微创第三代牛津单髁置换术治疗膝关节内侧间室骨关节病的远期效果随访  

Long-term outcome follow-up of Oxford unicompartmental knee arthroplasty for medial compartment osteoarthropathy:a single center′s experience for 10 years

作　　者：王鸿宇 王妍 杨瑞祥[3] 王远贺[1] 胡川 李良刚 刘永山 田少奇[1] 孙康[1] Wang Hongyu;Wang Yan;Yang Ruixiang;Wang Yuanhe;Hu Chuan;Li Lianggang;Liu Yongshan;Tian Shaoqi;Sun Kang(Department of Orthopedics,the Affiliated Hospital of Qingdao University,Qingdao 266000,China;Department of Gynecology,Qingdao Women′s and Children′s Hospital,Qingdao 266000,China;Department of Orthopedics,the Third People′s Hospital of Qingdao,Qingdao 266000,China;Zhejiang University School of Medicine,Hangzhou 310000,China;Department of Orthopedics,Anshun Xixiu District People′s Hospital,Anshun 561000,China)

机构地区：[1]青岛大学附属医院关节外科,青岛266000 [2]青岛市妇女儿童医院妇科,青岛266000 [3]青岛市第三人民医院骨科,青岛266000 [4]浙江大学医学院,杭州310000 [5]安顺市西秀区人民医院骨科,安顺561000

出　　处：《中华外科杂志》2022年第7期703-708,共6页Chinese Journal of Surgery

摘　　要：目的探讨微创第三代牛津单髁置换术(UKA)治疗膝关节内侧间室骨关节病的远期临床效果。方法回顾性分析2007年1月至2016年1月青岛大学附属医院关节外科采用第三代牛津单髁假体行微创UKA治疗的594例(701膝)患者的临床资料。男性155例,女性439例,年龄(62.6±10.9)岁(范围:44~81岁),体重指数(26.9±3.8)kg/m2(范围:21.1~36.2 kg/m2);骨性关节炎676膝,股骨内侧髁特发性骨坏死25膝;其中行单侧UKA 487例(其中66例一侧行UKA,另一侧行全膝关节置换术),行双侧UKA 107例。收集患者术前和末次随访时的假体生存率、膝关节活动度(ROM)、疼痛视觉模拟评分(VAS)、西安大略和麦克马斯特大学(WOMAC)骨关节炎指数、美国膝关节协会评分(KSS)等,记录并发症情况,评估患者术后临床效果。手术前后数据的比较采用配对样本t检验。结果所有患者均顺利完成手术,未发生术中骨折、术后感染及症状性血管栓塞性疾病等。术后平均随访121.6个月(范围:70~178个月)。发生术后垫片脱位、假体松动、胫骨平台塌陷、外侧间室退变以及术后疼痛等并发症18例,并发症发生率为3.0%(18/594);其中行全膝关节置换术翻修13例,更换垫片部分翻修4例,假体翻修率为2.9%(17/594);若以翻修作为假体生存率研究的终点,则该组病例远期随访手术成功率为97.1%(577/594)。患者ROM由术前的(105.9±11.8)°升至末次随访时的(114.0±13.3)°(t=10.796,P<0.01),KSS中临床和功能评分分别由术前的(54.3±3.6)分和(55.9±3.9)分升至末次随访时的(90.1±6.0)分和(87.5±5.7)分(t=124.325,P<0.01;t=110.985,P<0.01);WOMAC骨关节炎指数由术前的(54.8±6.7)分降至末次随访时的(9.2±3.1)分(t=150.860,P<0.01);VAS由术前的(6.1±1.1)分降至末次随访时的(1.5±1.0)分(t=74.941,P<0.01)。结论微创UKA治疗膝内侧间室骨关节病远期随访假体生存率高,翻修率低,并发症少,患者膝关节功能改善明显,临床疗效满意。Objective To investigate the long-term outcomes of minimally invasive Oxford phaseⅢunicompartmental knee arthroplasty(UKA)for patients with medial compartment osteoarthropathy.Methods The clinical data of 594 patients(701 knees)who underwent minimally invasive UKA with Oxford phaseⅢunicompartmental prosthesis at Department of Orthopedics,the Affiliated Hospital of Qingdao University from January 2007 to January 2016 were retrospectively analyzed.There were 155 males and 439 females,aged(62.6±10.9)years(range:44 to 81 years),with a body mass index of(26.9±3.8)kg/m2(range:21.1 to 36.2 kg/m2).There were 359 left knees and 342 right knees,676 knees with osteoarthritis and 25 knees with idiopathic osteonecrosis of the medial femoral condyle.There were 487 cases underwent UKA(66 cases underwent UKA on one side and total knee arthroplasty on the other)and 107 cases underwent bilateral UKA.Patients′prosthetic survival,complications,range of motion(ROM)of the knee,visual analogue score(VAS),Western Ontario and McMaster University(WOMAC)osteoarthritis index,and American knee society score(KSS)were collected to assess clinical outcomes.Paired sample t test was used to compare the data before and after operation.Results All patients completed the surgery successfully.There was no intraoperative fractures,postoperative infections or symptomatic vascular embolic disease occurred.The postoperative complications,including mobile bearing dislocation,prosthesis loosening,tibial plateau collapse,the lateral compartment degeneration and postoperative pain were occurred in 18 cases(3.0%,18/594).Thirteen patients suffered complications were transferred to total knee arthroplasty,4 underwent partial revision,if this was used as the endpoint of the study,the surgical success rate was 97.1%(577/594)and the prosthetic revision rate was 2.9%.The ROM was improved from(105.9±11.8)°preoperatively to(114.0±13.3)°at the last follow-up(t=10.796,P<0.01);the KSS clinical score was increased from 54.3±3.6 to 90.1±6.0(P<0.01)and the fu

关 键 词：骨关节炎 膝 治疗结果 单髁置换术 牛津三代单髁假体 长期临床疗效 

分 类 号：R687.4[医药卫生—骨科学]