摘要：
Objective To compare the clinical effect of the different osteotomy order in Total knee arthroplaty (TKA).Methods The clinical data of 80 cases in the Provincial Hospital Affiliated to Anhui Medical university from november 2010 to september 2013 were retrospectively analyzed.Eighty cases of TKA were divided into two group:oberservation group (distal femur osteotomy first) and control group (tibial osteotomy first).The operative time,anteroposterior diameter of lateral and medial tibial plateau exposed in the operation,postoperative drainage,range of motion(ROM) of knee and HSS score of all cases were evaluated and statistically analyzed.Results The follow-up time of 80 cases was 6 to 14 months.The operative time and postoperative drainage of oberservation group were (53.4 ± 13.8) min and(310 ±46) ml.The operative time and postoperative drainage of control group were (72.5 ± 14.7) min and (425 ± 40) ml.The differences were statistically significant (t =5.99,t =11.93,all P values ＜ 0.01).The anteroposterior diameters of lateral tibial plateau exposed in the operation of oberservation group and control group were (44.1 ± 3.7) mm and (21.8 ± 3.3) mm.The difference of two groups was statistically significant (t =28.45,P ＜ 0.01).The anteroposterior diameters of medial tibial plateau exposed in the operation of oberservation group and control group were (45.6 ± 3.5) mm and (43.5 ± 4.2) mm.The difference of two groups was not statistically significant (t =2.43,P ＞ 0.05).The ROMs of knee after 6 weeks and 12 weeks of operation of oberservation group were 87.6° ± 14.2° and 103.6° ± 7.4°.The ROMs of knee after 6 weeks and 12 weeks of operation of control group were 88.6° ± 13.6° and 102.3° ± 6.8°.The differences of two groups were not statistically significant (t =0.32,t =0.82,all P values ＞ 0.05).The HSS scores after 6 weeks and 12 weeks of operation of oberservation group were (90.12 ±8.6) and (91.66 ±6.6).The HSS scores after 6 weeks and 12 weeks of operation of control group were (89.45 ± 9.9) and (91.87 ± 7.5).The differences of two groups were not statistically significant (t =0.32,t =0.13,all P values ＞0.05).Conclusions Distal femur osteotomy first in TKA can fully expose tibial plateau,simplify surgical procedure and reduce surgical trauma.%目的 比较两种截骨顺序在全膝关节置换术(TKA)中的临床应用效果.方法 回顾性分析2010年11月-2013年9月安徽医科大学附属省立医院行TKA的80例(80膝)膝关节骨性关节炎患者的临床资料,根据截骨顺序不同分成两组:观察组40膝,先行股骨截骨;对照组40膝,先行胫骨截骨.比较两组手术时间、术中胫骨内、外侧平台显露前后径范围、术后引流量、术前术后膝关节功能情况及HSS评分,并进行统计学分析.结果 两组80例患者均获得随访6～ 14个月(平均11.3个月).手术时间和术后引流量观察组分别为(53.4±13.8)min和(310 ±46) ml,对照组分别为(72.5±14.7)min和(425±40)ml,差异均有统计学意义(t值分别为5.99、11.93,P值均＜0.01);胫骨外侧平台显露前后径观察组为(44.1±3.7)mm,对照组为(21.8±3.3)mm,差异有统计学意义(t=28.45,P＜0.01);胫骨内侧平台显露前后径观察组为(45.6±3.5)mm,对照组为(43.5±4.2) mm,差异无统计学意义(t=2.43,P＞0.05);观察组术后6周和12周的膝关节活动度分别为87.6°±14.2°和103.6°±7.4°,对照组分别为88.6°±13.6°和102.3°±6.8°,差异均无统计学意义(t值分别为0.32和0.82,P值均＞0.05);观察组术后6周和12周的HSS评分分别为(90.12±8.6)分和(91.66±6.6)分,对照组术后6周和12周的HSS评分分别为(89.45±9.9)分和(91.87±7.5)分,差异均无统计学意义(t值分别为0.32和0.13,P值均＞0.05).结论 TKA中先行股骨截骨可以使胫骨的显露更为充分,起到简化手术操作,减少术中失血,缩短手术时间的作用.
