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中华关节外科杂志(电子版) ›› 2018, Vol. 12 ›› Issue (03) : 385 -389. doi: 10.3877/cma.j.issn.1674-134X.2018.03.015

所属专题: 文献

综述

膝关节单髁置换术的并发症及防治
李立1, 徐卫东1,()   
  1. 1. 200433 上海,海军军医大学第一附属医院(上海长海医院)关节骨病外科
  • 收稿日期:2017-08-10 出版日期:2018-06-01
  • 通信作者: 徐卫东

Treatment and prevention of unicompartmental knee arthroplasty complications

Li Li1, Weidong Xu1,()   

  1. 1. Department of Orthopedics, Changhai Hospital of Shanghai, the Second Military Medical University, Shanghai 200433, China
  • Received:2017-08-10 Published:2018-06-01
  • Corresponding author: Weidong Xu
  • About author:
    Corresponding author: Xu Weidong, Email:
引用本文:

李立, 徐卫东. 膝关节单髁置换术的并发症及防治[J]. 中华关节外科杂志(电子版), 2018, 12(03): 385-389.

Li Li, Weidong Xu. Treatment and prevention of unicompartmental knee arthroplasty complications[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2018, 12(03): 385-389.

膝关节单髁置换术(UKA)是一种治疗膝关节单侧间室退行性骨关节炎的外科手术,起步于自上世纪70年代。最初,手术效果并不理想,然而随着植入物设计进步和手术技术的改进,UKA逐渐产生令人满意的效果,现在已越来越多被应用。不过UKA仍然面临着诸多问题有待解决。本文综述了膝关节UKA后常见的并发症及其防治。

Unicompartmental knee arthroplasty is a surgical intervention for degenerative osteoarthritis of the knee, which was originated in the 1970s. Initially, the effect was not ideal, however, with the improvement of implant design and surgical technique, the effect became satisfactory gradually. As a result, more and more surgeons start to choose unicompartmental knee arthroplasty as an usual treatment. However, there are still many problems to be solved. This article reviewed the treatment and prevention of common complications of unicompartmental knee arthroplasty.

表1 UKA术后并发症的原因、治疗和预防
并发症 原因 治疗 预防
聚乙烯衬垫脱位 1.关节过度屈曲
2.关节屈伸间隙不平衡
3.关节内翻程度>5°
4.内侧副韧带松弛或损伤
5.撞击
6.活动型衬垫
7.衬垫型号过小
8.继发于假体松动
1.手术修补和加固松弛或损伤的内侧副韧带
2.关节镜下撞击产生点清理
3.更换加大型号衬垫
4.TKA翻修
1.适当纠正膝关节内翻畸形
2.保护膝内侧副韧带
3.注意清除多余的骨水泥和骨赘
4.衬垫安放后测试膝关节活动
聚乙烯衬垫磨损 1.在固定型衬垫中与疲劳和压力相关
2.在活动型衬垫中与耐磨和粘附性相关
1.衬垫替换
2.TKA翻修
1.使用高质量聚乙烯衬垫
2.避免产生过多的内翻畸形
撞击 1.股骨髁后方骨赘残留
2.关节滑膜过度增生
3.交叉韧带水肿
4.骨水泥脱落
1.关节镜下清理术
2.交叉韧带修补
3.衬垫更换
4.TKA翻修
1.去除骨赘
2.避免骨水泥残留
3.关节滑膜清理
假体周围骨折 1.置换侧胫骨负荷过大
2.胫骨平台抗压载荷减退
3.假体型号过小
4.股胫角不佳
5.矢状面截骨时锯片倾斜损伤后方皮质骨
1.保守治疗
2.切开复位内固定
3.TKA翻修
1.仔细操作
2.小心进行截骨开槽
3.选择正确的股胫角
内侧副韧带损伤 内侧张力过大 韧带修补 避免衬垫假体过厚
对侧间室关节炎进展 1.股胫角过度纠正
2.衬垫假体磨损产生的聚乙烯颗粒刺激滑膜快速增生,进而破坏对侧关节软骨
TKA翻修 1.调整内翻畸形防止衬垫脱位及磨损
2.不可过多调整内翻畸形,以防止对侧压力过度
金属假体松动 1.截骨不精确
2.股骨髁假体放置外翻
3.假体与骨面贴合不够紧密
4.截骨后打磨不彻底
5.骨水泥无法坚强固定
6.衬垫假体磨损产生的聚乙烯颗粒刺激骨溶解,导致假体松动
1.TKA翻修
2.股骨髁假体更换
1.适合的假体和衬垫
2.严格手术适应证
3.术中精确截骨
不明原因的疼痛 1.内侧间室负荷过大
2.不当的膝内侧软组织松解
3.对侧间室或髌股关节骨关节炎进展
4.其他未知
1.抗炎止痛药物
2.TKA翻修
/
[1]
Song MH, Kim BH, Ahn SJ, et al. Early complications after minimally invasive Mobile-Bearing medial unicompartmental knee arthroplasty[J]. J Arthroplasty, 2009, 24(8):1281-1284.
[2]
Morris MJ, Molli RG, Berend KR, et al. Mortality and perioperative complications after unicompartmental knee arthroplasty[J]. Knee, 2013, 20(3):218-220.
[3]
Parvizi J, Sullivan TA, Trousdale RT, et al. Thirty-day mortality after total knee arthroplasty[J]. J Bone Joint Surg Am, 2001, 83A(8):1157-1161.
[4]
Gill GS, Mills D, Joshi AB. Mortality following primary total knee arthroplasty[J]. J Bone Joint Surg Am, 2003, 85A(3):432-435.
[5]
Mahomed NN, Barrett J, Katz JN, et al. Epidemiology of total knee replacement in the United States Medicare population[J]. J Bone Joint Surg Am, 2005, 87A(6):1222-1228.
[6]
Kyung TK, Song LE, Jae IL, et al. Analysis and treatment of complications after unicompartmental knee arthroplasty[J]. Knee Surg Relat Res, 2016, 28(1):46-54.
[7]
Ko YB, Gujarathi MR, Oh KJ. Outcome of unicompartmental knee arthroplasty: a systematic review of comparative studies between fixed and Mobile bearings focusing on complications[J]. Knee Surg Relat Res, 2015, 27(3):141-148.
[8]
Ji JH, Park SE, Song IS, et al. Complications of medial unicompartmental knee arthroplasty[J]. Clin Orthop Surg, 2014, 6(4):365-372.
[9]
Choy WS, Kim KJ, Lee SK, et al. Mid-term results of Oxford medial unicompartmental knee arthroplasty[J]. Clin Orthop Surg, 2011, 3(3):178-183.
[10]
Lim HC, Bae JH, Song SH, et al. Oxford phase 3 unicompartmental knee replacement in Korean patients[J]. J Bone Joint Surg Br, 2012, 94(8):1071-1076.
[11]
Kim SJ, Postigo R, Koo S, et al. Causes of revision following Oxford phase 3 unicompartmental knee arthroplasty[J]. Knee Surg Sports Traumatol Arthrosc, 2014, 22(8):1895-1901.
[12]
张启栋,郭万首,刘朝晖,等.膝关节单髁置换术早中期并发症分析[J/CD].中华关节外科杂志(电子版),2013,7(4):443-447.
[13]
Clark M, Campbell DG, Kiss G, et al. Reintervention after Mobile-bearing Oxford Unicompartmental Knee Arthroplasty[J]. Clin Orthop Relat Res, 2010, 468(2):576-580.
[14]
Manson TT, Kelly NH, Lipman JD, et al. Unicondylar knee retrieval analysis[J]. J Arthroplasty, 2010, 25(6, 1):108-111.
[15]
Kim KT, Lee S, Kim TW, et al. The influence of postoperative tibiofemoral alignment on the clinical results of unicompartmental knee arthroplasty[J]. Knee Surg Relat Res, 2012, 24(2):85-90.
[16]
Emerson RH, Hansborough T, Reitman RA, et al. Comparison of a mobile with a fixed-bearing unicompartmental knee implant[J]. Clin Orthop Relat Res, 2002, 404(44):62-70.
[17]
Kim KT, Lee S, Cho KH, et al. Fracture of the medial femoral condyle after unicompartmental knee arthroplasty[J]. J Arthroplasty, 2009,24:1143. e21-24.
[18]
Green TR, Fisher J, Stone M, et al. Polyethylene particles of a′critical size′ are necessary for the induction of cytokines by macrophages in vitro[J]. Biomaterials, 1998, 19(24):2297-2302.
[19]
Bhattacharya R, Scott CE, Morris HE, et al. Survivorship and patient satisfaction of a fixed bearing unicompartmental knee arthroplasty incorporating an allpolyethylene tibial component[J]. Knee, 2012,19(4):348-351.
[20]
Scott CE, Wade FA, Bhattacharya RA, et al. Changes in bone density in Metal-Backed and All-Polyethylene medial unicompartmental knee arthroplasty[J]. J Arthroplasty, 2016, 31(3):702-709.
[21]
Baker PN, Petheram T, Avery PJ, et al. Revision for unexplained pain following unicompartmental and total knee replacement[J]. J Bone Joint Surg Am, 2012, 94(17):e126.
[22]
Van DJ. Zuiderbaan HA,pearle AD.why do medial unicompartmental knee arthroplasties fail Today[J]. J Arthroplasty, 2016, 31(5):1016-1021.
[23]
Kandil A, Werner BC, Gwathmey WF, et al. Obesity, morbid obesity and their related medical comorbidities are associated with increased complications and revision rates after unicompartmental knee arthroplasty[J]. J Arthroplasty, 2015, 30(3):456-460.
[24]
张占丰,王丹,闵继康,等.膝关节单髁置换术65例的中期随访效果分析[J].中华骨与关节外科杂志,2016,9(6):472-475.
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