Oxford膝关节单髁置换术胫骨后倾角度的变化对术后中期疗效的影响  

Effect of changes in posterior tibial slope on the mid-term clinical outcomes of Oxford unicompartmental knee arthroplasty

作　　者：蒋言坤 张启栋[1] 黄诚 丁冉[1] 刘朝晖[1] 程立明[1] 王卫国[1] 郭万首[1] Jiang Yankun;Zhang Qidong;Huang Cheng;Ding Ran;Liu Zhaohui;Cheng Liming;Wang Weiguo;Guo Wanshou(Department of Orthopedics,China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]中日友好医院骨科,北京100029

出　　处：《中华医学杂志》2024年第5期344-349,共6页National Medical Journal of China

基　　金：首都卫生发展科研专项(2020-2-4067);中央高水平医院临床科研业务费(2022-NHLHCRF-YGJE-05);中日友好医院“菁英计划”人才培育工程(ZRJY2021-GG08)

摘　　要：目的探讨Oxford膝关节单髁置换术(OUKA)胫骨后倾角(PTS)的变化对术后患者中期疗效的影响。方法随访研究。回顾性分析2012年1月至2013年1月中日友好医院连续收治的135例(150膝)OUKA患者资料,随访至少10年时间。依据手术前后胫骨内侧平台PTS的变化值ΔPTS将患者分为3组:A组(后倾减小>5°)、B组(后倾变化≤5°)、C组(后倾增大>5°)。比较3组病例末次随访时膝关节学会临床评分(KSS-C)、膝关节学会功能评分(KSS-F)、牛津膝关节评分(OKS)、关节遗忘评分(FJS)及膝关节活动度(ROM)。结果截至末次随访,6例患者死亡,9例患者失访,共纳入120例患者(135膝),男30例,女90例,年龄为(66.29±8.62)岁,随访时间为(10.54±0.72)年。其中,A组32例34膝,B组77例90膝,C组11例11膝。截至末次随访,A组1例出现假体松动,C组2例出现聚乙烯垫片脱位,1例出现垫片碎裂,3组并发症发生率差异有统计学意义(P<0.05)。术前OKS为(33.91±6.59)分,KSS-F为(43.46±8.99)分,KSS-C为(41.05±5.70)分,ROM为115.23°±13.53°,术后则分别为(18.82±7.01)分、(81.51±7.34)分、(82.64±7.94)分和119.07°±8.62°,差异均有统计学意义(均P<0.001)。术后A组OKS为(21.44±8.46)分,FJS为(63.83±11.40)分,B组分别为(17.07±5.81)分和(70.49±12.45)分,C组则分别为(25.09±5.07)分和(59.48±10.09)分,3组差异均有统计学意义(均P<0.05),但3组术后KSS评分、ROM差异均无统计学意义(均P>0.05)。结论OUKA手术前后,当ΔPTS<5°时,术后中期疗效更好,同时OUKA中PTS虽以Oxford推荐7°为中心,但要个体化,建议参考术前角度,手术前后变化最好不要超过5°。Objective To investigate the impact of changes in the posterior tibial slope(PTS)in Oxford unicompartmental knee arthroplasty(OUKA)on the mid-term clinical outcomes of postoperative patients.Methods This study was a follow-up study.The data of 135 patients(150 knees)who underwent OUKA at the China-Japan Friendship Hospital from January 2012 to January 2013 were analyzed retrospectively.The patients were followed-up for at least ten years.According to the changes in PTS of the medial tibial plateau before and after surgery,patients were divided into three groups:group A(PTS decreased by more than 5°),group B(PTS changed by 5°or less),and group C(PTS increased by more than 5°).The Knee Society Clinical Score(KSS-C),Knee Society Functional Score(KSS-F),Oxford Knee Score(OKS),Forgotten Joint Score(FJS),and knee range of motion(ROM)among the three groups were compared at the last follow-up.Results Prior to the final follow-up assessment,six patients expired,and an additional nine patients were lost to follow-up.A total of 120 patients(135 knees)were enrolled in this study(30 males and 90 females).The mean age was(66.29±8.62)years,and the follow-up time was(10.54±0.72)years.Group A consisted of 32 patients(34 knees),group B comprised 77 patients(90 knees),and group C included 11 patients(11 knees).One knee in group A suffered prosthesis loosening,and two knees in group C experienced postoperative bearing dislocation,one knee encountered bearing fragmentation.The incidence of postoperative complications differed significantly among the three groups(P<0.05).The preoperative OKS was(33.91±6.59)points,KSS-F was(43.46±8.99)points,KSS-C was(41.05±5.70)points and ROM was 115.23°±13.53°;after the surgery,they changed to(18.82±7.01)points,(81.51±7.34)points,(82.64±7.94)points,and 119.07°±8.62°,respectively,and all the differences were statistically significant(all P<0.001).In terms of postoperative outcomes,group A had an OKS of(21.44±8.46)points and a FJS of(63.83±11.40)points,group B had an OKS of(17.07±5.

关 键 词：关节成形术 置换 膝 骨关节炎 膝关节单髁置换术 胫骨后倾角 临床疗效 

分 类 号：R687.4[医药卫生—骨科学]