| 田鑫铎,缪祎,魏海强,等.个体化股骨远端外旋截骨全膝关节置换术对膝关节骨性关节炎病人关节功能及康复效果的影响.骨科,2024,15(3): 211-217. |
| 个体化股骨远端外旋截骨全膝关节置换术对膝关节骨性关节炎病人关节功能及康复效果的影响 |
| Effect of Individualized Distal Femoral External Rotation Osteotomy Total Knee Arthroplasty on Joint Function and Rehabilitation Outcomes in Patients with Knee Osteoarthritis |
| 投稿时间：2024-03-13 |
| DOI：10.3969/j.issn.1674-8573.2024.03.004 |
| 中文关键词: 个体化股骨远端外旋截骨 骨性关节炎 膝关节功能 临床效果 MMP-9 |
| 英文关键词: Individualized distal femoral external rotation osteotomy Osteoarthritis Knee joint function Clinical effect MMP-9 |
| 基金项目:河北省医学科学研究课题计划（20221736） |
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| 中文摘要: |
| 目的 探究个体化股骨远端外旋截骨全膝关节置换术（TKA）对膝关节骨性关节炎（KOA）病人膝关节功能及康复效果的影响。方法 选取2021年3月至2022年3月我院医治的98例KOA病人，依据随机数字表法分为两组，各49例。对照组采用常规TKA治疗，研究组采用个体化股骨远端外旋截骨TKA治疗。比较两组围术期情况，手术前后纽约特种外科医院膝关节评分（HSS）、美国膝关节学会评分（KSS）、关节活动度，以及关节液基质金属蛋白酶-9（MMP-9）、可溶性细胞间黏附分子-1（sICAM-1）、关节液肿瘤坏死因子-α（TNF-α）等康复效果相关指标，冠状位股骨远端机械轴外侧角（mLDFA）、下肢机械轴夹角（HKA）等力线参数，支撑时间百分比、步幅、步速等步态参数，疼痛视觉模拟量表（VAS）评分，关节炎生活质量测量量表2（AIMS2）评分，术后并发症。结果 两组随访时间均在6个月以上，无失访病例。研究组住院时间明显短于对照组［（6.24±1.18） d vs. （7.36±1.05） d］，差异有统计学意义（P＜0.05）。术后研究组并发症发生率（6.12%）与对照组（10.20%）相比，差异无统计学意义（P＞0.05）。两组术后各项指标均较术前改善，且研究组术后第3、6个月HSS评分、KSS稳定性评分、活动度均高于对照组，冠状位mLDFA、HKA均低于对照组，支撑时间百分比、步速、步幅均高于对照组，VAS评分、AIMS2评分低于对照组，组间比较，差异均有统计学意义（P＜0.05）。术后第3个月，研究组和对照组关节液TNF-α、sICAM-1、MMP-9水平均低于术前（P＜0.05），但组间比较，差异无统计学意义（P＞0.05）。结论 与常规TKA治疗相比，个体化股骨远端外旋截骨TKA治疗能降低关节液TNF-α、sICAM-1、MMP-9水平，改善关节力线参数，提高膝关节功能，调整步态参数，降低术后疼痛程度，提高病人术后生活质量。 |
| 英文摘要: |
| Objective To explore the effect of individualized distal femoral external rotation osteotomy total knee arthroplasty (TKA) on knee function and rehabilitation outcomes in patients with knee osteoarthritis (KOA). Methods A total of 98 patients with KOA treated in our hospital from March 2021 to March 2022 were selected and randomly divided into two groups according to a random number table method, with 49 cases in each group. The control group received conventional TKA treatment, while the study group received individualized distal femoral external rotation osteotomy TKA treatment. The perioperative conditions of the two groups were compared, as well as the New York Hospital for Special Surgery knee score (HSS), American Knee Society score (KSS), joint range of motion, matrix metalloproteinase-9 (MMP-9) in joint fluid, soluble intercellular adhesion molecule-1 (sICAM-1), tumor necrosis factor-α (TNF-α) in joint fluid, and other rehabilitation effect-related indicators such as the mechanical axis lateral angle of the distal femur (mLDFA) and the lower limb mechanical axis angle (HKA) in the coronal plane, as well as the percentage of support time, stride length, pace, and other gait parameters. The visual analogue scale (VAS) score for pain and arthritis quality of life measurement scale 2 (AIMS2) score were also compared. The postoperative complications of the two groups were also compared. Results The follow-up time of both groups was more than 6 months, and there were no lost cases. The hospitalization time of the study group was shorter than that of the control group ［(6.24±1.18) days vs. (7.36±1.05) days］, and the difference was statistically significant (P＜0.05). The incidence of complications in the study group after surgery (6.12%) was not significantly different from that in the control group (10.20%) (P＞0.05). Both groups showed improvement in various indicators after surgery, and the HSS score, KSS stability score, and joint range of motion of the study group were higher, the coronal mLDFA and HKA were lower, the percentage of support time, pace, and stride length were higher, the VAS score and AIMS2 score were lower than those of the control group at 3rd and 6th month after surgery (all P＜0.05). At 3rd month after surgery, the levels of TNF-α, sICAM-1, and MMP-9 in joint fluid in both groups were lower than those before surgery (P＜0.05), but there was no significant difference between the groups (P＞0.05). Conclusion Compared with conventional TKA treatment, individualized distal femoral external rotation osteotomy TKA treatment can reduce the levels of TNF-α, sICAM-1, and MMP-9 in joint fluid, improve joint alignment parameters, enhance knee function, adjust gait parameters, reduce postoperative pain, and improve patients' quality of life after surgery. |
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