关节间隙宽度测量对内侧膝关节单髁置换效果及预后的影响  

Impact of measurement of joint space width on effectiveness and prognosis of medial unicondylar knee arthroplasty

作　　者：徐耿彬 茹江英 Xu Gengbin;Ru Jiangying(Department of Orthopedics,The Sixth Affiliated Hospital of Guangzhou Medical University,Qingyuan People’s Hospital,Qingyuan 511518,Guangdong Province,China)

机构地区：[1]广州医科大学附属第六医院,清远市人民医院骨关节科,广东省清远市511518

出　　处：《中国组织工程研究》2024年第36期5877-5883,共7页Chinese Journal of Tissue Engineering Research

摘　　要：背景:与全膝关节置换相比,膝关节单髁置换具有康复快、成本低、本体感觉好等优点,但其术后高翻修率也是不容忽视的问题。目前对于导致膝关节单髁置换后高翻修率的原因尚不完全明确,因此术前严格把握手术指征对改善膝关节单髁置换后疗效和降低翻修率至关重要。作为常用的影像学测量手段,关节间隙宽度的评估可能对膝关节单髁置换手术指征的选择具有重要的临床参考价值。目的:综述关节间隙宽度的测量方法及对判定内侧膝关节单髁置换疗效和预后的影响。方法:通过万方和PubMed数据库检索1950-01-01/2023-06-01发表关于膝关节单髁置换疗效评价因素和关节间隙宽度对膝关节单髁置换疗效影响的相关文献,通过将文献汇总、分析,对关节间隙宽度的测量方法、术前内侧间室关节间隙宽度对内侧膝关节单髁置换疗效的影响、内侧膝关节单髁置换后外侧间室关节间隙宽度变化对预后的影响做以综述。结果与结论:①尽管目前用于研究和测量膝关节关节间隙宽度的方法很多,但负重位下X射线片测量关节间隙宽度仍是日常骨科实践中评估骨关节炎进展的常用方法,其可适度反映软骨厚度。②术前膝关节内侧间室关节间隙宽度会影响内侧活动平台膝关节单髁置换后的疗效,内侧关节间隙宽度/外侧关节间隙宽度<40%或内侧关节间隙宽度≤2mm的膝骨关节炎患者,可能更适合行内侧活动平台膝关节单髁置换。③内侧膝关节单髁置换后外侧间室关节间隙宽度变化对预后产生一定影响,术后通过改善外侧间室的关节匹配度,可延缓外侧间室关节退变的进展、降低假体翻修率,但尚欠缺相关的临床研究。总之,关节间隙宽度的影像学测量对判定内侧膝关节单髁置换的术后疗效和预后具有重要的临床参考价值。BACKGROUND:Compared with total knee arthroplasty,unicondylar knee arthroplasty has such advantages as quick recovery,low cost and good proprioception,but its high revision rate after operation is also a problem that cannot be ignored.At present,the reasons for the high revision rate after unicondylar knee arthroplasty are not completely clear.Therefore,preoperative strict control of surgical indication may be crucial to improve postoperative outcome and reduce revision rate after unicondylar knee arthroplasty.As an index commonly used in the measurement of imaging,the evaluation of joint space width may have important clinical reference value in the selection of indications for unicondylar knee arthroplasty.OBJECTIVE:To review the measurement of joint space width and its effect on the curative effect and outcome of medial unicondylar knee arthroplasty.METHODS:WanFang and PubMed were used to search the relevant literature published from January 1,1950 to June 1,2023 on the evaluation factors of curative effect of unicondylar knee arthroplasty and the influence of joint space width on the curative effect of unicondylar knee arthroplasty.By summarizing and analyzing the literature,the measurement methods of joint space width,the influence of preoperative medial compartment joint space width on the curative effect of medial compartment joint space width,and the influence of postoperative lateral compartment joint space width on the outcome were reviewed.RESULTS AND CONCLUSION:(1)Although many methods have been used to study and measure knee joint space width,X-ray measurement of joint space width under weight-bearing position is still a common method in daily orthopedic practice to assess the progression of osteoarthritis,and it can moderately reflect the thickness of cartilage.(2)Preoperative medial compartment joint space width of knee joint can affect the efficacy of medial movable platform after unicondylar knee arthroplasty.Patients with knee osteoarthritis whose medial joint space width/lateral joint space widt

关 键 词：关节间隙宽度 单髁置换 内侧膝关节 疗效 预后 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] Q441[生物学—生理学]