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中华关节外科杂志(电子版) ›› 2021, Vol. 15 ›› Issue (03) : 364 -368. doi: 10.3877/cma.j.issn.1674-134X.2021.03.018

临床经验

探讨单髁置换术于膝内侧间室骨关节炎的价值
罗文礼1, 王磊2, 罗明星3, 林向进1,()   
  1. 1. 310000 杭州,浙江大学附属第一医院骨科
    2. 266234 青岛市即墨区普东卫生院
    3. 315000 宁波市杭州湾医院骨科
  • 收稿日期:2020-09-17 出版日期:2021-06-01
  • 通信作者: 林向进

Evaluation of single condyle replacement in medial compartment osteoarthritis of knee

Wenli Luo1, Lei Wang2, Mingxing Luo3, Xiangjin Lin1,()   

  1. 1. Department of Orthopedics, The First Affiliated Hospital of Zhejiang University, Hangzhou 310000, China
    2. Qingdao Jimo District Pudong Health Center, Qingdao 266234, China
    3. Department of Orthopedics, Ningbo Hangzhou Bay Hospital, Ningbo 315000, China
  • Received:2020-09-17 Published:2021-06-01
  • Corresponding author: Xiangjin Lin
引用本文:

罗文礼, 王磊, 罗明星, 林向进. 探讨单髁置换术于膝内侧间室骨关节炎的价值[J/OL]. 中华关节外科杂志(电子版), 2021, 15(03): 364-368.

Wenli Luo, Lei Wang, Mingxing Luo, Xiangjin Lin. Evaluation of single condyle replacement in medial compartment osteoarthritis of knee[J/OL]. Chinese Journal of Joint Surgery(Electronic Edition), 2021, 15(03): 364-368.

目的

探讨单髁置换术治疗膝内侧间室骨关节炎的中短期疗效、髌骨弹响及膝外翻病因。

方法

回顾性分析2017年7月至2019年5月于浙江大学附属第一医院行单髁置换术的膝内侧间室骨关节炎患者84例(84膝)的临床治疗。采用独立样本t检验比较患者术前及末次随访(术后1年)膝关节功能,内容包括美国纽约特种外科医院膝关节评分(HSS)、膝关节活动度(ROM),视觉模拟疼痛评分(VAS)、下肢力线包括胫骨角(FTA)及髋-膝-踝角(HKA),并记录患者并发症情况。

结果

所有患者手术切口均为甲级愈合并均获得随访。术后24 h引流量平均(121±81)ml,4例患者接受异体输血治疗,其输血率为4.76%。末次随访患者VAS评分低于术前(t=70.721, P<0.05),末次随访患者HSS评分及ROM均高于术前(t=-37.6、-6.800,均为P<0.05);患者末次随访HKA角度较术前升高(t=-10.965,P<0.05),患者末次随访FTA角度较术前减低(t=14.022,P<0.05)。2例患者出现了屈膝时髌骨弹响,4例患者出现术后膝外翻,并发症患者在末次随访时均自愈。

结论

单髁置换术治疗膝内侧间室骨关节炎的短期疗效较为满意,但要求术者在手术过程中注意避免并发症。

Objective

To investigate the short and medium term curative effect, patella bounce and causes of knee valvular osteoarthritis treated by monocondylar replacement.

Methods

Eighty-four patients (84 knees) with medial compartment osteoarthritis of the knee underwent unicondylar replacement in the First Affiliated Hospital of Zhejiang University from July 2017 to May 2019. The clinical treatment was retrospectively analyzed.Independent sample t test was used to compare the knee function of the patients before surgery and at the last follow-up (one year after surgery). Hospital for Special Surgery knee score (HSS), knee range of motion (ROM), visual analogue scale (VAS), and lower limb strength line including tibial angle (FTA) and hip-knee-ankle angle (HKA) were measured, and complications were recorded.

Results

All the surgical incisions were healed at grade A and all the patients were followed up. Twenty-four hours after the operation, the drainage volume was (121±81) ml on average. Four patients received allogeneic transfusion, and the transfusion rate was 4.76%.VAS score of the patients in the last follow-up was lower than that before surgery (t=70.721, P<0.05), and HSS score and ROM of the patients in the last follow-up were higher than that before surgery (t=-37.6, -6.800; both P<0.05). The HKA angle in the last follow-up was higher than that before the surgery (t=-10.965, P<0.05), and the FTA angle in the last follow-up was lower than that before the surgery (t=14.022, P<0.05). Two patients had patella flapping when bending the knee, and four patients had knee valgus after the surgery. All the complications healed by themselves at the last follow-up.

Conclusion

The short-term efficacy of monocondylar replacement for medial compartment osteoarthritis is satisfactory, but it requires surgeons to pay attention to avoid complications during the operation.

图1 膝关节骨关节炎患者术前MRI图像。图A为膝关节MRI冠状面,图B为膝关节MRI矢状面,示膝关节内侧髁水肿明显,内侧半月板磨损严重,内侧关节间隙显著变窄,膝关节外侧间室基本正常
图2 膝骨关节炎患者术前右膝X线正侧位片,示膝关节内侧间室股骨髁及胫骨平台退行性改变明显,关节软骨硬化,关节间隙变窄,膝关节外侧间室轻度退变
表1 术前及末次随访VAS评分、HSS评分及ROM比较[n=84,(±s)]
图3 膝骨关节炎患者单髁置换术后右膝X线正侧位片,示膝关节假体位置良好
图4 膝骨关节炎患者右单髁置换术后双下肢全长X线正位片,示右膝关节假体位置良好,右下肢力线可,左膝内侧间室退行性改变,关节间隙变窄,软骨硬化
表2 下肢力线评价[n=84,°,(±s)]
[1]
林飞太,冯尔宥,张怡元,等.内侧固定平台单髁置换术治疗膝关节前内侧骨关节炎或自发性骨坏死[J].中华创伤骨科杂志,2020,22(6):540-543.
[2]
李腾,李宝军,何改生,等.单髁置换术治疗膝关节内侧间室骨性关节炎的早期疗效[J].中国医师杂志,2020,22(6):896-900.
[3]
Winnock DP, Barbier J, Luyckx T, et al. Outcomes of a Fixed-Bearing,medial,cemented unicondylar knee arthroplasty design:survival analysis and functional score of 460 cases[J]. J Arthroplasty, 2018, 33(9):2792-2799.
[4]
马俊军,李二虎,李长福,等.人工膝关节单髁置换术与全膝置换术治疗骨性膝关节炎的临床疗效[J].中国医师杂志,2020,22(5):759-762.
[5]
周晓强,虞宵,荆翔,等.静脉应用氨甲环酸联合局部灌注含氨甲环酸混合镇痛药物在单髁置换术中的应用[J].中国骨与关节损伤杂志,2020,35(4):401-404.
[6]
杨赞礼,袁跃群,谢剑新,等.胫骨内侧关节线改变程度对单髁置换术患者膝关节屈伸功能的影响[J].中国骨与关节损伤杂志,2020,35(2):134-136.
[7]
谢国庆,任忠明,金文孝,等.单髁置换术治疗膝内侧间室骨关节炎近中期疗效[J].中国矫形外科杂志,2019,27(21):1998-2000.
[8]
冷燕奎,林俊宏,曹智强,等.单髁置换术与腓骨上段截骨联合关节镜清理术治疗膝关节内侧间室骨性关节炎的对比研究[J].浙江医学,2019,41(20):2204-2207.
[9]
曾智敏,陶崑,凌晶,等.固定平台单髁置换术治疗膝关节内侧骨性关节炎[J].中国骨伤,2019,32(8):755-758.
[10]
屈宗斌,唐刚健,柴晟,等.术前应用关节镜探查对内侧单髁置换手术疗效的影响[J].中国内镜杂志,2019,25(7):26-29.
[11]
Mortensen JF, Rasmussen LE,Østgaard SE, et al. Randomized clinical trial of medial unicompartmentel versus total knee arthroplasty for anteromedial tibio-femoral osteoarthritis.The study-protocol[J/OL]. BMC Musculoskelet Disord, 2019, 20(1):119.doi:10.1186/s12891-019-2508-1.
[12]
范美芬,徐莹,胡文娟,等.单髁置换治疗内侧间室膝骨关节炎的围手术期护理和疗效分析[J].国际护理学杂志,2019,38(4):518-521.
[13]
朱家佳,祝怡飞,王源基,等.单髁与全膝置换术治疗膝内侧间室关节炎的临床疗效分析[J].医药论坛杂志,2019,40(7):9-12.
[14]
Miller S, Agarwal A, Haddon WB, et al. Comparison of gait kinetics in total and unicondylar knee replacement surgery[J]. Ann R Coll Surg Engl, 2018, 100(4):267-274.
[15]
朱若夫,王治栋,陈广东,等.髌股关节退变对膝关节内侧单髁置换术疗效影响的研究[J].中国矫形外科杂志,2018,26(24):2215-2219.
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