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中华关节外科杂志(电子版) ›› 2020, Vol. 14 ›› Issue (01) : 46 -51. doi: 10.3877/cma.j.issn.1674-134X.2020.01.008

所属专题: 文献

临床论著

骨髓水肿对髌股关节炎患者内侧单髁置换术的影响
王宇1, 岳家吉1, 杨春喜1,()   
  1. 1. 200001 上海交通大学医学院附属仁济医院骨关节外科
  • 收稿日期:2018-04-25 出版日期:2020-02-01
  • 通信作者: 杨春喜
  • 基金资助:
    上海市科委引导项目(16411971700)

Influence of bone marrow edema on medial unicompartmental knee arthroplasty for patients with patellofemoral osteoarthritis

Yu Wang1, Jiaji Yue1, Chunxi Yang1,()   

  1. 1. Department of bone and joint surgery, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200001, China
  • Received:2018-04-25 Published:2020-02-01
  • Corresponding author: Chunxi Yang
  • About author:
    Corresponding author: Yang Chunxi, Email:
引用本文:

王宇, 岳家吉, 杨春喜. 骨髓水肿对髌股关节炎患者内侧单髁置换术的影响[J/OL]. 中华关节外科杂志(电子版), 2020, 14(01): 46-51.

Yu Wang, Jiaji Yue, Chunxi Yang. Influence of bone marrow edema on medial unicompartmental knee arthroplasty for patients with patellofemoral osteoarthritis[J/OL]. Chinese Journal of Joint Surgery(Electronic Edition), 2020, 14(01): 46-51.

目的

比较术前髌骨有无骨髓水肿对内侧单髁置换(UKA)临床预后的差异,并评估髌股关节炎对术后功能的影响。

方法

选取上海市第十人民医院141例(146膝)膝关节内侧间室骨关节炎接受内侧UKA患者作为研究对象。纳入标准:具有完整的前交叉韧带;15°以内的内翻畸形,并可在外翻应力下纠正;15°以内的屈曲挛缩和超过90°的屈曲度。排除标准:既往术侧下肢的骨折或手术史;有术后并发症存在;炎症性骨关节炎;前交叉韧带损伤。据术前髌股关节的Kellgren-Lawrence(K-L)分级和磁共振成像上的骨髓水肿状态(BMEP)分,被分为3组:A组,无髌股关节炎(K-L 0级);B组,有髌股关节炎,但无骨髓水肿(K-L≥1级,BMEP 0级);C组,有髌股关节炎,合并骨髓水肿(K-L≥1级,BMEP≥1级)。在术后3个月和2年随访时,采用疼痛视觉模拟评分(VAS)、美国特种外科医院(HSS)膝关节评分及关节活动度(ROM)评价术后疗效。定量资料多组比较采用单因素方差分析,组间两两比较采用LSD法,定性资料使用卡方检验。

结果

骨髓水肿和UKA术后的预后不良高度相关。在术后3个月时,在膝前痛VAS评分及关节主动活动度方面3组间差异有统计学意义(F=30.767、92.269、均为P<0.05),C组均不及其他两组,差异有统计学意义(均为P<0.05)。术后2年时,膝前痛VAS评分与关节主动活动度在3组间差异仍有统计学意义(F=3.268、10.220,P<0.05);其中C组的相对于无骨髓水肿的患者仍然较差,差异有统计学意义(均为P<0.05)。

结论

在无骨髓水肿的患者中,不管是否患有髌股关节炎,临床预后均没有明显差异;髌骨骨髓水肿状态因其对单髁置换预后的不利影响应受到重视。

Objective

To compare the difference of clinical outcomes after unicompartmental knee arthroplasty(UKA) between medial compartmental osteoarthrispatients with and without bonemarrow edema (BME) in the patella and to evaluate the effect of patellofemoral osteoarthritis (PFOA) on postoperative functionafter UKA.

Methods

A total of 141patients (146knees) undergone medial UKA were selected in Shanghai Tenth Hospital. Inclusion criteria: intact anterior cruciate ligament; varus deformity within 15° which can be corrected under valgus stress; flexion contracture within 15° and flexion over 90°. Exclusion criteria: previous fracture or operation history of lower limb on the operative side; postoperative complications; inflammatory osteoarthritis; anterior cruciate ligament injury. According to the Kellgren-Lawrence (K-L) scale and bonemarrow edema (BMEP) pattern grade of patellofemoral joints, patients were divided into three groups: Group A, non-PFOA (K-L=0); group B, PFOA without BME (K-L≥1, BMEP=0); group C, PFOA with BME (K-L≥1, BMEP≥1). The visual analog scale (VAS) scores, Hospital for Special Surgery (HSS) scores, and range of motions (ROMs)were used to assess the clinical outcomes atthe postoperative follow-up of three months and two years. The data comparison was performed with the analysis of variance, LSD test and chi-square test.

Results

BME was highly correlated to poor outcome in patients with UKA. At follow-up of three months, group A was worse than the others in terms of knee pain VAS scores and active ROMs(F=30.767, 92.269, P<0.05). At follow-up of two years, the anterior knee painVAS scores and active ROMs were still worse thanthat of patients without BME(F=3.268, 10.220, P<0.05).

Conclusions

Clinical outcomes in patients without BME are no difference whether combining PF OA or not. The condition of BME in the patella should be taken serious consideration due to the adverse effect on theoutcome after UKA.

图1 膝关节失状位MRI T2加权像髌骨BMEP(骨髓水肿状态)。图A为BMEP 1级,髌骨的关节表面局部累及范围≤ 25%(白色箭头所示);图B为BMEP 2级,髌骨的关节表面局部累及范围在25%~50%之间(白色箭头所示);图C为BMEP 3级,髌骨的关节表面局部累及范围大于50%(白色箭头所示);*-示髌上囊明显的关节积液
表1 患者基线资料比较
表2 术前临床测量值比较(±s)
表3 术后3个月临床测量值比较(±s)
表4 术后2年随访时的临床测量值比较(±s)
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