目的：探讨全膝关节置换术中，旋转平台与固定平台的临床疗效。方法2008年1月至2011年1月于我院关节外科行单侧全膝关节置换术的140例（140膝）膝关节骨性关节炎终末期患者纳入本前瞻性随机对照试验，随机分为固定平台组（70例，采用固定平台假体）和旋转平台组（70例，采用旋转平台假体）。记录两组患者的手术时间、并发症、假体生存率，并分别于术前，术后6个月，术后1、2、5年采用美国膝关节协会（American Knee Society, AKS）综合评分系统评价患者术后的膝关节功能（膝关节最大屈曲度、疼痛评分、功能评分、爬楼分数），同期摄膝关节正侧位X线片。结果127例患者完成5年随访（旋转平台组66例、固定平台组61例）。固定平台组1例因感染翻修，旋转平台组1例因无菌性松动翻修。固定平台组发生1例深静脉血栓、1例髌骨骨折、1例膝关节脱位、1例不明原因的膝关节弹响；旋转平台组发生3例不明原因的膝关节弹响。旋转平台组术后5年的膝关节最大屈曲度为109.8°±8.1°，膝关节功能评分为（68.7±14.3）分，疼痛评分为（37.8±4.3）分，爬楼得分为（35.8±10.1）分；固定平台组术后5年的膝关节最大屈曲度为110.4°±5.5°，膝关节功能评分为（69.9±17.2）分，疼痛评分为（38.1±5.0）分，爬楼得分为（37.5±11.0）分。两组间不同时间点的以上指标的差异均无统计学意义（均P＞0.05）。结论在术后5年内，与固定平台相比，旋转平台并没有提供更好的最大膝关节屈曲度，更好的膝关节功能以及更好的假体生存率。%Objective To investigate the clinical effect of the rotating⁃platform and the fixed⁃platform in total knee arthroplasty. Methods Cases of 140 patients (140 knees) of end stage osteoarthritis of the knee joint in our hospital from January 2008 to January 2011 were included in this prospective randomized controlled trial. They were randomly divided into fixed⁃bearing group (70 cases, using a fixed platform prosthesis) and rotating⁃platform group (70 cases, using a rotating platform prosthesis). The operation time, complications and implant survival rate of two groups were recorded, and the American Knee Society (AKS) knee score system was used to evaluate the knee function of patients at 6th month, and 1st, 2nd, 5th year postoperatively. The radio⁃graphs were taken at the same time. Results Sixty⁃six cases in the rotating⁃platform group and 61 in the fixed⁃bearing group were followed up for 5 years. There was one revision in fixed⁃bearing group because of infection, and one in rotating⁃platform group due to aseptic loosening. There was 1 case of deep vein thrombosis, 1 case of patellar fracture, 1 case of knee joint dislocation and 1 case of unexplained knee snapping in fixed⁃bearing group, and there were 3 cases of unexplained knee snapping in rotating⁃platform group. Knee maximum range of motion at 5th year postoperatively in the rotating⁃platform group was 109.8° ± 8.1° , the functional score was 68.7 ± 14.3, the pain scores was 37.8 ± 4.3, and the stair climbing scores were 35.8 ± 10.1. Knee maximum range of motion at 5th year postoperatively in the rotating⁃platform group was 110.4°±5.5°, the functional scores were 69.9 ± 17.2, the pain scores was 38.1 ± 5.0, and the stair climbing scores were 37.5 ± 11.0. There was no signifi⁃ cantly differences between two groups in all above indexes at every time point (P>0.05 for all). Conclusion In this randomized clinical trial, the rotating⁃platform total knee design did not provide better maximum knee flexion, better function, or better durability at 5th year postoperatively than a posterior⁃stabilized, fixed⁃bearing design.
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