摘要
目的探讨外侧单髁置换术治疗膝关节外侧间室骨关节炎的手术技巧及早期临床效果。方法回顾性分析首都医科大学附属北京朝阳医院骨科2016年1月至2019年1月收治的22例行外侧单髁置换术治疗的膝外侧间室骨关节炎患者的临床资料。其中男性8例(8膝),女性14例(14膝),年龄65.7岁(范围:54~83岁)。患者在术前均行影像学检查并除外关节外畸形。手术采用髌旁外侧入路,胫骨截骨采用髓外定位法,先垂直截骨,再水平截骨;股骨髁采用摆锯手工切除外髁残存软骨直至软骨下骨。选择合适假体,术中反复确认间隙的松紧度及关节的稳定性。记录患者术后并发症情况及影像学检查结果,统计患者术前及末次随访时的牛津大学膝关节评分(OKS)、美国膝关节协会评分(KSS)。采用配对样本t检验对手术前后指标进行分析。结果所有患者均获得随访,随访时间24.6个月(范围:8~40个月)。术后未发现切口渗出、皮肤坏死、下肢深静脉血栓形成等并发症,截至末次随访时,未见假体松动、垫片过度磨损、脱位及术后感染病例。末次随访时,患者的OKS由术前的(46.5±3.1)分降至(22.4±3.3)分(t=13.4,P=0.00),KSS由术前的(69.5±8.7)分升至(90.2±7.4)分(t=16.9,P=0.00),差异有统计学意义。结论外侧单髁置换术治疗外侧间室膝关节骨关节炎,具有膝关节功能恢复快、并发症少及创伤小等优势,近期临床效果满意。长期效果仍有待观察。
Objective To discuss the surgical technique of lateral unicondylar knee replacement(UKR)for patients with lateral compartment osteoarthritis and evaluate its recent clinical efficacy.Methods A retrospective analysis was conducted on 22 cases of lateral compartment osteoarthritis patients receiving lateral UKR at Orthopedic Department,Beijing Chao Yang Hospital,Capital Medical University from January 2016 to January 2019.There were 8 males(8 knees)and 14 females(14 knees),aged 65.7 years(range:54 to 83 years).All patients completed preoperative imaging examination and excluded extra-articular deformity.Lateral parapelatellar approach was used for the operation and the tibial osteotomy was performed by extramedullary positioning.The residual cartilage of the external condyle was removed by pendulum saw to subchondral bone.Appropriate prosthesis were selected,and the tightness of the gap and the stability of the joints were repeatedly confirmed during the operation.The postoperative complications and the results of physical and imaging examinations were collected.The preoperative and postoperative Oxford knee Score(OKS)and knee society score(KSS)of patients were recorded and compared by paired t test.Results All patients were followed up for 24.6 months(range:8 to 40 months).No complications such as incision exudation,skin necrosis and deep venous thrombosis of lower limbs were found after the operation.No cases of prosthesis loosening,excessive wear of pads,dislocation and postoperative infection were found at the last follow-up.The OKS decreased from 46.5±3.1 preoperative to 22.4±3.3 postoperative(t=13.4,P=0.00)and KSS improved from 69.5±8.7 preoperative to 90.2±7.4 postoperative(t=16.9,P=0.00).Conclusions For the treatment of lateral compartment osteoarthritis,UKR has the advantages of rapid recovery of knee function,less complications and less trauma.The short-term efficacy is satisfactory,but the long-term efficacy remains to be observed.
作者
张博
林源
任世祥
潘江
王志为
温亮
陈彤
周磊
马德思
赵潇雄
于洋
Zhang Bo;Lin Yuan;Ren Shixiang;Pan Jiang;Wang Zhiwei;Wen Liang;Chen Tong;Zhou Lei;Ma Desi;Zhao Xiaoxiong;Yu Yang(Orthopedic Department,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)
出处
《中华外科杂志》
CAS
CSCD
北大核心
2020年第2期125-130,共6页
Chinese Journal of Surgery
基金
北京市优秀人才培养资助青年骨干个人项目(2017000021469G230)。
关键词
关节成形术
置换
膝
骨关节炎
单髁置换
外侧间室
Arthroplasty,replacement,knee
Osteoarthritis
Unicondylar replacement
Lateral compartment
作者简介
通信作者:林源,Email:linyuan@ccmu.edu.cn。
