个性化全膝关节置换术的影像学评估及近期临床效果评价

Imaging Evaluation and Recent Clinical Outcome Evaluation of Personalized Total Knee Arthroplasty

摘要: 目的：探究个性化全膝关节置换术对膝关节骨性关节炎初次手术患者的影像学及近期临床效果。方法：本研究为回顾性队列研究，选取299例济宁医学院附属医院关节与运动医学科的膝关节骨性关节炎患者作为研究对象，根据接受手术方式不同将患者分为常规组(n = 152)与个性化组(n = 147)。常规组患者采用传统全膝关节置换术式治疗，个性化组患者采用个性化全膝关节置换术式治疗。对比分析两组患者手术前后下肢力线、假体位置、术中无拇指实验合格率、术中胫骨试模抬离阳性率、手术时间、血红蛋白、美国纽约特种外科医院(Hospital for Special Surgery, HSS)评分等多项指标。结果：较常规组，个性化组术后平片提示有着更优良的下肢力线和假体位置。个性化组无拇指实验合格率明显优于常规组，差异有统计学意义(P < 0.05)。常规组胫骨试模抬起阳性率高于个性化组，差异有统计学意义(P < 0.05)。术后第3个月HSS评分个性化组优于常规组，两组间膝关节功能评分差异有统计学意义(P < 0.05)。个性化组术后血红蛋白明显高于常规组血红蛋白，两组术后血红蛋白差异有统计学意义(P < 0.01)。余下指标，个性化组和常规组差异无统计学意义。结论：相较于传统全膝关节置换术式，个性化全膝关节置换术式可获得更理想的下肢力线和假体安放位置，而且显示出更优良的短期临床疗效。在初次全膝关节置换术中，个性化全膝关节置换术是一种可行的手术方案。

Abstract: Objective: To investigate the imaging and recent clinical outcomes of personalized total knee arthroplasty in patients undergoing primary surgery for osteoarthritis of the knee. Methods: This study was a retrospective cohort study, 299 patients with knee osteoarthritis in the Department of Joint and Sports Medicine, Affiliated Hospital of Jining Medical College were selected as the study objects, and the patients were divided into the conventional group (n = 152) and the personalized group (n = 147) according to the different ways of receiving surgery. Patients in the conventional group were treated with traditional total knee replacement, and patients in the personalized group were treated with personalized total knee replacement. Comparative analysis of the two groups of patients before and after the operation of the lower limb force line, the prosthesis position, intraoperative thumbless experiment pass rate, intraoperative tibial trial mold lifting off the positive rate, the operation time, hemoglobin, the United States of America, New York Hospital for Special Surgery score and other indicators. Results: Compared with the conventional group, the postoperative plain radiographs of the personalized group suggested a better lower limb line of force and prosthesis position. The pass rate of thumbless test in the personalized group was significantly better than that in the conventional group, and the difference was statistically significant (P < 0.05). The positive rate of tibial trial lifting in the conventional group was higher than that in the personalized group, and the difference was statistically significant (P < 0.05). The HSS score in the 3rd postoperative month was better in the personalized group than in the conventional group, and the difference in knee function score between the two groups was statistically significant (P < 0.05). Postoperative Hemoglobin in the personalized group was significantly higher than Hemoglobin in the conventional group, and the difference in postoperative Hemoglobin between the two groups was statistically significant (P < 0.01). For the remaining indicators, the difference between the personalized group and the conventional group was not statistically significant. Conclusion: Compared to conventional total knee replacement, personalized total knee replacement achieves a more optimal lower extremity line of force and prosthesis placement, and demonstrates better short-term clinical outcomes. Personalized total knee arthroplasty is a viable surgical option in primary total knee replacement