一期膝关节单髁置换术联合前交叉韧带重建治疗膝关节骨关节炎合并前交叉韧带损伤  

COMBINED UNICOMPARTMENTAL KNEE ARTHROPLASTY AND ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION IN TREATMENT OF OSTEOARTHRITIS AND ANTERIOR CRUCIATE LIGAMENT INJURY

作　　者：田少奇[1] 王斌[2] 刘论[1] 哈承志[1] 王远贺[1] 刘江俊 李启才[1] 杨旭[1] 孙康[1] 

机构地区：[1]青岛大学附属医院关节外科,山东青岛266000 [2]青岛市第三人民医院骨科

出　　处：《中国修复重建外科杂志》2015年第12期1457-1461,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的 探讨一期膝关节单髁置换术（unicompartmental knee arthroplasty,UKA）联合前交叉韧带（anterior cruciate ligament,ACL）重建治疗膝关节骨关节炎（osteoarthritis,OA）合并ACL损伤的早中期疗效。方法2006年1月-2014年1月,收治32例膝关节OA伴ACL损伤患者,均一期行UKA联合ACL重建术。其中男12例,女20例;年龄41~63岁,平均50岁。左膝17例,右膝15例。ACL损伤原因为运动伤（25例）及交通事故伤（7例）;其中陈旧性损伤27例,急性损伤5例。患者主要临床症状均为膝关节内侧室疼痛,伴膝关节运动不稳。术前X线片测量示膝关节内翻角为（3.1±0.6）°。结果 术后患者切口均Ⅰ期愈合,无手术相关并发症发生。患者均获随访,随访时间16~112个月,平均55个月。2例发生活动半月板脱位,均更换较厚半月板垫片后获较好疗效。X线片复查示,经手术矫正患肢膝关节外翻角为（4.0±0.7）°。随访期间均未出现假体松动迹象,但10例存在胫骨侧假体生理性透亮线（〈1 mm）。末次随访时,患者牛津膝关节评分（OKS）、膝关节学会评分系统（KSS）临床及功能评分以及Tegner运动评分与术前比较,差异均有统计学意义（P〈0.05）。末次随访时患肢胫骨假体后倾角为（3.9±1.2）°,与末次随访时膝关节活动度（123.5±2.8）°成正相关（r=0.392,P=0.031）。结论 对于原发性ACL损伤伴继发性膝关节内侧室OA或膝关节内侧室OA伴急性ACL损伤,选择一期UKA联合ACL重建术可获得较好早中期疗效。Objective To explore the shortand mid-term effectivenesses of combined unicompartmental knee arthroplasty （UKA） and anterior cruciate ligament （ACL） reconstruction for osteoarthritis （OA） and ACL injury. Methods Between January 2006 and January 2014, 32 patients with knee OA and ACL injury were treated by combined UKA and ACL reconstruction. There were 12 males and 20 females, aged 41-63 years （mean, 50 years）; 17 left knees and 15 right knees were involved. The causes of ACL injury were sports injury （25 cases） and traffic accident injury （7 cases）, including 27 cases of old injury and 5 cases of acute injury. Pain of the medial compartment of the knee and unstable knee joint were the main clinical symptoms. Preoperative X-ray films showed （3.1±0.6）° of varus deformity. Results All incisions healed by first intention, without complication. The patients were followed up 16-112 months （mean, 55 months）. Mobile bearing dislocation occurred in 2 cases after operation, and was cured after replacing much thicker mobile bearings. X-ray films showed （4.0±0.7）° of valgus at last follow-up. There was no loosening of the prosthesis. Physiological radiolucent line （〈1 mm） was observed around the tibial component in 10 patients. The Oxford Knee Score （OKS）, Knee Society Score （KSS） clinical score, KSS functional score, and Tegner activity score at last follow-up were improved significantly （P〈0.05）. The range of motion （ROM） of the operated knee was （123.5±2.8）% and the posterior slope of the tibial component was （3.9±1.2）° at last follow-up; a significant correlation was found between ROM and posterior slope according to the Pearson＇s correlation （r=0.392, P=0.031）.Conclusion Combined UKA and ACL reconstruction has good short- and mid-term effectivenesses for OA and ACL injury.

关 键 词：膝关节 骨关节炎 前交叉韧带 单髁置换术 

分 类 号：R687.4[医药卫生—骨科学]