单髁置换术治疗膝内侧间室骨关节炎的中短期疗效及并发症分析  

Short to mid-term effectiveness of unicompartmental knee arthroplasty on medial knee osteoarthritis and analysis of the complications

作　　者：单鹏程[1] 赵铁军[1] 何名江[1] 荆琳[1] 尹天[1] 邱成新 张洪美[1] 

机构地区：[1]中国中医科学院望京医院骨关节一科,北京100102

出　　处：《中华骨与关节外科杂志》2017年第5期377-381,共5页Chinese Journal of Bone and Joint Surgery

摘　　要：背景:单髁置换术是治疗膝关节单间室病变的常用手术方法,具有创伤小、功能恢复快以及保留更多骨量等优点,而且中长期随访疗效良好,但随着手术数量增多,下肢力线异常、假体松动、脱位及假体周围骨折等并发症屡有报道,需要深入分析原因并总结经验。目的:探讨单髁置换术治疗膝内侧间室骨关节炎的中短期疗效并分析髌骨弹响及膝外翻病因。方法:回顾性分析2010年1月至2016年12月行内侧间室单髁置换手术的膝骨关节炎患者76例(82膝),记录术后伤口引流量,分析术前及末次随访时膝关节视觉模拟评分法(visual analogue scale,VAS)疼痛评分、关节活动度及美国纽约特种外科医院膝关节评分(hospital for special surgery knee score,HSS),术前及随访时拍摄负重下肢全长正位X线片并测量胫股角,记录手术相关并发症。结果:术后48 h引流量为10~580 ml,平均(120.6±86.2)ml。76例全部获得随访,随访时间7~78个月,平均(36.4±21.1)个月。末次随访时膝关节VAS疼痛评分由术前(7.05±0.89)分降至(1.16±0.88)分,关节活动度由术前(118.05°±8.85°)升至(124.70°±5.57°),HSS评分由术前(64.35±5.40)分升至(88.71±3.33)分,组间比较差异均具有统计学意义(P<0.001)。3例患者术后膝外翻畸形,其中1例行单髁翻修手术,2例患者术后出现髌骨弹响,末次随访时均自愈。结论:单髁置换术治疗膝内侧间室骨关节炎中短期疗效满意,但须术者熟练掌握单髁置换技术避免手术并发症。Background： Unicompartmental knee arthroplasty（UKA） is an effective method for medial or lateral compartmental knee osteoarthritis. It shows many advantages including less traumas, quick rehabilitation and more bone preservation. Although many researches demonstrated good results of mid to long term follow up, we must pay more attention to the complications of UKA. Objective： To explore the short to mid term effectiveness of UKA on medial knee osteoarthritis and analyze the complications. Methods： A total of 76 patients with 82 knees undergoing UKA in our hospital from January2010 to December 2016 had been retrospectively analyzed. The VAS score, range of joint motion and HSS score before operation and at the last follow up after operation were compared to evaluate the pain and function of the knee joint. All patients underwent X ray examination before operation and at the last follow up after operation to observe the alignment of the lower limbs. The complications were recorded. Results： All patients were followed up for an average of（36.4 ± 21.1）months after operation. The average drainage was（120.6±86.2） ml. The VAS score decreased from（7.05±0.89） before operation to（1.16 ± 0.88） at the last follow up, the range of joint motion increased from（118.05° ± 8.85°） before operation to（124.70°±5.57°） at the last follow up. The HSS score increased from（64.35±5.40） before operation to（88.71±3.33） at the last follow up. All of them had remarkable significant difference（P〈0.001）. Three cases with knee joint valgus deformity were observed and one of them received UKA revision operation because of knee and ankle joint pain. Two cases with patellar clunk were observed, and they finally recovered without operation. Conclusions： The short to mid term result of UKA for treating medial unicompartmental knee osteoarthritis is satisfying. Excellent operation technique and rich experience are necessary to avoid complications.

关 键 词：单髁置换 膝 骨关节炎 并发症 

分 类 号：R687.4[医药卫生—骨科学]