内侧活动平台膝单髁置换术后衬垫脱位原因分析及治疗措施  

Etiology analysis and treatment management of mobile-bearing dislocation following Oxford unicompartmental knee arthroplasty

作　　者：齐新宇 黎嘉澔 李宜金 陈锦伦 叶鹏程 曾建春[1] 冯文俊[1] 周赛妮 庞智晖[1] 唐立明[1] 王海彬[1] 曾意荣[1] QI Xinyu;LI Jiahao;LI Yijin;CHEN Jinlun;YE Pengcheng;ZENG Jianchun;FENG Wenjun;ZHOU Saini;PANG Zhihui;TANG Liming;WANG Haibin;ZENG Yirong(Department of Orthopaedics,The First Affiliated Hospital of Traditional Chinese Medicine of Guangzhou University,Guangzhou 510405;Traditional Chinese Medicine of Guangzhou University,Guangzhou 510405,China)

机构地区：[1]广州中医药大学第一附属医院骨科,广州510405 [2]广州中医药大学,广州510405

出　　处：《中华骨与关节外科杂志》2023年第3期219-225,共7页Chinese Journal of Bone and Joint Surgery

基　　金：广州市科技计划项目(202201011212);广东省中医药局科研项目(20221130)。

摘　　要：目的:分析内侧活动平台膝单髁置换术(UKA)后衬垫脱位原因,探讨其治疗措施。方法:回顾性分析2012年8月至2022年8月接受内侧活动平台UKA共723例745膝。观察术后衬垫脱位发生的时间和诱因,分析其发生原因并探讨其治疗措施。结果:745膝随访8~121个月,平均随访时间(52.4±24.1)个月。共9例10膝术后发生衬垫脱位,术后衬垫脱位率为1.34%(10/745),发生脱位时间为术后1~61个月,平均为术后(22.0±19.4)个月,其中约30%的衬垫脱位发生在术后半年之内,50%发生在术后1年之内。术后衬垫脱位诱因:2膝有明确外伤病史,3膝为下蹲站起或过度屈曲后发生,1膝为侧躺后发生,4膝无明显诱因。翻修术中探查发现:4膝发生内侧副韧带或关节囊松弛,3膝出现假体位置安装不良,1膝出现衬垫磨损,1膝衬垫与骨赘撞击,1膝无明确原因导致脱位。5膝采用全膝关节置换术进行翻修,2膝更换新的原厚度衬垫,2膝更换加厚衬垫并同时进行了关节囊紧缩术或内侧副韧带锚钉固定,1膝患者在外院更换加厚衬垫后再次发生脱位,最终接受全膝关节置换术进行翻修。结论:内侧活动平台UKA术后衬垫脱位率较低。术后衬垫脱位主要与术中内侧副韧带损伤、假体位置安装不良、衬垫撞击、衬垫磨损等有关。治疗方法包括麻醉下手法复位、更换新的衬垫、更换为固定衬垫、采用全膝关节置换术进行翻修等,应针对引起脱位的具体原因进行治疗。Objective:To analyze the causes of mobile-bearing dislocation following Oxford unicompartmental knee arthroplasty(UKA),and to explore prevention and treatment methods for mobile-bearing dislocation.Methods:A total of 723 patients(745 knees)undergoing Oxford UKA from August 2012 to August 2022 were retrospectively analyzed in this study.The dislocation time and inducement were recorded.The causes of mobile-bearing dislocation and treatments were analyzed.Results:The mean duration of follow-up was(52.4±24.1)months(range,8-121 months)in these patients.The dislocations occurred in 9 patients(10 knees),and the incidence of mobile-bearing dislocation was 1.34%(10/745).The mean dislocation time was(22.0±19.4)months(range,1-61 months)after surgery.About 30%of bearing dislocation occurred within six months and 50% within one year after surgery.In terms of the causes of dislocation,two knees had a history of trauma,three were found after squat standing or excessive flexion,one occurred after side lying,and four had no obvious causes.During the revision procedure,medial collateral ligament or capsule loosening were found in 4 knees,implant malposition in 3 knees,bearing wear in one knee,impingement between the bearing and implant in one knee,and one dislocation without clear reason.Five knees underwent total knee arthroplasty(TKA),new original thickness of bearings were implanted in 2 knees,a thicker bearing was replaced in 2 knees with capsule tightening or medial collateral ligament fixation with suture anchor,and one patient(one knee)experienced dislocation after replacement of a thickened bearing in another hospital and underwent TKA in our hospital.Conclusions:The incidence of mobile-bearing dislocation is low after Oxford UKA.The dislocation is mainly related to intraoperative medial collateral ligament injury,implant malposition,impingement between the mobile bearing and tissue,and bearing wear.Treatment methods include manual reduction under anesthesia,replacement with new mobile bearing,replacement with fixed bea

关 键 词：膝单髁置换术 活动平台假体 衬垫脱位 治疗 

分 类 号：R684.3[医药卫生—骨科学]