收稿日期: 2023-11-27
网络出版日期: 2024-05-15
基金资助
河南省中医药科学研究专项课题项目(2019ZY2035);河南省高校科技创新团队项目(24IRTSTHN040)
Comparison of the effects of CR and PS prostheses in the treatment of knee osteoarthritis
Received date: 2023-11-27
Online published: 2024-05-15
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。
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 . DOI: 10.3969/j.issn.1006-5725.2024.09.012
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.
| 1 | 钱琨，于辰曦，李毅，等. 运动处方在膝骨性关节炎应用的进展［J］. 中国矫形外科杂志，2023，31（19）：1773-1777. |
| 2 | 王文，王敏，孟庆奇，等. 单髁置换术与胫骨高位截骨术治疗膝关节内侧间室骨关节炎的疗效对比［J］. 实用医学杂志，2021，37（19）：2497-2500. |
| 3 | DOWSEY M M， GOULD D J， SPELMAN T， et al. A Randomized Controlled Trial Comparing a Medial Stabilized Total Knee Prosthesis to a Cruciate Retaining and Posterior Stabilized Design： A Report of the Clinical and Functional Outcomes Following Total Knee Replacement ［J］. J Arthroplasty， 2020，35（6）：1583-1590. doi:10.1016/j.arth.2020.01.085 |
| 4 | HECKMANN N D， STECK T， SPORER S M， et al. Conforming Polyethylene Inserts in Total Knee Arthroplasty： Beyond the Posterior-Stabilized and Cruciate-Retaining Debate ［J］. J Am Acad Orthop Surg， 2021，29（22）：e1097-e1104. doi:10.5435/jaaos-d-20-01232 |
| 5 | BROBERG J S， NDOJA S， MACDONALD S J， et al. Comparison of Contact Kinematics in Posterior-Stabilized and Cruciate-Retaining Total Knee Arthroplasty at Long-Term Follow-Up ［J］. J Arthroplasty， 2020，35（1）：272-277. doi:10.1016/j.arth.2019.07.046 |
| 6 | MEI F， LI J， ZHANG L， et al. Posterior-Stabilized Versus Cruciate-Retaining Prostheses for Total Knee Arthroplasty： An Overview of Systematic Reviews and Risk of Bias Considerations ［J］. Indian J Orthop， 2022，56（11）：1858-1870. doi:10.1007/s43465-022-00693-6 |
| 7 | LIU X， LIU Y， LI B， et al. Comparison of the clinical and patient-reported outcomes between medial stabilized and posterior stabilized total knee arthroplasty： A systematic review and meta-analysis ［J］. Knee， 2022，36：9-19. doi:10.1016/j.knee.2022.03.010 |
| 8 | MOISAN P， BARIMANI B， KINDI M AL， et al. Semiconstrained posterior-stabilized total knee arthroplasty： indications， risks and benefits in primary and revision surgery ［J］. Can J Surg， 2023，66（2）：E103-E108. doi:10.1503/cjs.000622 |
| 9 | 张京新，梁伟，王永会，等. MB/CR假体与FB/PS假体全膝关节置换术早期疗效观察 ［J］.中国骨科临床与基础研究杂志，2015，7（4）：208-213. doi:10.3969/j.issn.1674-666X.2015.04.003 |
| 10 | GRAY H A， GUAN S， YOUNG T J， et al. Comparison of posterior-stabilized， cruciate-retaining， and medial-stabilized knee implant motion during gait ［J］. J Orthop Res， 2020，38（8）：1753-1768. doi:10.1002/jor.24613 |
| 11 | KANNA R， MURALI S M， RAMANATHAN A T， et al. Cruciate retaining total knee arthroplasty has a better 10 year survival than posterior stabilized total knee arthroplasty： a systematic review and meta-analysis ［J］. J Exp Orthop， 2023，10（1）：19. doi:10.1186/s40634-023-00583-2 |
| 12 | KIM M S， KOH I J， KIM C K， et al. Comparison of Joint Perception Between Posterior-Stabilized and Ultracongruent Total Knee Arthroplasty in the Same Patient ［J］. J Bone Joint Surg Am， 2021，103（1）：44-52. doi:10.2106/jbjs.20.00279 |
| 13 | JANG S W， KIM M S， KOH I J， et al. Comparison of Anterior-Stabilized and Posterior-Stabilized Total Knee Arthroplasty in the Same Patients： A Prospective Randomized Study ［J］. J Arthroplasty， 2019，34（8）：1682-1689. doi:10.1016/j.arth.2019.03.062 |
| 14 | SONG S J， KIM K I， PARK C H. Comparison of risk for postoperative hyperextension between cruciate retaining and posterior stabilized total knee arthroplasties ［J］. Arch Orthop Trauma Surg， 2021，141（10）：1779-1788. doi:10.1007/s00402-021-03822-2 |
| 15 | 段于平，赵华磊，徐永升，等. 两种假体行全膝关节置换术治疗膝骨关节炎的疗效比较［J］. 临床骨科杂志， 2022，25（2）：202-206. doi:10.3969/j.issn.1008-0287.2022.02.016 |
| 16 | 徐一宏，年申生，韩学全，等. 全膝关节置换的后稳定型假体和保留后交叉韧带疗效比较［J］. 中华关节外科杂志（电子版），2020，14（6）：685-690. |
| 17 | 高晨鑫，韩大鹏，丁浩源，等. 后交叉韧带保留型和后稳定型全膝关节假体治疗晚期膝骨关节炎早期关节遗忘度评价［J］.生物骨科材料与临床研究，2023，20（4）：46-50. doi:10.3969/j.issn.1672-5972.2023.04.010 |
| 18 | 廖新根，唐智明，吴梨华，等. 保留和不保留后交叉韧带的全膝关节置换治疗重度骨关节炎近期疗效前瞻对照研究［J］. 实用医学杂志， 2020，36（19）：2672-2677. |
| 19 | 陈铭璁，陈扬，傅煊健. 后交叉韧带保留型假体与后稳定型假体全膝关节置换术后近期疗效比较［J］. 中国骨与关节损伤杂志， 2022，37（10）：1084-1087. doi:10.7531/j.issn.1672-9935.2022.10.022 |
| 20 | 万大地，段祥瑞，范鑫超，等. 后稳定型与后交叉韧带保留型膝关节假体在全膝关节置换中的疗效：系统综述和Meta分析［J］. 中国组织工程研究， 2021，25（36）：5897-5904. |
| 21 | 李萍，柴恺. CR假体与PS假体对全膝关节置换术疗效的影响［J］. 河北医科大学学报，2021，42（1）：42-46+76. doi:10.3969/j.issn.1007-3205.2021.01.010 |
| 22 | SONG S J， PARK C H， BAE D K. What to Know for Selecting Cruciate-Retaining or Posterior-Stabilized Total Knee Arthroplasty ［J］. Clin Orthop Surg， 2019，11（2）：142-150. doi:10.4055/cios.2019.11.2.142 |
| 23 | 廖新根，唐智明，吴梨华，等. 保留和不保留后交叉韧带的全膝关节置换治疗重度骨关节炎近期疗效前瞻对照研究［J］. 实用医学杂志， 2020，36（19）：2672-2677. |
| 24 | PERKINS M R， ARNHOLT C M， MACDONALD D W， et al. Retrieval Analysis of Cruciate-Retaining and Posterior-Stabilized Total Knee Arthroplasty and Correlations to Laxity and Wear ［J］. J Arthroplasty， 2020，35（8）：2249-2253. doi:10.1016/j.arth.2020.03.027 |
| 25 | SINGLETON N， NICHOLAS B， GORMACK N， et al. Differences in outcome after cruciate retaining and posterior stabilized total knee arthroplasty ［J］. J Orthop Surg （Hong Kong）， 2019，27（2）：2309499019848154. doi:10.1177/2309499019848154 |
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