微创单髁置换治疗膝关节骨性关节炎及骨坏死的中期临床疗效  

Midterm clinical outcome for minimally invasive unicompartmental knee replacement of knee osteoarthritis and osteonecrosis

作　　者：田少奇[1] 王斌[2] 刘江俊 王远贺[1] 刘论[1] 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,266003 [2]青岛市第三人民医院骨科

出　　处：《中华创伤杂志》2016年第7期632-637,共6页Chinese Journal of Trauma

摘　　要：目的探讨微创单髁置换术（UKR）治疗膝关节骨性关节炎及骨坏死的中期临床疗效。方法回顾性分析2006年1月一2010年6月采用Oxford3代假体行UKR及完整随访的402例患者（440膝），其中男165例（177膝），女237例（263膝）；年龄（58．3±4．7）岁；体重指数（BMI）（24．14±3．75）kg／In。。左侧232膝，右侧208膝。骨性关节炎427膝，股骨内侧髁特发性骨坏死13膝。364例患者为单侧微创UKR，38例患者为同期双侧微创UKR。通过x线片、美国膝关节协会评分（KSS）、西安大略和麦克马斯特大学骨关节炎指数（WOMAC）评分及视觉模拟评分（VAS）等进行疗效评价。结果402例患者获得随访（73．0±1．9）个月。患者手术切15长度为（5．0±0．2）cm。无一例发生术中骨折、术后胫骨平台塌陷、感染、血栓形成或假体松动等。发生活动半月板脱位4例，其中3例行更换半月板手术，1例翻修行全膝关节置换术。术中内侧副韧带损伤1例，术中关节腔内残留骨水泥后行二次手术关节镜取出2例，术后患肢残留中度疼痛2例。冠状位股胫角（FTA）由术前（183．6±5．1）°减至术后（174．3±4．2）°（P〈0．01），矫正内翻（9．3±1．2）°：KSS临床和功能评分分别由术前（42．4±2．9）分和（53．5±3．8）分增至术后（92．9±3．8）分和（93．5±4．0）分（P〈0．01）；WOMAC评分由术前（47．5±3．1）分减至术后（12．3±1．5）分（P〈0．01）：VAS由术前（7．78±1．85）分减至术后（1．56±0．23）分（P〈0．01）。结论微创UKR具有创伤小、解剖结构破坏少、术后疼痛轻、并发症少、康复快等优点，治疗膝关节骨性关节炎及骨坏死的中期临床疗效满意。Objective To determine the midterm clinical outcome in knee osteoarthropathy patients undergoing minimally invasive unicompartmental knee replacement（UKR）. Methods A total of 402 patients （440 knees） undergone Oxford Ⅲ UKR from January 2006 to June 2010 were included. There were 165 males （177 knees） and 237 females （263 knees） , at age of （58.3 ± 4.7 ）years. Body mass index （BMI） was （24.14 ± 3.75 ）kg/m^2. There were 232 left knees and 208 right knees. A total of 427 knees were diagnosed with medial compartment osteoarthrosis and 13 knees with idiopathic necrosis in the medial femoral condyle. Thirty-eight patients accepted bilateral simultaneous minimally invasive UKR and 364 patients unilateral minimally invasive UKR. Results were assessed with X-rays, American Knee Society Score （KSS）, Western Ontario and McMaster Universities （WOMAC） osteoarthritis index, and Visual Analogue Scale （VAS）. The varus deformity of the knee prior to surgery and the valgus degree after surgery were measured and recorded. Results Period of follow-up was （ 73.0 ± 1.9） months.Length of the surgical incisions was （5.0 ± 0.2） era. No patients had intraoperative fracture, and no tibial plateau collapse, infection, thrombosis and aseptic loosening were present after operation. Mobile bearing dislocation occurred in four patients after operation, among which three had the operation of mobile bearing change and one had revision total knee replacement. One patient sustained medial collateral ligament injury during operation, two underwent a second arthroscopic surgery to remove the residual cement in joint cavity, and two had moderate pain in the operated knee after operation. Femorotibial angle （ERA） decreased from （183.6 ± 5.1 ） ° preoperatively to （ 174.3 ± 4.2） ° postoperatively in the coronal plane, and rectified varus deformity angle was （9.3 ± 1.2 ） °. KSS clinical and function scores were improved from （42.4 ± 2.9 ） points and （53.5 ± 3.8） points t

关 键 词：骨关节炎 骨坏死 关节成形术 置换 膝 膝关节假体 

分 类 号：R687.4[医药卫生—骨科学]