采用内侧枢轴设计的低约束内衬是十字韧带固定全膝关节置换术良好疗效的潜在预测因素:倾向评分匹配分析

IF 4.3 3区 材料科学 Q1 ENGINEERING, ELECTRICAL & ELECTRONIC
Yoshinori Okamoto, Takafumi Saika, Tomohiro Okayoshi, Takashi Ishitani, Hitoshi Wakama, Shuhei Otsuki
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引用次数: 0

摘要

目的:采用内侧枢轴设计的十字韧带固定(CR)全膝关节置换术(TKA)中,聚乙烯植入物的一致性对术后效果的影响仍不确定。因此,本研究旨在评估CR-TKA中聚乙烯假体符合性对患者报告结果的影响:对255名患者的255个膝关节(FINE全膝关节系统)的数据进行了回顾性分析,比较平均随访2.2年(2.0-5.5年)期间,通过历史对照确定的高约束或低约束内侧枢轴假体的疗效。多变量逻辑回归分析用于确定FJS-12(Forgotten Joint Score-12)患者可接受症状状态(PASS)的预测因素。在年龄、性别、体重指数、Kellgren-Lawrence分级、Charlson合并症指数、膝关节屈曲挛缩、FJS-12和随访时间方面建立倾向得分匹配队列,进行组间比较(每组50人):结果:低约束插入(p = 0.031)和年龄(p = 0.043)是 FJS-12 达到 PASS(>33,153/255)的独立预测因素。匹配成功后,与高约束嵌入物相比,低约束嵌入物提高了患者的满意度(上下楼时的疼痛 p = 0.029,上楼功能 p = 0.047),并增加了达到 FJS-12 最小临床意义差异(p = 0.019)和 PASS(p = 0.025)的可能性。在低约束嵌入组中,胫骨后斜度与 FJS-12 之间存在明显的相关性(p 结论:在低约束嵌入组中,胫骨后斜度与 FJS-12 之间存在明显的相关性:与高约束植入物相比,低约束内侧枢轴植入物的功能效果和患者满意度更高。因此,植入物的一致性可能对CR-TKA的结果起着至关重要的作用:证据等级:三级。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Low-constraint insert with a medial pivot design as a potential predictor of favourable outcomes in cruciate-retaining total knee arthroplasty: A propensity score-matched analysis.

Purpose: The influence of polyethylene insert conformity on the outcomes of cruciate-retaining (CR) total knee arthroplasty (TKA) with a medial pivot design remains uncertain. Therefore, this study aimed to evaluate the effects of polyethylene insert conformity in CR-TKA on patient-reported outcomes.

Methods: The data of 255 knees (FINE Total Knee System) from 255 patients were retrospectively analysed to compare outcomes for high- or low-constraint medial pivot inserts, as determined through historical controls, over an average follow-up period of 2.2 years (range, 2.0-5.5 years). Multivariate logistic regression analysis was used to identify predictors of achieving the patient-acceptable symptom state (PASS) for the Forgotten Joint Score-12 (FJS-12). Propensity score-matched cohorts for age, sex, body mass index, Kellgren-Lawrence grade, Charlson Comorbidity Index, knee flexion contracture, FJS-12 and follow-up duration were created for between-group comparison (n = 50 in each group).

Results: Low-constraint insert (p = 0.031) and age (p = 0.043) were independent predictors of achieving the PASS for the FJS-12 (>33, 153/255). After successful matching, compared to the high-constraint insert, the low-constraint insert improved patient satisfaction (p = 0.029 for pain on going up or downstairs, and p = 0.047 for the function of going upstairs) and increased the likelihood of achieving the minimal clinically important difference (p = 0.019) and PASS (p = 0.025) for the FJS-12. A significant correlation was observed between the posterior tibial slope and the FJS-12 in the low-constraint insert group (p < 0.001), indicating that a greater posterior tibial slope was associated with better functional outcomes in this group.

Conclusions: Compared with high-constraint inserts, low-constraint medial pivot inserts yielded higher functional outcomes and patient satisfaction. Therefore, insert conformity may play a crucial role in CR-TKA outcomes.

Level of evidence: Level III.

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