前交叉韧带损伤对膝关节前内侧骨性关节炎单髁置换术效果的短期影响  

Short-term effect of anterior cruciate ligament deficiency on Oxford unicompartmental knee arthroplasty

作　　者：文涛[1] 薛华明[1] 马童[1] 杨涛[1] 蔡珉巍[1] 涂意辉[1] 

机构地区：[1]同济大学附属杨浦医院骨科,上海200090

出　　处：《中国骨与关节损伤杂志》2015年第12期1259-1262,共4页Chinese Journal of Bone and Joint Injury

摘　　要：目的 探讨前交叉韧带（ACL）损伤对膝关节前内侧骨性关节炎单髁置换术后短期临床效果的影响。方法 回顾性分析自2009-01—2012-01尝试采用微创单髁置换术治疗的合并ACL损伤的膝关节骨性关节炎60例（60膝）,其中50例ACL完全断裂,10例ACL部分断裂。术中直视下确认ACL的损伤情况。术前及末次随访时采用KSS评分评估膝关节功能,比较手术前后膝关节活动度、下肢力线,观察有无假体的松动、感染、磨损、脱位等并发症。结果 60例术后均获平均30.5（25-48）个月随访。所有患者术后均无感染、脂肪栓塞或下肢深静脉血栓形成,未出现假体位置不良、假体脱位及假体松动。术后膝关节X线片显示内翻畸形矫正,假体位置良好。术后髋膝踝角平均内翻0.8°（0.5°-2.0°）,较术前明显减小,差异有统计学意义（t=14.235,P〈0.001）。术后膝关节活动度平均122°（110°-130°）,较术前明显改善,差异有统计学意义（t=11.124,P〈0.001）。末次随访时KSS关节评分平均84（70-90）分,KSS功能评分平均95.1（80-100）分,均较术前明显提高,差异有统计学意义（t=15.523,P〈0.001;t=9.258,P〈0.001）。结论 ACL损伤对单髁置换术后短期效果没有影响,中长期的影响尚需进一步随访研究。Objective To explore the short-term effect of anterior cruciate ligament deficiency（ACLD） on Oxford unicompartmental knee arthroplasty（UKA）. Methods Between January 2009 and January 2012,60 consecutive patients（60knees） with ACLD in unicompartmental arthritic knees were treated with minimally invasive UKA（MI-UKA）, of which 50 cases of ACL were completely broken, and 10 cases of ACL partial rupture. During surgery, the surgeon assessed the integrity of the ACL by visual inspection. The function of the knees before and at last follow-up after operation was evaluated by KSS score system. The range of motion（ROM） and alignment of the lower limbs were measured and compared. Complications including prosthesis loosening, infection, wear, and dislocation were also reviewed. Results All cases were fully reviewed with a mean follow-up of 30.5 months（range, 25 to 48 months）. None had complications of infection, fat embolism, deep vein thrombosis, malposition of prosthesis, dislocation and loosening. Postoperative radiographs of knee joint demonstrated that varus deformity of the knee was corrected and the position of implant was good. At the last follow-up, the average hip-kneeankle angle was significantly decreased to varus angle of 0.8°（range, 0.5° to 2.0°） postoperatively（t =14.235,P〈0.001）. The average ROM was significantly increased to 122°（range, 110° to 130°） postoperatively（t =11.124,P〈0.001）. The average KSS joint score and functional score were significantly increased to 84（range, 70 to 90） and 95.1（range, 80 to 100） postoperatively（t =15.523,P〈0.001;t =9.258,P〈0.001）. Conclusion ACLD has no effect on the short-term effect of UKA, however,further mid- and long-term studies are required.

关 键 词：膝关节骨性关节炎 前交叉韧带损伤 微创单髁置换术 

分 类 号：R687.4[医药卫生—骨科学]