钽金属骨小梁胫骨假体在初次全膝置换术后的中期疗效研究

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摘要目的比较初次全膝关节置换术(total knee arthroplasty，TKA)中应用钽金属骨小梁一体化胫骨假体(tantalum monoblock tibial component，TMT)和骨水泥型胫骨假体的中期临床效果。方法回顾分析2012—2015年在西京医院初次全膝关节置换术中应用TMT的患者54例(65膝)和骨水泥型胫骨假体43例(52膝)。TMT组54例(65膝)，其中男性10例，女性44例；平均年龄(62.8±5.6)岁。骨水泥型胫骨假体组43例(52膝)，其中男性8例，女性35例；平均年龄(64.4±4.8)岁。比较分析TMT组和骨水泥型胫骨假体组患者术后末次随访美国膝关节协会评分(knee society score，KSS)临床评分、KSS功能评分、疼痛视觉模拟评分(visual analogue scale，VAS)、关节活动度(range of motion，ROM)和胫股角(femorotibial angle，FTA)，术后X线评价，并发症及假体生存率；比较分析TMT组患者术前及术后末次随访KSS临床评分、KSS功能评分、VAS评分、ROM和FTA。结果所有患者均获随访，随访4~7年，平均(5.0±1.8)年；两组患者术后末次随访KSS临床评分、KSS功能评分、ROM、VAS、FTA比较差异无统计学意义；TMT组患者术前与术后末次随访KSS临床评分、KSS功能评分、ROM、VAS、FTA比较差异有统计学意义。TMT组1例因膝关节不稳翻修，骨水泥型胫骨假体组2例因假体周围感染(periprostheticjoint infection，PJI)行部分翻修；TMT组术后早期透亮线逐渐消失，展现出良好的骨长入特性；TMT组PJI发生率较骨水泥型胫骨假体组低，两组术后其他并发症及假体生存率比较差异无统计学意义。结论初次TKA中应用TMT具有良好的骨长入和抑菌性等优势，临床效果良好，理论假体生存率长，但长期效果仍需观察评估。

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	吴奇
	郭海涛
	张景艺
	燕明
	第五维龙

关键词 ：全膝关节置换术, 钽金属骨小梁一体化胫骨假体, 非骨水泥, 骨水泥

Abstract：Objective To compare the postoperative outcomes of the cementless tantalum monoblock tibial component (TMT) with cemented fixation of the tibial component in the primary total knee arthroplasty.Methods A retrospective analysis was performed on 54 patients (65 knees) who were treated with TMT and 43 patients (52 knees) with cemented fixation of the tibial component in primary TKA in Xijing Hospital from 2012 to 2015.There were 54 patients (65 knees) in TMT group，including 10 males and 44 females，with an average age of (62.8±5.6) years.There were 43 patients (52 knees) in cemented fixation of the tibial component group，including 8 males and 35 females，with an average age of (64.4±4.8) years.Knee society score(KSS)，range of motion (ROM)，visual analogue scale(VAS)and femorotibial angle(FTA)，radiographic evaluation，postoperative complications and the midterm survivor rate of prosthesis were compared between the two groups before and after operation.KSS，ROM，VAS and FTA were compared TMT group before and after operation.Results All patients had been followed up for 4~7 years，with an average of (5±1.8) years.There was no significant differences in KSS，ROM，VAS and FTA between two groups after operation.There was significant differences in KSS，ROM，VAS and FTA of TMT group before and after operation.1 case underwent revision due to knee instability in TMT group.2 cases underwent partial revision due to periprosthic joint infection (PJI) in cemented fixation of the tibial component group.Early radiolucent line in TMT group gradually disappeared showing good bone ingrowth.Incidence of PJI was lower in TMT group than in cemented fixation of the tibial component group.There was no significant difference in other complications and implant suevivorship between the two groups.Conclusion The application of TMT in the primary TKA has the advantage of better bone ingrowth and bacteriostasis，with good clinical results and better theoretical prosthesis survival rate.However，the long-term effect still needs to be observed and evaluated.

Key words： total knee arthroplasty the tantalum monoblock tibial component cementless cemented

通讯作者: 第五维龙

作者简介: 吴奇(1981－ )，男，副主任医师，西安交通大学附属红会医院风湿免疫关节矫形科，18629289107@163.com

引用本文:

吴奇，郭海涛，张景艺，燕明，第五维龙. 钽金属骨小梁胫骨假体在初次全膝置换术后的中期疗效研究[J]. 实用骨科杂志, 2023, 29(6): 497-.
Wu Qi，Guo Haitao，Zhang Jingyi，Yan Ming，Diwu Weilong. Study on the Medium Term Efficacy of the Tantalum Monoblock Tibial Component in Primary Total Knee Arthroplasty. sygkzz, 2023, 29(6): 497-.

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http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2023/V29/I6/497

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