis is superior to PS prosthesis in terms of intraoperative blood loss and post?operative drainage volume， which can reduce surgical risk. Both kinds of prosthesis can achieve good knee stability after surgery， while PS prosthesis has better early clinical effect， while CR prosthesis has better long?term clinical effect.

Key words: knee joint, knee osteoarthritis, total knee arthroplasty, PS prosthesis, CR prosthesis

中图分类号:

R605

王上增,张北,王禛,马尚,阮张德阳,殷志颖,朱云麒,胡昆鹏,程韶. CR假体与PS假体治疗膝骨性关节炎的效果比较[J]. 实用医学杂志, 2024, 40(9): 1251-1256.

Shangzeng WANG,Bei ZHANG,Zhen WANG,Shang MA,Deyang RUANGZHANG,Zhiying YIN,Yunqi ZHU,Kunpeng HU,Shao CHENG. Comparison of the effects of CR and PS prostheses in the treatment of knee osteoarthritis[J]. The Journal of Practical Medicine, 2024, 40(9): 1251-1256.

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组别	HGB（g/L）	ROM（°）	VAS（分）	HSS（分）
观察组（n = 32）	129.88 ± 10.51	75.13 ± 5.67	8.25 ± 1.18	61.72 ± 5.35
对照组（n = 32）	126.25 ± 8.49	75.44 ± 10.08	7.89 ± 0.95	59.63 ± 5.31
t值	-1.517	0.153	-1.362	-1.570
P值	0.134	0.879	0.178	0.121

组别	手术时间（min）	术后引流量（mL）	术后住院时间（d）
观察组（n = 32）	76.53 ± 11.00	78.70 ± 18.6	13.81 ± 1.87
对照组（n = 32）	75.66 ± 9.27	101.20 ± 21.83	13.94 ± 2.08
t值	-0.344	4.438	0.253
P值	0.732	0.000	0.801

组别	术前HGB	术后HGB	HGB减小值
观察组（n = 32）	129.88 ± 10.51	97.59 ± 15.20	32.28 ± 10.15
对照组（n = 32）	126.25 ± 8.49	86.53 ± 11.70	39.72 ± 9.62
t值	-1.517	-3.263	3.009
P值	0.134	0.002	0.004

组别	术前（°）	术后7 d（°）	术后14 d（°）	术后45 d（°）	术后3个月（°）	术后6个月（°）	术后1年（°）
观察组（n = 32）	75.13 ± 5.67	82.00 ± 8.45	88.47 ± 8.42	94.63 ± 5.49	102.66 ± 10.24	116.50 ± 9.53	131.47 ± 10.30
对照组（n = 32）	75.44 ± 10.08	86.63 ± 7.53	92.56 ± 7.16	98.72 ± 7.94	105.47 ± 9.53	111.50 ± 10.1	125.47 ± 9.54
t值	0.153	2.309	-2.096	2.398	1.138	-2.037	-2.418
P值	0.879	0.024	0.04	0.019	0.260	0.046	0.019

组别	术后7 d	术后14 d	术后45 d	术后3个月	术后6个月	术后1年
观察组（n = 32）	-	-	-	5.91 ± 1.33	5.91 ± 1.23	5.97 ± 1.15
对照组（n = 32）	-	-	-	5.47 ± 1.19	5.47 ± 0.98	5.66 ± 0.865
t值				-1.387	1.574	1.229
P值	-	-	-	0.170	0.121	0.224