通用型人工膝关节置换：性别与疗效的关系

摘要

背景：男性和女性膝关节在解剖结构上存在着一定差异，促使了专门为女性设计的符合女性膝关节解剖特点的新型人工膝关节假体的诞生。从理论上讲，通用型人工膝关节置换的疗效应该与性别相关，但实际临床工作中并未发现非常明显的疗效差异。　　目的：分析不同性别患者使用通用型人工膝关节置换假体进行膝关节置换的疗效差异，藉此决定是否有必要在合适人群中推广女性膝关节假体。　　方法：回顾性分析2001年5月至2011年6月间接受人工膝关节置换的患者的临床资料。在312例患者(共行350例人工膝关节置换)患者中排除置换后3年内死亡、失访与翻修患者。观察不同性别患者膝关节功能评价及影像学变化。　　结果与结论：在剩余的285例患者(300例膝关节)中，女性和男性患者置换前膝关节评分、屈膝功能以及疼痛评分接近，但女性患者的伸膝功能以及膝关节功能比男性低，且女性和男性患者置换前后膝关节评分、屈膝、疼痛以及膝关节功能方面差异无显著性意义，但男性患者在伸膝功能方面比女性改善更好。而女性与男性患者放射学透亮带及并发症方面差异无显著性意义。因此说明女性和男性患者使用通用型膝关节置换假体进行人工膝关节置换的疗效差异很小。%BACKGROUND:There were certain differences in the anatomical structure of knee joint between man and woman. Gender knee solution is a new type of artificial knee joint prosthesis, which is specialy designed for women. Theoreticaly, the outcome of unisex total knee arthroplasty prosthesis should be related to gender, but we did not find very obvious differences in practical clinical work. OBJECTIVE:To analyze the differences in curative effects of the unisex knee arthroplasty prosthesis between male and female patients undergoing total knee arthroplasty so as to find out if it is necessary to apply female knee prosthesis among appropriate crowd. METHODS: We retrospectively analyzed the clinical data of patients undergoing total knee arthroplasty from May 2001 to June 2011. Among 312 patients (350 knees receiving total knee arthroplasty), patients who died within 3 years after surgery, lost to folow-up and underwent revision were excluded. Changes in knee functions and imaging were observed between males and females. RESULTS AND CONCLUSION:The women and men had similar mean pre-operative knee scores, flexion function, pain score among 285 patients (300 knees). However, the women had significantly lower mean extension function and function scores than the men. There were no significant differences in improvement in the knee scores, flexion, the pain and knee function between women and men before and after surgery. Nevertheless, men had better extension than women. No significant difference in radiolucencies and complications was seen between females and males. Therefore, there was little difference in outcomes between women and men who used the unisex total knee arthroplasty prosthesis.