微创单髁置换术治疗膝关节自发性骨坏死的中短期疗效分析  

Short-term Curative Effect Analysis of Minimally Invasive Monocular Replacement for Spontaneous Osteonecrosis of Knee Joint

作　　者：卢明峰 杨伟铭[2] 朱东平 曹学伟[2] 

机构地区：[1]广州中医药大学第二临床医学院,广州510403 [2]广东省广州市广东省中医院

出　　处：《中国中医骨伤科杂志》2017年第10期32-37,共6页Chinese Journal of Traditional Medical Traumatology & Orthopedics

摘　　要：目的:探讨微创单髁置换术治疗膝关节自发性骨坏死的中短期临床效果及手术技术,以期为临床工作提供依据。方法:选取本院2014年1月至2016年12月因膝关节自发性坏死行膝关节微创单髁置换术(UKA)治疗的68例患者作为研究对象,所有患者都经MRI明确诊断,同时排除外侧间室和髌骨关节严重退变的患者。全部病例均由同一主刀医师完成,使用第三代牛津膝单髁假体系统,行膝关节内侧单髁置换,采取微创UKA小切口技术。手术前后均行患侧膝关节正侧位X线片及双下肢全长负重位X线片,对膝关节HSS评分、膝关节疼痛VAS评分、关节活动度、下肢力线等进行评估分析,同时观察有无UKA术后并发症出现,分析单髁关节置换临床效果。结果:本研究68例患者均获得随访,其中男28例28膝,女36例36膝,平均随访时间为(15.3±8.1)个月。平均年龄(66.53±7.51)岁,平均体质量(66.45±12.00)kg,平均BMI指数为22.36±3.12,平均手术时间为(68.36±12.27)min,平均出血量为(75.00±25.35)mL,平均住院时间为(7.80±2.26)d.骨坏死患者术前术后VAS及HSS评分比较,差异有统计学意义(P<0.05),两组患者术前和随访时FTA,HKA,ROM比较,差异有统计学意义(P<0.05)。所有病例均无死亡、肺栓塞、下肢静脉血栓形成、心脑血管意外、创伤后精神障碍等严重并发症发生。结论:微创单髁置换术治疗膝关节自发性骨坏死中短期疗效满意,具有创伤小、恢复快、症状改善明显、术后功能良好等特点。Objective： To investigate the short -term clinical effect and surgical technique of minimally invasive monocular replacement for the treatment of spontaneous osteonecrosis of knee joint, so as to provide the basis for clinical work. Methods： From January 2014 to December 2016, 68 patients with spontaneous necrosis of the knee were treated with minimally invasive single-condylar arthroplasty in our hospital. All patients were diagnosed by MRI and patients with lateral degeneration from the lateral compartment and patella joints were excluded. All cases were performed by the same surgeon, using the third generation of Oxford knee condylar prosthesis system, the knee lateral medial condylar replacement, to take minimally invasive UKA small incision technique. The X-ray film of the ipsilateral knee and the total length of the lower extremities were analyzed before and after the operation. The HSS score, knee joint pain VAS score, joint mobility and lower limb force line were analyzed. The complications of UKA were observed and the clinical effect of single condy- lar joint replacement was analyzed. Results： In this study, 68 patients were followed up, including 28 males 28 knees and 36 females 36 cases. The mean follow-up time, mean age, mean weight, mean BMI, mean operative time, mean blood loss, average hospital stay were （15.3±8. 1） months, （66.53±7.51） years, （66.45±12.00） kg, （22. 36±3. 12）,（68.36±12.27） min, （75.00±25.35） mL, （7. 80±2. 26） d, respectively. The difference of VAS and HSS scores before and after operation was statistically significant （P〈 0.05）. The difference of FTA, HKA and ROM between pre-operation and follow-up was statistically significant （P〈0.05）. No severe complications such as death, pulmonary embol- ism, lower extremity venous thrombosis, cardiovascular and cerebrovascular accident, post-traumatic mental disorders and other serious complications were found in all cases. Conclusion： Minimally invasive monocular replacement of knee joi

关 键 词：单髁置换 微创 中短期 自发性骨坏死 

分 类 号：R687.3[医药卫生—骨科学]