背景:屈曲挛缩的改善在膝关节置换术中很重要,因为术后残余的屈曲挛缩与生活质量和患者满意度下降有关。在这项研究中,我们调查了双交叉稳定(BCS)型全膝关节置换术(TKA)与后稳定(PS)型TKA对骨关节炎伴屈曲挛缩的原发性膝关节的影响。
方法:从2014年1月到2020年12月有59个TKAs,其中30个是PS型TKAs(NexGenLPS-flex®;76.3年,BMI27.5)和29个BCS型TKAs(旅程II﹤;72.5年,BMI28.6),术前屈曲挛缩15°或更大的膝关节骨关节炎。在所有TKAs期间,术中获得了完全延伸。临床结果,放射学评估,在回顾性研究设计中评估了TKA期间额外的股骨远端截骨术的数量。
结果:两组的活动范围均得到改善。BCS组术后屈曲挛缩显著改善。膝关节社会评分两组均有显著改善,两组之间无差异。PS组追加股骨远端截骨量为2.5±1.3mm,BCS组1.8±1.5mm,显示显著差异(p=0.04)。
结论:与PS型TKA相比,BCS型TKA可显着改善术前屈曲挛缩,并减少了额外的股骨远端截骨量。这归因于BCS型TKA中的前凸轮,在BCS型膝关节伸展中,股骨后髁从胫骨组件后缘的突出量较小,与PS型相比。
The improvement of flexion contracture is important in knee arthroplasty since residual flexion contracture postoperatively is associated with decreased quality of life and patient satisfaction. In this study, we investigated the effect of bi-cruciate stabilized (BCS)-type total knee arthroplasty (TKA) as compared to posterior stabilized (PS)-type TKA on osteoarthritic primary knees with flexion contractures.
59 TKAs from January 2014 to December 2020, of which 30 were PS-type TKAs (NexGen LPS-flexⓇ; 76.3 years, BMI 27.5) and 29 BCS-type TKAs (Journey IIⓇ; 72.5 years, BMI 28.6), were performed for knee osteoarthritis with preoperative flexion contracture of 15° or greater. Full extension was obtained intraoperatively during all TKAs. Clinical outcomes, radiological evaluations, and the amount of additional distal femoral osteotomy during TKA were evaluated in a retrospective study design.
The range of motion improved in the both groups. Postoperative flexion contracture was significantly improved in the BCS group. Knee Society Score improved significantly in both groups, with no difference between the two groups. The amount of additional distal femoral osteotomy was 2.5 ± 1.3 mm for the PS group, and 1.8 ± 1.5 mm for the BCS group, showing a significant difference (p = 0.04).
The BCS-type TKA significantly improved preoperative flexion contracture and reduced the amount of additional distal femoral osteotomy compared to PS-type TKA. This is attributed to the anterior cam in the BCS-type TKA, which leads to a smaller amount of protrusion of the posterior femoral condyle from the posterior margin of the tibial component in the BCS-type in knee extension, as compared to the PS-type.