前交叉韧带缺陷对固定平台单髁置换后中期疗效的影响  

Influence of anterior cruciate ligament defect on the mid-term outcome of fixed-bearing unicompartmental knee arthroplasty

作　　者：刘少华 周观明[2] 陈希聪[2] 肖可明[2] 蔡剑[2] 刘效仿 Liu Shaohua;Zhou Guanming;Chen Xicong;Xiao Keming;Cai Jian;Liu Xiaofang(Foshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Chinese Medicine,Foshan 528000,Guangdong Province,China;Tenth Department of Orthopedics,Foshan Hospital of Traditional Chinese Medicine,Foshan 528000,Guangdong Province,China)

机构地区：[1]广州中医药大学附属佛山中医院,广东省佛山市528000 [2]佛山市中医院骨十科,广东省佛山市528000

出　　处：《中国组织工程研究》2021年第6期860-865,共6页Chinese Journal of Tissue Engineering Research

基　　金：广东省医学科学技术研究(20161181228306),项目参与者:刘少华。

摘　　要：背景:固定平台单髁置换已成为治疗膝关节内侧单间室骨性关节炎的有效方法,近年来随着单髁假体设计及手术技术的不断发展,年龄、体质量、髌股关节病变不再是固定平台单髁置换手术的绝对禁忌证,然而对于前交叉韧带缺陷是否影响固定平台单髁置换假体的生存率还存在争议。目的:探讨固定平台单髁置换技术应用于膝关节内侧单间室骨性关节炎合并前交叉韧带缺陷患者的手术疗效及翻修率。方法:选择2014年3月至2016年3月佛山市中医院收治的膝关节内侧单间室骨性关节炎患者268例,其中男111例,女157例,均接受固定平台单髁置换治疗,根据术前MRI和术中探查分为前交叉韧带缺陷组(n=45)与前交叉韧带完整组(n=223)。术后随访4-6年,统计假体生存率,采用HSS评分、Tegner评分对手术前后膝关节功能进行评估,分析髋膝踝角、后倾角评估下肢力线情况,同时利用红外光导航膝关节三维动态评估系统获取膝关节六自由度运动学参数,客观评估术后膝关节功能。研究获得佛山市中医院伦理委员会批准,批准号20140317。结果与结论:①两组均出现术后持续性疼痛、外侧间室进展性关节炎等并发症,前交叉韧带缺陷组术后翻修率为4.40%,前交叉韧带完整组翻修率为4.03%,两组间比较差异无显著性意义(P>0.05);②末次随访时,两组间HSS评分、Tegner评分、髋膝踝角、后倾角角比较差异均无显著性意义(P>0.05);③末次随访时,两组间膝关节内外翻角度、屈伸活动角度、内外旋角度、上下位移、内外位移、前后位移运动分析6个自由度数据相似(P>0.05);④结果表明在随访期内,固定平台单髁置换治疗术前膝关节稳定的前交叉韧带缺陷患者与前交叉韧带完整患者具有相同的手术疗效和假体生存率。BACKGROUND:Fixed-bearing unicompartmental knee arthroplasty has become an effective method for the treatment of medial single-compartment osteoarthritis of the knee joint.In recent years,with the continuous development of the design of unicompartmental prosthesis and surgical techniques,age,body mass idex and patellofemoral joint lesions are no longer the absolute contraindication for fixed-bearing unicompartmental knee arthroplasty.However,it is still controversial whether anterior cruciate ligament defects affect the survival rate of fixed-bearing unicompartmental knee arthroplasty.OBJECTIVE:To investigate the clinical effect and revision rate of unicompartmental knee arthroplasty in the patients with medial univentricular osteoarthritis and anterior cruciate ligament deficiency.METHODS:A total of 268 patients with single-compartment osteoarthritis of the medial knee joint admitted to Foshan Hospital of Traditional Chinese Medicine from March 2014 to March 2016 were selected,including 111 males and 157 females,who were all treated with fixed-bearing unicompartmental knee arthroplasty.According to preoperative MRI and intraoperative exploration,the patients were divided into anterior cruciate ligament defect group(n=45)and anterior cruciate ligament intact group(n=223).After 4-6 years of follow-up,the survival rate of the prosthesis was counted.The knee function was evaluated by hospital for special surgery knee score and Tegner scores.Hip knee ankle angle and posterior slope angle were analyzed to evaluate the lower limb alignmentthe.Six degrees of freedom kinematic parameters of the knee joint were obtained by the three-dimensional dynamic evaluation system guided by infrared light to evaluate objectively knee joint function after operation.The study was approved by Ethics Committee of Foshan Hospital of Traditional Chinese Medicine(approval No.20140317).RESULTS AND CONCLUSION:(1)Complications such as postoperative persistent pain and progressive arthritis of lateral compartment occurred in both groups.The rat

关 键 词：骨 置换 单髁置换 膝关节 前交叉韧带 单间室 关节炎 

分 类 号：R459.9[医药卫生—治疗学] R318.08[医药卫生—临床医学]