本文選題：高屈曲度型 + 普通屈曲度型��； 參考：《大連醫(yī)科大學》2017年碩士論文

【摘要】：背景:人工膝關節(jié)置換術(TKA Total Knee Arthroplasty)的日益成熟,使之成為治療各種終末期膝關節(jié)疾病的治療手段,且取得了確切的臨床療效。同時,隨著我國老齡化進程的加劇,生活水平的日益提高,人們對自己的生活質量也更加注重,加之人工關節(jié)的逐漸普及,人工膝關節(jié)置換術被人們逐漸接受的同時,也對術后的期望,也不在僅僅局限于單純地解決疼痛,更期望著有個更加舒適的術后體驗,滿足日常生活的需求的同時,滿足一些特殊的生活需求,如蹲、跪等,這不僅僅給術者提出了更高的要求,對膝關節(jié)假體也是一個極大的考驗,因為常規(guī)普通的膝關節(jié)假體,從原始設計上,對假體的屈曲角度的設計大約為120度,從設計根源上就不能滿足要求,因而假體設計者們,通過原假體在臨床過程中出現(xiàn)的眾多問題,以及大量的生物力學實驗,設計出新型的高屈曲度型膝關節(jié)假體,使假體在屈曲155度時仍不會出現(xiàn)常規(guī)假體的所面臨的的點面接觸、磨損加重等不利因素,但其臨床實際療效卻仍存在爭議[1]。目的:探討對比高屈曲度型膝關節(jié)假體(NexGex.LPS-Flex ZIMMER)與普通屈曲型度膝關節(jié)假體(Vanguard PS Biomet)初次人工全膝關節(jié)置換術后早期的臨床療效的差異性。方法:回顧性分析2014.09-2016.06大連醫(yī)科大學附屬第二醫(yī)院關節(jié)外科患者中行初次人工全膝關節(jié)置換術患者,其中將選擇高屈曲度膝關節(jié)假體37例51膝(11男12膝,26女39膝)分為A組,選擇普通屈曲度膝關節(jié)假體38人52膝(5男6膝,33女46膝)為B組。運用SPSS20.0統(tǒng)計學軟件對比分析兩組患者手術時間、術中出血量、置換前后膝關節(jié)活動度(ROM)、置換前后股骨后髁偏心距(PCO),置換前及術后1月、6月及最后一次后KSS評分[2](美國膝關節(jié)協(xié)會評分Knee society Score of American,期中包括臨床評分及功能評分),及常見的臨床并發(fā)癥。結果與結論:兩組患者總計73例患者均得到了術后隨訪,隨訪患者術中術后除了5例切口延遲愈合,1例腓總神經損傷,2例術后疼痛、功能欠佳,但均未發(fā)生感染、假體周圍骨折、僵硬等重大并發(fā)癥。兩組患者手術時間、術后PCO均無顯著性差異(P0.05),術中術后輸血無統(tǒng)計學差異(P0.05);術中失血兩組之間有統(tǒng)計學差異(P0.05),B組患者出血量較A組患者少,兩組患者膝關節(jié)活動度、KSS評分中臨床評分、功能評分術后與術前有顯著性差異(P0.05),而同時期中兩組患者之間術后膝關節(jié)活動度、KSS評分中臨床評分、功能評分均有顯著性差異(P0.05),A組膝關節(jié)活動度及KSS評分均優(yōu)于B,提示:使用不同假體的人工膝關節(jié)置換術,對患者術后都有顯著效果,都能改善患者的膝關節(jié)功能,改善生活質量;兩組患者術中時間無統(tǒng)計學差異,但使用普通屈曲度型膝關節(jié)假體的患者術中出血少于高屈曲度型膝關節(jié)假體;但使用高屈曲度型膝關節(jié)假體有更好的膝關節(jié)屈曲度,術后的整體膝關節(jié)功能優(yōu)于普通屈曲度型膝關節(jié)假體。
[Abstract]:Background: with the increasing maturity of TKA Total knee arthroplasty (TKA Total knee arthroplasty), it has become a method for the treatment of various end-stage knee diseases, and has achieved a definite clinical effect. At the same time, with the aggravation of aging process and the improvement of living standard in our country, people pay more attention to their quality of life, and with the popularization of artificial joints, artificial knee arthroplasty is gradually accepted by people. Also, the expectation for the operation is not only to solve the pain simply, but also to have a more comfortable experience after the operation, to meet the needs of daily life, and to meet some special needs of life, such as squatting, kneeling, etc. This is not only a higher request for the operator, but also a great test for the knee joint prosthesis, because the conventional knee joint prosthesis, in terms of its original design, is designed at a flexion angle of about 120 degrees. The root causes of the design can not meet the requirements, so the prosthesis designers design a new type of high flexion knee joint prosthesis through many problems in the clinical process and a large number of biomechanical experiments. The point and surface contact and wear aggravation of conventional prosthesis can not occur when the prosthesis is flexion 155 degree, but the clinical effect is still controversial [1]. Objective: to compare the clinical effects of high flexion type knee prosthesis NexGex.LPS-Flex ZIMMER-Vanguard PS Biomet in the early stage of total knee arthroplasty. Methods: the primary total knee arthroplasty was performed in the second affiliated Hospital of Dalian Medical University from April to June 2014.The patients were divided into two groups: group A, with 37 cases with high flexion degree knee prosthesis, 51 knees, 11 men, 12 knees, 26 knees, and 39 knees. In group B, 52 knees of 38 patients with common flexion degree and 5 men and 6 knees with 33 knees and 46 knees were selected as group B. SPSS 20.0 statistical software was used to compare the operation time and intraoperative bleeding volume between the two groups. Knee motion before and after arthroplasty, posterior femoral condylar eccentricity before and after replacement, KSs score before and after replacement [2] (American knee Association score, score of knee society score of American, mid-term including clinical score and functional score) And common clinical complications. Results and conclusion: a total of 73 patients in both groups were followed up after operation. In addition to 5 cases of delayed wound healing and 1 case of common peroneal nerve injury, 2 cases suffered from postoperative pain. Periprosthetic fracture, stiffness and other major complications. There was no significant difference in the operation time and PCO between the two groups (P 0.05), and there was no significant difference in blood transfusion between the two groups (P 0.05), but there was no significant difference between the two groups in blood loss during operation (P 0.05) and the amount of blood loss in group B was less than that in group A (P 0.05). There was a significant difference in the clinical score and functional score between the two groups in the KSS score of the knee joint motion and the clinical score in the KSS score of the knee joint motion after operation between the two groups at the same time, and there was a significant difference between the two groups before and after the operation (P < 0.05). There were significant differences in functional scores. The range of knee motion and KSS score of group A were better than that of group B. It was suggested that artificial knee arthroplasty with different prostheses had significant effect on patients after operation and could improve the function of knee joint of patients. There was no significant difference in intraoperative time between the two groups, but the intraoperative bleeding of patients with common flexion type knee prosthesis was less than that of high flexion type knee prosthesis. But the knee joint prosthesis with high flexion degree has better flexion degree, and the global knee joint function is better than that of the common flexion knee joint prosthesis.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R687.4

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本文編號：2005986