膝关节外侧间室软骨退变对膝关节内侧单髁置换手术的影响  

Value of the mild cartilage degeneration of lateral compartment with knee osteoarthritis in unicompartmental knee replacement

作　　者：梁钰琪 牛东生[1] 李立新[1] 李军[1] 马军[1] 

机构地区：[1]宁夏回族自治区人民医院(西北民族大学第一附属医院)骨一科,宁夏银川750001

出　　处：《中国骨与关节损伤杂志》2017年第4期354-356,共3页Chinese Journal of Bone and Joint Injury

基　　金：宁夏自治区科技支撑计划项目(2014ZYH69);宁夏银川市科技攻关项目(2014YCKJ50)

摘　　要：目的探讨膝关节合并外侧间室软骨轻度退变是否可行膝关节单髁置换术(UKA)及3.0T MRI在UKA病例选择的应用。方法笔者自2013-11—2015-08共诊治60例膝关节外侧间室软骨退变,根据术前X线片检查结果的Kellgren-Lawrence分级进行分组。A组:内侧间室软骨退变≥3级,前交叉韧带无明显损伤,外侧间室和髌股关节软骨退变0级,行UKA;B组:内侧软骨≥3级,外侧软骨1级。再通过膝关节3.0T MRI的Recht分级、美国医学会关节韧带损伤分度结果分组,B1组:内侧软骨≥Ⅲ级,外侧软骨损伤Ⅰ~Ⅱ级,关节韧带无明显损伤,行UKA;B2组:内侧软骨≥Ⅲ级,可合并外侧软骨损伤>Ⅱ级、关节韧带≥Ⅰ°,行全膝关节置换术。结果共43例行UKA。UKA术后所有随访平均11.8(6~18)个月。A组(35例)、B1组(8例)末次随访KSS评分均较术前有所改善,差异有统计学意义(P<0.05)。对2组间术后疼痛评分比较行方差齐性检验,方差不齐,差异无统计学意义(F=2.770,P=0.102);对2组术后功能评分比较行方差齐性检验,方差不齐,差异无统计学意义(F=1.102,P=0.299)。结论膝关节内侧间室软骨严重退变合并外侧间室软骨Ⅰ~Ⅱ级退变对UKA术后短期疗效未见明显影响。Objective To investigate the feasibility of unicompartmental knee replacement （UKA） for the mild cartilage degeneration of lateral compartment with knee osteoarthritis, and application of 3.0T MRI in UKA case selection. Methods From November 2013 to August 2015, 60 patients with cartilage degeneration of lateral compartment were treated. According to the Kellgren-Lawrence grading scale in the weight-bearing knee joint X-ray film, the patients were divided into different groups. Group A, the cartilage degeneration of medial compartment was ≥3 level, anterior cruciate ligament was intact and the cartilage of others compartments was intact. Group A underwent UKA. Group B, the cartilage degeneration of medial compartment was ≤3, the cartilage degeneration of lateral compartment was 1 level. According to the knee joint 3.0T MRI Recht grading and articular ligament injury grading by American Medical Association, group B was divided into subgroups. Group B1, the cartilage degeneration of medial compartment was ≥Ⅲ level, the cartilage degeneration of lateral compartment was Ⅰ-Ⅲ level, and the ligament was intact. The rest patients were included in group B2. Group B1 received UKA while group B2 underwent the total knee replacement. Results Forty three patients underwent UKA. Group A （35 patients） and group Bl（8 patients） were followed up for 6 to 18 months （an average of 11.8 months）. Through the preoperative and postoperative KSS the clinical curative effect was evaluated. The difference was statistically significant （P 〈0.05）. Homogeneity of variance test was performed on two groups of patients with pain score at the last follow-up, and missing variance with Dunnett-t method and had not significant differences between two groups（F =2.770, P=0.102）. Homogeneity of variance test was performed on two groups of patients with function score at the last follow-up, and missing variance with Dunnett-t method and had not significant differences between two groups（F =1.102, P=0.299）. Con

关 键 词：膝关节 软骨退变 MRI 单髁置换术 

分 类 号：R687.3[医药卫生—骨科学]