单髁置换联合自体骨软骨移植治疗双间室骨关节炎的中短期疗效研究

Study on the Short and Medium Term Efficacy of Single Condyle Replacement Combined with Autologous Osteochondral Graft in the Treatment of Bicompartment Osteoarthritis

目的观察内侧单髁置换联合自体骨软骨移植治疗膝关节双间室骨关节炎的中短期临床疗效。方法回顾性分析2018年6月至2019年9月在中国中医科学院望京医院关节一科采用膝关节单髁置换术(unicompartmental knee arthroplasty,UKA)联合自体骨软骨移植技术治疗膝关节双间室骨关节炎患者22例,其中男性6例,女性16例;年龄58(53,64)岁。收集手术前后影像学资料,记录并分析术前及术后3、6、12个月疼痛视觉模拟评分(visual analogue scale,VAS)、美国膝关节协会评分(knee society score,KSS)及并发症。结果全部患者均获随访,随访时间18~26个月。(1)与术前相比,术后关节内成角、内翻畸形角、膝关节后倾角均明显减小,差异有统计学意义(P<0.05)。(2)膝关节疼痛及功能活动术后较术前明显改善,末次评分显著增加,差异有统计学意义(P<0.05)。(3)术后随访,仅1例出现关节失稳,治疗后恢复良好。结论对合并轻度髌股关节炎的膝内侧重度骨关节炎患者,选择UKA联合自体骨软骨移植技术早中期临床疗效最佳。

Objective To observe the short and medium term clinical efficacy of medial unicompartmental knee arthroplasty(UKA)combined with autologous osteochondral transplantation in the treatment of two-compartment osteoarthritis of knee joint.Methods A retrospective analysis has been performed on 22 patients from June 2018 to September 2019 in Orthopaedics Department of Wangjing Hospital of China Academy of Chinese Medical Sciences.6 male cases and 16 female cases were included.The age ranged from 53 to 64,with an average of 58.The patients with two-compartment osteoarthritis of the knee were treated with UKA combined with autologous osteochondral transplantation.Imaging data before and after surgery were collected,and visual analogue VAS scores,American knee society score(KSS)scores and complications were recorded before and 3,6 and 12 months after surgery.Results All patients have been followed up for 18~26 months.(1)Compared with the operation,intraarticular angulation,varus deformity Angle and knee posterior inclination Angle were significantly decreased after operation,and the differences were statistically significant(P<0.05).(2)Knee pain and functional activity were significantly improved after surgery,and the final score was significantly increased,with statistical significance(P<0.05).(3)In postoperative follow-up,only 1 patient had joint instability and recovered well after treatment.Conclusion UKA combined with autologous osteochondral transplantation has the best clinical efficacy in early and middle stage for patients with severe medial knee osteoarthritis complicated with mild patellofemoral joint.