切换至 "中华医学电子期刊资源库"
高级检索
中华关节外科杂志(电子版)

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:
全文 ( ) 下载PDF ( ) 导出引用
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]. 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]. 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。

关键词: 膝, 关节成形术, 骨髓, 水肿
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.

Key words: Knee, Arthroplasty, Bone marrow, Edema
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
组别 例数 膝关节数(例) 性别(男/女) 年龄(岁) 随访时间(年) BMI(kg/m2)
A组 80 80 14/62 65.6±9.0 2.9±0.9 23.4±1.6
B组 51 51 11/39 66.8±8.4 2.9±0.8 23.1±1.7
C组 15 15 6/9 67.5±6.5 2.9±1.1 23.2±1.5
统计值     χ2＝3.401 F＝0.448 F＝0.124 F＝0.505
P值     >0.05 >0.05 >0.05 >0.05
表2 术前临床测量值比较(±s)
组别 例数 膝前痛VAS评分 膝后痛VAS评分 HSS评分 负重下主动ROM(°) 被动ROM(°)
A组 80 5.6±1.2 4.8±0.9 51.1±7.1 97.6±8.1 133.5±7.2
B组 51 5.9±0.8 5.1±1.1 53.9±9.1 100.9±10.0 133.3±7.3
C组 15 6.6±0.9ab 5.3±0.9 52.5±7.4 88.0±8.2ab 132.3±6.2
F值   6.559 1.967 1.977 11.850 0.163
P值   <0.05 >0.05 >0.05 <0.05 >0.05
表3 术后3个月临床测量值比较(±s)
组别 例数 膝前痛VAS评分 膝后痛VAS评分 HSS评分 负重下主动ROM(°) 被动ROM(°)
A组 80 2.2±0.7 2.2±0.6 86.4±7.0 121.2±9.3 131.4±7.1
B组 51 2.1±0.7 2.1±0.5 85.1±6.3 124.1±7.7 133.5±7.0
C组 15 3.6±1.0ab 2.0±0.7 81.8±4.6a 91.0±6.9ab 131.0±7.6
F值   30.767 0.626 3.209 92.269 1.542
P值   <0.05 >0.05 <0.05 <0.05 >0.05
表4 术后2年随访时的临床测量值比较(±s)
组别 例数 膝前痛VAS评分 膝后痛VAS评分 HSS评分 负重下主动ROM(°) 被动ROM(°)
A组 80 1.9±0.8 2.3±0.9 87.8±6.1 125.9±7.4 131.8±8.8
B组 51 1.8±0.8 2.2±0.7 87.0±7.5 127.5±8.5 134.0±10.5
C组 15 2.5±0.7ab 2.3±0.8 85.8±6.4 117.3±5.9ab 130.3±9.2
F值   3.268 0.276 0.646 10.220 1.192
P值   <0.05 >0.05 >0.05 <0.05 >0.05
[1]
Banks SA, Fregly BJ, Boniforti F, et al. Comparing in vivo kinematics of unicondylar and bi-unicondylar knee replacements[J]. Knee Surg Sports Traumatol Arthrosc, 2005, 13(7): 551-556.
[2]
Heyse TJ, El-Zayat BF, De Corte R, et al. UKA closely preserves natural knee kinematics in vitro[J]. Knee Surg Sports Traumatol Arthrosc, 2014, 22(8): 1902-1910.
[3]
Song EK, Park JK, Park CH, et al. No difference in anterior knee pain after medial unicompartmental knee arthroplasty in patients with or without patellofemoral osteoarthritis[J]. Knee Surg Sports Traumatol Arthrosc, 2016, 24(1): 208-213.
[4]
卞为伟，刘璠，唐晓波，等．单髁置换与全膝关节置换治疗单间室膝骨关节炎临床对比研究[J/CD]．中华关节外科杂志(电子版)，2018，12(1): 30-34.
[5]
王一鸣，王琦，张先龙．膝关节单髁置换术的适应证及远期疗效综述[J/CD]．中华关节外科杂志(电子版)，2016，10(3)：341-346.
[6]
Argenson JN, Blanc G, Aubaniac JM, et al. Modern unicompartmental knee arthroplasty with cement: a concise follow-up, at a mean of twenty years, of a previous report[J]. J Bone Joint Surg Am, 2013, 95(10): 905-909.
[7]
Berger RA, Meneghini RM, Sheinkop MB, et al. The progression of patellofemoral arthrosis after medial unicompartmental replacement-results at 11 to 15 years[J]. Clin Orthop Relat Res, 2004, 452(428): 92-99.
[8]
Sierra RJ, Kassel CA, Wetters NG, et al. Revision of unicompartmental arthroplasty to total knee arthroplasty: not always a slam dunk！[J]. J Arthroplasty, 2013, 28(8 Suppl): 128-132.
[9]
何川，冯建民，刘志宏，等．髌股关节退变对Oxford内侧单髁置换疗效的影响[J/CD]．中华关节外科杂志(电子版)，2013，7(4)：459-463.
[10]
Hamilton TW, Pandit HG, Maurer DG, et al. Anterior knee pain and evidence of osteoarthritis of the patellofemoral joint should not be considered contraindications to mobile-bearing unicompartmental knee arthroplasty：a 15-year follow-up[J]. Bone Joint J, 2017, 99－B(5): 632-639.
[11]
Berend KR, Lombardi AV, Jr, Adams JB. Obesity, young age, patellofemoral disease, and anterior knee pain: identifying the unicondylar arthroplasty patient in the United States[J]. Orthopedics, 2007, 30(5 Suppl): 19-23.
[12]
Murray DW. Mobile bearing unicompartmental knee replacement[J]. Orthopedics, 2007, 30(9): 768-769.
[13]
Felson DT, Chaisson CE, Hill CL, et al. The association of bone marrow lesions with pain in knee osteoarthritis[J]. Ann Intern Med, 2001, 134(7): 541-549.
[14]
Dore D, Quinn S, Ding C, et al. Natural history and clinical significance of MRI-detected bone marrow lesions at the knee: a prospective study in community dwelling older adults[J/OL]. Arthritis Res Ther, 2010, 12(6): R223. doi：10.1186/ar3210.
[15]
Scher C, Craig J, Nelson F. Bone marrow edema in the knee in osteoarthrosis and association with total knee arthroplasty within a three-year follow-up[J]. Skeletal Radiol, 2008, 37(7): 609-617.
[16]
郭万首．单髁关节置换的病例选择[J/CD]．中华关节外科杂志(电子版)，2015，9(3)：377-379.
[17]
Emrani PS, Katz JN, Kessler CL, et al. Joint space narrowing and Kellgren-Lawrence progression in knee osteoarthritis: an analytic literature synthesis[J]. Osteoarthritis Cartilage, 2008, 16(8): 873-882.
[18]
Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis[J]. Ann Rheum Dis, 1957, 16(4): 494-502.
[19]
Argenson JN, Chevrol-Benkeddache Y, Aubaniac JM. Modern unicompartmental knee arthroplasty with cement: a three to ten-year follow-up study[J]. J Bone Joint Surg Am, 2002, 84(12): 2235-2239.
[20]
Berger RA, Meneghini RM, Jacobs JJ, et al. Results of unicompartmental knee arthroplasty at a minimum of ten years of follow-up[J]. J Bone Joint Surg Am, 2005, 87A(5): 999-1006.
[21]
徐勤光，顾新丰，郑昱新，等．骨髓水肿与骨关节炎的临床研究进展[J/CD]．中华关节外科杂志(电子版)，2014，8(2)：256-259.
[22]
Jacobs CA, Christensen CP, Karthikeyan T. Subchondral bone marrow edema had greater effect on postoperative pain after medial unicompartmental knee arthroplasty than total knee arthroplasty[J]. J Arthroplasty, 2016, 31(2): 491-494.
[1] 金鑫, 谢卯, 刘芸, 杨操, 杨述华, 许伟华. 个性化股骨导向器辅助初次全髋关节置换的随机对照研究[J]. 中华关节外科杂志(电子版), 2023, 17(06): 780-787.
[2] 邓华梅, 袁札根, 曾德荣, 潘珊珊, 张葆青, 欧爱华, 曹学伟. 全膝关节置换术中气压止血带应用效果与影响因素分析[J]. 中华关节外科杂志(电子版), 2023, 17(06): 788-794.
[3] 张思平, 刘伟, 马鹏程. 全膝关节置换术后下肢轻度内翻对线对疗效的影响[J]. 中华关节外科杂志(电子版), 2023, 17(06): 808-817.
[4] 李培杰, 乔永杰, 张浩强, 曾健康, 谭飞, 李嘉欢, 王静, 周胜虎. 细菌培养阴性的假体周围感染诊治的最新进展[J]. 中华关节外科杂志(电子版), 2023, 17(06): 827-833.
[5] 林文, 王雨萱, 许嘉悦, 王矜群, 王睿娜, 何董源, 樊沛. 人工关节置换登记系统的研究进展[J]. 中华关节外科杂志(电子版), 2023, 17(06): 834-841.
[6] 闫文, 谢兴文, 顾玉彪, 雷宁波, 马成, 于文霞, 高亚雄, 张磊. 微小RNA与全膝关节置换术后深静脉血栓的研究进展[J]. 中华关节外科杂志(电子版), 2023, 17(06): 842-846.
[7] 黄子荣, 罗渝鑫, 杨文瀚, 陈小虎, 谢环宇, 朱伟民. 前交叉韧带重建对膝关节稳定性影响的研究进展[J]. 中华关节外科杂志(电子版), 2023, 17(06): 847-854.
[8] 樊绪国, 赵永刚, 杨砚伟. 腓骨在膝骨关节炎作用的研究观点[J]. 中华关节外科杂志(电子版), 2023, 17(06): 855-859.
[9] 贺敬龙, 尚宏喜, 郝敏, 谢伟, 高明宏, 孙炜, 刘安庆. 重度类风湿关节炎患者行多关节置换术的临床手术疗效[J]. 中华关节外科杂志(电子版), 2023, 17(06): 860-864.
[10] 孟繁宇, 周新社, 赵志, 裴立家, 刘犇. 侧位直接前方入路髋关节置换治疗偏瘫肢体股骨颈骨折[J]. 中华关节外科杂志(电子版), 2023, 17(06): 865-870.
[11] 吴香敏, 吴鹏. 超声引导下收肌管阻滞联合腘动脉与膝关节后囊间隙阻滞在老年患者全膝关节置换术中的应用效果[J]. 中华损伤与修复杂志(电子版), 2023, 18(06): 516-522.
[12] 中华医学会骨科分会关节学组. 中国髋、膝关节置换日间手术围手术期管理专家共识[J]. 中华老年骨科与康复电子杂志, 2023, 09(06): 321-332.
[13] 邱红生, 林树体, 梁朝莹, 劳世高, 何荷. 模拟现实步态训练对膝关节前交叉韧带损伤的功能恢复及对跌倒恐惧的影响[J]. 中华老年骨科与康复电子杂志, 2023, 09(06): 343-350.
[14] 付庆鹏, 邓晓强, 高伟, 姜福民, 范永峰, 吴海贺, 齐岩松, 包呼日查, 徐永胜. 新型股骨测量定位器在全膝关节置换术中的临床应用[J]. 中华临床医师杂志(电子版), 2023, 17(9): 980-987.
[15] 李岩松, 李涛, 张元鸣飞, 李志鹏, 周谋望. 头戴式虚拟现实设备辅助全膝关节置换术后康复的初步研究[J]. 中华临床医师杂志(电子版), 2023, 17(06): 676-681.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号