膝单髁置换治疗晚期内侧间室膝关节自发性骨坏死  

Unicompartmental knee arthroplasty used for advanced spontaneous osteonecrosis of the knee

作　　者：冯恩辉 麦秀钧 黄永明 曹振武 陈康耀 苏海涛 

机构地区：[1]广州中医药大学第二附属医院骨科,广东省广州市510006

出　　处：《中国组织工程研究》2017年第35期5577-5582,共6页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金项目(81273781);课题名称:骨性关节炎中软骨细胞病变TDP-43负调控机制及补肾活血中药干预的研究~~

摘　　要：背景:膝关节单髁置换因其创伤小、恢复快、并发症低和接近膝关节正常生物力学等优点,在临床上越来越多的被用于修复膝关节单间室疾病。近年来应用膝关节单髁置换治疗晚期膝关节自发性骨坏死在国外已有大量成功的经验报道,但国内开展该技术较晚,目前尚无此方面的长期随访研究报道。目的:探讨膝关节单髁置换治疗晚期膝关节自发性骨坏死的短期临床疗效。方法:回顾分析2015年1至8月收治的12例(12膝)采用膝关节单髁置换治疗的晚期膝关节自发性骨坏死患者的病历资料,均发生在膝关节内侧间隙。采用Biomet公司第3代Oxford单髁假体行膝关节单髁置换治疗。术后第3,6,12,18个月随访,对患者的关节活动度、膝关节疼痛目测类比评分、美国特种外科医院(HSS)膝关节评分及胫股角进行疗效评估。结果与结论:(1)随访12-18个月。所有患者术后切口Ⅰ期愈合,术后未出现感染、下肢血栓、骨折等并发症;(2)末次随访时,患者的疼痛目测类比评分由术前的(6.67±0.78)分降至(1.75±0.97)分,HSS膝关节评分由术前的(63.92±7.27)分上升至(91.67±2.87)分,胫股角由术前的(178.28±3.38)°改变为术后的(176.82±2.37)°,差异均有显著性意义(P<0.05);术前患者的膝关节活动度与末次随访时差异无显著性意义;(3)结果提示,膝关节单髁置换治疗晚期内侧间隙膝关节自发性骨坏死的短期疗效满意。BACKGROUND： Unicompartment knee replacement is more popular for small trauma, rapid recovery, low less complications and almost normal knee mechanics, and has been used to repair unicompartmental knee diseases. At abroad, unicompartmental knee arthroplasty for advanced spontaneous osteonecrosis of knee （SONK） has obtained satisfactory outcomes, but its long-term efficacy and safety are not known in China. OBJECTIVE： To explore the short-term effectiveness of unicompartmental knee arthroplasty for advanced SONK. METHODS： Clinical data of 12 SONK patients （12 knees） admitted between January and August 2015 were analyzed retrospectively. Unicompartmental knee arthroplasty was operated by the same surgical team using the 3rdgeneration of Oxford？Unicompartmental Knee. The Visual Analogue Scale, femorotibial angle, range of motion of the knee and Hospital for Special Surgery scores were used to evaluate the curative efficacy at 3, 6, 12, and 18 months postoperatively. RESULTS AND CONCLUSION： （1） All patients were followed up for 12-18 months. The incision in all patients achieved primary union, and no infection, lower limb venous thrombosis or fracture occurred. （2） At the end of follow-up, the Visual Analogue Scale scores were significantly reduced from preoperative （6.67±0.78） to （1.75±0.97）; the Hospital for Special Surgery scores were significantly increased from preoperative （63.92±7.27） to （91.67±2.87）; the femorotibial angle changed from preoperative （178.28±3.38）° to （176.82±2.37）°（All P 〈 0.05）. But the range of motion of the knee joint did not differ significantly before and after surgery. （3） That is to say, unicompartmental knee arthroplasty obtains satisfactory short-term efficacy in the treatment of advanced SONK.

关 键 词：骨科植入物 人工假体 膝关节单髁置换术 膝关节自发性骨坏死 膝关节置换术 膝关节骨关节炎 骨坏死 膝关节退行性病变 膝关节疼痛 膝关节假体 国家自然科学基金 

分 类 号：R318[医药卫生—生物医学工程]