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中华关节外科杂志(电子版)

中华关节外科杂志(电子版) ›› 2021, Vol. 15 ›› Issue (01) : 18 -22. doi: 10.3877/cma.j.issn.1674-134X.2021.01.004

所属专题： 文献；

临床论著

前交叉韧带MRI异常患者单髁膝关节置换随访分析
吴颖斌1, 卢伟杰1,†(), 郑冲2, 李之琛1, 陈东峰1, 唐林1, 潘恩豪1   
  1. 1. 510000　广州医科大学附属第一医院关节外科
    2. 441000　襄阳，湖北文理学院附属医院，襄阳市中心医院骨科
  • 收稿日期:2019-09-11 出版日期:2021-02-01
  • 通信作者: 卢伟杰
  • 基金资助:
    广州市科学技术协会科普项目(K20190202029)

Follow-up analysis of unicompartmental knee arthroplasty in patients with abnormal anterior cruciate ligament on MRI

Yingbin Wu1, Weijie Lu1,†(), Chong Zheng2, Zhichen Li1, Dongfeng Chen1, Lin Tang1, Enhao Pan1   

  1. 1. Department of Joint Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510000, China
    2. Department of Orthopedics, Xiangyang Central Hospital, Affiliated Hospital of Hubei Universty of Arts, Xiangyang 441000, China
  • Received:2019-09-11 Published:2021-02-01
  • Corresponding author: Weijie Lu
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吴颖斌, 卢伟杰, 郑冲, 李之琛, 陈东峰, 唐林, 潘恩豪. 前交叉韧带MRI异常患者单髁膝关节置换随访分析[J]. 中华关节外科杂志(电子版), 2021, 15(01): 18-22.

Yingbin Wu, Weijie Lu, Chong Zheng, Zhichen Li, Dongfeng Chen, Lin Tang, Enhao Pan. Follow-up analysis of unicompartmental knee arthroplasty in patients with abnormal anterior cruciate ligament on MRI[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2021, 15(01): 18-22.

目的

探讨术前膝关节核磁共振(MRI)前交叉韧带(ACL)异常结果对单髁膝关节置换术(UKA)疗效影响。

方法

本研究采用t检验、秩和检验、方差分析等统计方法，回顾性分析广州医科大学附属第一医院关节外科2014年5月至2019年5月收治的单髁膝关节置换术治疗膝前内侧骨关节炎患者。纳入标准：确诊膝关节前内侧骨关节炎、膝关节MRI提示除内侧间室软骨磨损、ACL异常外结构正常、术中直视下仅前内侧软骨磨损且ACL功能完整。排除标准：多间室骨关节炎、类风湿关节炎、感染性关节炎。通过术前膝关节MRI结果上显示ACL的情况，分为ACL-MRI正常组、ACL-MRI异常组。共55例患者(61膝)，其中26例(30膝)ACL完整，29例(31膝)ACL异常。对两组分别采用美国特种外科医院膝关节评分(HSS)、疼痛视觉模拟评分(VAS)及膝关节活动度(ROM)对术前及末次随访时膝关节功能进行评估，并观察两组术后有无假体的松动、感染，垫片有无磨损、脱位等并发症。

结果

所有患者获得随访，随访最长时间5年，平均随访(21±17)个月。术后ACL-MRI正常组末次随访时HSS评分平均(75.9±7.6)分、VAS评分平均1.0(0.7，1.3)分、ROM平均(109.9±9.9)°；术后ACL-MRI异常组末次随访时HSS评分平均(77.7 ± 6.6)分、VAS平均0.8(0.6，1.1)分、ROM平均(108.0±10.6)°均较术前有明显改善。两组在膝关节活动度、膝关节HSS评分及疼痛评分上差异无统计学意义(P>0.05)。两组在术后并发症上均未出现假体感染、松动、脂肪栓塞，垫片磨损、脱位等并发症。

结论

术前MRI显示ACL异常但术中未见ACL断裂、其功能良好者UKA术后短中期疗效好，长期结果尚需随访。

关键词: 关节成形术, 膝, 前交叉韧带, 磁共振成像
Objective

To investigate the incluence of abnormal anterior cruciate ligament (ACL) MRI on the efficacy of unicompartmental knee arthroplasty (UKA).

Methods

This study used statistical methods such as t test, rank sum test, and analysis of variance to retrospectively analyse the patients with anterior medial knee osteoarthritis treated by UKA admitted from May 2014 to May 2019 in the department of joint surgery of The First Affiliated Hospital of Guangzhou Medical University.Inclusion criteria: diagnosed anteromedial knee osteoarthritis, knee MRI showed only medial compartment cartilage wear and ACL abnormality, intra-operative findings showed only anterior medial cartilage wear while ACL function was normal. Exclusion criteria: multi-compartment osteoarthritis, rheumatoid arthritis, infectious arthritis. The MRI results showed ACL conditions, which were divided into ACL-MRI normal group and ACL-MRI abnormal group. A total of 55 patients (61 knees), of which 26 cases (30 knees) had complete ACLs, and 29 cases (31 knees) had abnormal ACLs. For the two groups, the Hospital for Special Surgery knee score (HSS), visual analogue scale (VAS) and range of motion (ROM) were used to evaluate the knee joint functions before operation and the last follow-up situation after operation respectively.Whether the prosthesis was loosening or infected after the operation, and whether the gasket had abrasion, dislocation or other complications, were also observed.

Results

All the patients were followed up for the longest time of five years, with an average follow-up time of (21±17) months. At the last follow-up of normal ACL-MRI group after surgery, the average HSS score was(75.9 ± 7.6). The average VAS score was 1.0(0.7, 1.3), and the average ROM was (109.9±9.9)°. Postoperative ACL-MRI was abnormal at the last follow-up of the group. The average HSS score was(77.7 ± 6.6). The average VAS score was 0.8(0.6, 1.1), and the average ROM was(108.0±10.6)°. All the data were significantly improved compared with the preoperative scores. There was no statistically significant difference between the two groups in knee range of motion, knee HSS score and pain score (P>0.05). No complication such as prosthesis infection, loosening, fat embolism, gasket wear, or dislocation occurred in the two groups.

Conclusion

The patients with preoperative abnormal ACL MRI but the ACL is confirmed unbroken and good function during operation may have good short-term and mid-term effects after UKA, which still needs follow-up for the long-term results.

Key words: Arthroplasty, Knee, Anterior cruciate ligament, Magnetic resonance imaging
图1 左侧膝关节3.0T MRI平扫图像截图，可见ACL增粗、信号增高但未见松弛，符合ACL变性诊断
表1 两组患者术前临床指标比较(±s)
组别 例数 年龄(岁) BMI(kg/m2) 随访时间(个月)
ACL-MRI正常组 30 67±10 26±4 23±19
ACL-MRI异常组 31 68±6 26±3 24±13
F值   1.01 0.64 0.66
P值   >0.05 >0.05 >0.05
表2 两组患者手术前后各临床评分比较
组别 例数 HSS评分(±s) t值 P值
术前 末次随访
ACL-MRI正常组 30 52.5±5.3 75.9±7.6 -14.273 <0.05
ACL-MRI异常组 31 51.7±3.6 77.7±6.6 -19.271 <0.05
F值   1.028 1.201    
P值   >0.05 >0.05    
组别 例数 VAS评分[M(P25，P75)] Z值 P值
术前 末次随访
ACL-MRI正常组 30 5.6(5.1，6.0) 1.0(0.7，1.3) 0.775 <0.05
ACL-MRI异常组 31 5.7(5.4，6.0) 0.8(0.6，1.0) 0.651 <0.05
Z值   0.961 0.951    
P值 >0.05 >0.05    
组别 例数 ROM[°，(±s)] t值 P值
术前 末次随访
ACL-MRI正常组 30 98.6±9.6 109.9±9.9 -3.785 <0.05
ACL-MRI异常组 31 96.4±9.5 108.0±10.6 -3.112 <0.05
F值   1.47 1.018    
P值   >0.05 >0.05    
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