髌股关节退变对膝关节内侧单髁置换术疗效影响的研究  

Influence of patellofemoral degeneration on outcome of medial unicompartmental knee arthroplasty

作　　者：朱若夫[1] 王治栋[1] 陈广东[1] 高懋峰[1] 施卫东[1] 徐耀增[1] ZHU Ruo-fu;WANG Zhi-dong;CHEN Guang-dong;GAO Mao-feng;SHI Wei-dong;XU Yao-zeng(Department of Orthopedics,The First Affiliated Hospital,Soochow University,Suzhou 215006,China)

机构地区：[1]苏州大学附属第一医院骨科,江苏苏州215006

出　　处：《中国矫形外科杂志》2018年第24期2215-2219,共5页Orthopedic Journal of China

摘　　要：[目的]探讨术前膝关节疼痛部位及影像学髌股关节退变对Oxford内侧单髁置换术疗效的影响。[方法]回顾性分析2012年6月～2017年6月本科采用内侧单髁置换术(Oxford系统)治疗膝关节内侧间室骨性关节炎56例(56膝)患者的临床资料,其中男16例,女40例;年龄50～82岁,平均(63.68±8.23)岁。体重指数21～30kg/m^2,平均(25.81±4.52) kg/m^2。术前伴有膝前痛的16膝(有膝前痛组),不伴有膝前痛的40膝(无膝前痛组)。采用OKS评分、AKSS评分、WOMAC骨关节炎指数评分和髌股关节评分评价临床效果。[结果]所有患者均获得完整随访,随访时间12～60个月,平均(35.47±8.96)个月。无感染、脂肪栓塞或下肢深静脉血栓,无假体位置不良、脱位及假体松动等并发症。与术前相比,有或无膝前痛的患者末次随访时的OKS和WOMAC评分均显著下降,而AKSS临床和功能评分,髌股关节评分评均显著增加,两时间点间的差异均有统计学意义(P<0.01),但有与无膝前痛患者组间上述指标在相应时间点的差异均无统计学意义(P>0.05)。[结论]膝前痛和髌股关节退变并不影响膝关节内侧单髁置换术的疗效,术前影像学表现有髌股关节退变不应作为膝关节内侧单髁置换术的绝对禁忌证。[Objective] To investigate the effect of patellofemoral degeneration on the clinical outcomes of Oxford medial unicondylar knee arthroplasty(UKA). [Methods] A retrospective study was conducted on 56 patients(56 knees) who underwent UKA for medial compartment osteoarthritis from June 2012 to June 2017. Of them, 16 males and 40 females aged from 50 to 82 years with an average of(63.68±8.23) years, and had body mass index(BMI) ranged from 21 to 30 kg/m^2 with an average of(25.81±4.52) kg/m^2. Before operation, 16 patients suffered from anterior knee pain(AKP group), while the remaining 40 patients were of no anterior knee pain(non-AKP group). The Oxford knee joint score(OKS), American Knee Society Score including clinical and functional AKSS, WOMAC osteoarthritis index score and patellofemoral joint score(PF total score) were used for comparison between the two group. [Results] All patients were followed up for 12 to 60 months with an average of(35.47±8.96) months. No serious complication, such as infection, fat embolism and deep vein thrombosis of lower extremity,poor prosthesis placed, dislocation and prosthesis loosening were found in anyone of them. Compared with those preoperatively,the OKS and WOMAC significantly decreased, while the clinical AKSS, functional AKSS and PF scores significantly increased at the last follow-up in both the AKP group and non-AKP group(P<0.05). However, compared the scores between the AKP group and the non-AKS group, no statistical significant difference was proved in any aforesaid score at corresponding time point(P>0.05). [Conclusion] Anterior knee pain and patellofemoral joint degeneration do not influence the outcome of UKA. Therefore, preoperative imaging findings of patellofemoral joint degeneration should not be an absolute contraindication of UKA.

关 键 词：骨性关节炎 单髁置换术 髌股关节 膝前痛 

分 类 号：R687.4[医药卫生—骨科学]