2020年 · 第100卷第45期

The knee joint is one of the largest joints in the whole body, it is the weight-bearing joint of the human body, and it is also the joint with the highest incidence of the whole body. Knee joint diseases mainly include: osteoarthritis, rheumatism and rheumatoid arthritis, synovitis, chondromalacia of patella, meniscus injury, ligament injury, etc. Among them, knee osteoarthritis is a degenerative disease with joint pain and dysfunction as the main symptoms caused by fibrosis, chapping, ulcer and loss of articular cartilage caused by various factors. The etiology is still unclear, and it is related to age, obesity, inflammation, trauma and genetic factors^[1]。 Knee osteoarthritis is more common in the elderly. The prevalence rate of people over 60 years old is about 50%, and the prevalence rate of people over 75 years old is as high as 80%. It is more common in women than in men^[2]。 Chronic injury synovitis is also more common in middle-aged and elderly people, and people with obesity or excessive weight bearing on the knee joint are more common.

The clinical efficacy of long-term follow-up after cervical disc replacement is good. The 15-year follow-up of Bryan's cervical disc replacement is the longest clinical follow-up so far. Twenty patients undergoing Bryan cervical disc prosthesis in a single center in France were included, 14 of whom underwent single-segment replacement and 6 of whom underwent double-segment replacement. The preoperative diagnosis of all cases was cervical spondylotic radiculopathy, and the mean follow-up time was 15.5 years. The results showed that 2 patients underwent secondary surgical treatment because of recurrence of operated segment symptoms; The visual analog scale of pain (VAS) at the last follow-up was 2.6, the VAS upper limb pain score was 1.8, and the cervical spine dysfunction index (NDI) score was 14.9; The clinical outcome was good in 16 patients according to Odom criteria. There was mobility in 15 (68.2%) segments at the last follow-up, and the mean mobility of all operated segments was 6.5°; Heterotopic ossification occurred in 12 (54.5%) segments, of which 11 segments were grade III or IV heterotopic ossification; The operated segments were divided into heterotopic ossification and non-heterotopic ossification groups, with a mean range of motion of 2.9° in heterotopic ossification and 12.2° in non-heterotopic ossification.

To evaluate the 10-year follow-up efficacy of continuous dual-level Prestige LP cervical disc replacement (CDA) for cervical degenerative diseases compared with dual-level anterior cervical discectomy and bone graft fusion (ACDF). This prospective multicenter randomized controlled study was approved by the US FDA. 209 cases were included in the CDA group and 188 cases were included in the ACDF group, of which 148 cases of CDA and 118 cases of ACDF were followed up. The clinical efficacy of the CDA group was no worse than that of the ACDF group. Among them, the overall success rate of the CDA group at the last follow-up was 80.4%, which was better than that of the ACDF group 62.2%. The success rate of NDI was 88.4% in the CDA group, which was better than 76.5% in the ACDF group; The neural improvement success rate of CDA was 92.6%, which was better than that of ACDF group (86.1%); The rate of secondary surgery in the operated segment was 4.7% in the CDA group, which was lower than 17.6% in the ACDF group; The secondary surgery rate of adjacent segments was 9.0% in the CDA group, which was lower than 17.9% in the ACDF group. At the last follow-up, the range of mobility of the upper and lower segments of CDA was 6.6° and 5.9°, respectively, and the incidence of grade IV heterotopic ossification in the upper and lower segments was 8.2% and 10.3%, respectively; The success rate of fusion was 95.2% and 97.9% in the upper and lower segments of the ACDF group at the last follow-up, respectively.