设计哲学:我们正在忽视中间枢纽设计吗? 基于英国国家联合注册表的分析
Acta orthopaedica Belgica
|June 9, 2023
概括
十字关节维护 (CR) 和中枢轴 (MP) 全膝关节置换 (TKR) 设计显示出优异的15年生存率. 超过13年的MP植入物优于CR,但仍然是最不受欢迎的,这突显了在外科决定中需要设计哲学数据的需要.
科学领域:
- 整形外科手术 整形外科手术
- 生物材料工程 生物材料工程
- 临床结果研究研究
背景情况:
- 英国国家联合注册局 (NJR) 之前没有报告过按设计理念分层的全膝关节置换 (TKR) 幸存率.
- 国际注册表提供了基于设计的植入物存活率的见解,但NJR数据需要专门的分析来进行这种比较.
研究的目的:
- 根据不同的设计理念,使用英国国家联合注册 (NJR) 数据报告全膝关节置换 (TKR) 的植入物存活率.
- 为了比较长期的性能和修订率的十字式保持 (CR),后部稳定 (PS),移动轴承 (MB) 和中枢轴 (MP) TKR设计.
主要方法:
- 利用NJR的2020年年度报告数据,包括1,144,384个具有可识别设计理念的TKR.
- 计算了CR,PS和MB理念的累计修订数据;从个别植入物品牌中推导出MP理念的生存率.
- 用Kaplan-Meier曲线来评估所有原因的修订率作为15年后续的终点.
主要成果:
- 交叉式保持 (CR) 是最常见的设计 (67.4%),其次是后部稳定 (PS) (23.1%),移动轴承 (MB) (6.9%) 和中间轴承 (MP) (2.6%).
- MP和CR植入物在15年后的生存率最高 (分别为95.7%和95.6%),从10年后的统计学上有显著差异.
- 在所有时间点中,PS和MB植入物都显示出较低的生存率 (94.5%在15年内). 在13年后,MP设计的性能超过了CR.
结论:
- 虽然所有TKR设计都表现出良好的生存率,但CR和MP哲学在10年以后提供了统计学上优异的结果.
- 中间枢纽 (MP) 设计在13年后显示出比CR的性能优势,尽管其利用率低.
- 根据设计哲学分类的TKR生存数据的发布对于帮助外科医生选择植入物和改善患者的治疗结果至关重要.
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