单髁膝关节置换术治疗伴有外侧盘状半月板的膝内侧间室骨关节炎  

Unicompartmental knee arthroplasty for medial knee osteoarthritis with lateral discoid meniscus

作　　者：张海森[1] 陈思 刘朝晖 王春雷 李龙杰[1] 刘畅[1] Zhang Haisen;Chen Si;Liu Zhaohui;Wang Chunlei;Li Longjie;Liu Chang(Department of Sports Medicine,Central Hospital of Cangzhou,Cangzhou 061001,China)

机构地区：[1]沧州市中心医院运动医学科,沧州061001

出　　处：《中华骨科杂志》2024年第22期1450-1456,共7页Chinese Journal of Orthopaedics

基　　金：沧州市重点研发计划指导项目(213106019)。

摘　　要：目的探讨单髁膝关节置换术(unicompartmental knee arthroplasty,UKA)治疗伴有外侧盘状半月板的膝内侧间室骨关节炎的临床效果。方法回顾性分析2016年1月至2021年7月,于沧州市中心医院接受UKA治疗的13例(16膝)伴有外侧盘状半月板的膝内侧间室骨关节炎患者临床资料,其中男7例(9膝)、女6例(7膝);年龄(59.1±7.7)岁(范围49~74岁);体质指数为(28.9±1.7)kg/m 2(范围25.2~31.3 kg/m 2);左侧10膝、右侧6膝;Kellgren-Lawrence分级3级9膝、4级7膝;病程(6.0±1.5)年(范围3~8年)。UKA术中对外侧盘状半月板均不予处理。采用髋膝踝角(hip knee ankle,HKA)评价下肢对线情况,采用美国特种外科医院(Hospital for Special Surgery,HSS)评分、牛津膝关节评分(Oxford knee score,OKS)和美国膝关节协会(American Knee Society,AKS)评分评价膝关节功能及疼痛程度。结果16膝的手术时间为(55.9±4.5)min(范围48~62 min),住院时间为(10.2±3.2)d(范围7~15 d)。所有患者均获得随访,随访时间(53.2±11.1)个月(范围36~68个月)。术前、术后6个月、1年及末次随访的HSS评分[57.00(54.25,58.00)、91.00(89.25,92.00)、95.50(92.00,97.00)、96.50(95.00,97.75)分]、OKS评分[37.00(36.00,39.00)、15.00(15.00,16.00)、14.00(13.00,14.00)、13.00(12.25,13.00)分]、AKS膝评分[52.00(50.00,53.75)、91.50(91.00,92.00)、95.00(95.00,97.00)、96.50(95.00,97.00)分]及AKS功能评分[53.00(45.00,55.00)、90.00(90.00,90.00)、95.00(92.00,99.25)、95.00(95.00,100.00)分]的差异均有统计学意义(P<0.001),术后1年及末次随访分别与术后6个月比较差异有统计学意义(P<0.05),术后1年与末次随访比较差异无统计学意义(P>0.05)。术前HKA角为内翻8.00°(6.25°,9.75°),术后为内翻3.00°(3.00°,3.75°),术后较术前减小,差异有统计学意义(Z=-3.419,P=0.001)。术后5年,1例(1膝)出现症状性关节游离体,行关节镜下游离体取出术。末次随访时所有患者假体位置均良好,未见松动和下沉,无一例发生假体周ObjectiveTo investigate the clinical efficacy of unicompartmental knee arthroplasty(UKA)in the treatment of medial compartment knee osteoarthritis(OA)with concomitant lateral discoid meniscus.MethodsA retrospective analysis was conducted on 13 patients(16 knees)who underwent UKA for medial compartment OA of the knee associated with lateral discoid meniscus at Central Hospital of Cangzhou between January 2016 and July 2021.The mean age of the patients was 59.1±7.7 years(range,49-74 years),with a mean body mass index(BMI)of 28.9±1.7 kg/m 2(range,25.2-31.3 kg/m 2).Of the 13 patients,7 were male(9 knees)and 6 were female(7 knees).The procedure was performed on 10 knees of the left leg and 6 knees of the right leg.Preoperative radiographic assessment showed that all patients had Kellgren-Lawrence grade 3-4 knee OA(9 knees with grade 3,7 knees with grade 4).The average duration of knee pain was 6.0±1.5 years(range,3-8 years).No surgical intervention was performed on the lateral discoid meniscus during the UKA procedure.The alignment of the lower limbs was assessed by measuring the hip-knee-ankle(HKA)angle using full-length weight-bearing X-rays.Functional outcomes were evaluated using the Hospital for Special Surgery(HSS)score,Oxford knee score(OKS),and American Knee Society(AKS)knee and function scores.The presence of lateral knee pain or tenderness along the lateral joint line was used to assess symptoms related to lateral meniscus injury.ResultsThe average surgical time for the 16 knees was 55.9±4.5 min(range,48-62 min),and the mean length of hospital stay was 10.2±3.2 days(range,7-15 days).The mean follow-up duration was 53.2±11.1 months(range,36-68 months).At 6 months,1 year,and the final follow-up,significant improvements were observed in HSS scores[57.00(54.25,58.00)vs.91.00(89.25,92.00)vs.95.50(92.00,97.00)vs.96.50(95.00,97.75)],OKS[37.00(36.00,39.00)vs.15.00(15.00,16.00)vs.14.00(13.00,14.00)vs.13.00(12.25,13.00)],AKS knee scores[52.00(50.00,53.75)vs.91.50(91.00,92.00)vs.95.00(95.00,97.00)vs.96.50(95.00,9

关 键 词：关节成形术 置换 膝 关节炎 膝 盘状半月板 

分 类 号：R687.4[医药卫生—骨科学]