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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。
BACKGROUND: Pediatric knee dysplasia is a congenital malformation of the body. Knee fusion and fixation can effectively relieve pain, but there are no articular joints with active functions. Total knee replacement is a safe and effective way to relieve pain and rebuild functions. With the continuous development of artificial total knee replacement, knee prosthesis types are also more and more. Objective: To investigate the effect of different prosthesis reconstruction methods on the therapeutic effect of pediatric knee dysplasia joint replacement. Methods: 120 cases of dysplasia in children with knee dysplasia were divided into treatment group and control group randomly according to the principle of random sampling. 60 cases in each group were treated by artificial knee replacement and completed by the same group of physicians. In the control group, the stable fixed platform prosthesis was selected. In the treatment group, non-restrictive prosthesis - the posterior cruciate ligament was excised with low contact pressure rotating platform prosthesis. The operation time, intraoperative blood loss, post-replacement hospital stay and complication were observed in two groups. All patients were followed up for 3 months after discharge. The knee function was evaluated by Hospital for Special Surgery (NYS) and American knee society knee score (KSS). Multivariate regression was used to analyze factors that could affect HSS scores at knee follow-up. RESULTS AND CONCLUSION: There was no significant difference in operative time, intraoperative blood loss and post-replacement hospital stay between the two groups (P> 0.05). In the treatment group, the overall incidence of complications such as inflammatory reaction, poor incision healing, periprosthetic infection and joint stiffness was significantly lower than that of the control group (P <0.05). The follow-up of 3 months, the treatment group HSS score, KSS clinical scores and functional scores were significantly higher than the control group, the difference was significant (P <0.05). According to the follow-up HSS score> 80, the multiple regression analysis showed that age, type of prosthesis and varus deformity were the main independent risk factors affecting the prognosis of knee joint replacement (P <0.05). Tip knee replacement in children with knee dysplasia have a good prognosis, while the application of non-limiting prosthesis reconstruction can effectively reduce postoperative complications, improve knee function.