膝关节单髁置换术联合前交叉韧带重建对膝内侧间室骨关节炎合并前交叉韧带缺损的中期疗效

Mid-term effects of unicompartmental knee arthroplasty combined with anterior cruciate ligament reconstruction for the medial compartment osteoarthritis with anterior cruciate ligament deficiency by proportioning with the pure medial compartment osteoarthritis

目的研究膝关节单髁置换术(UKA)联合前交叉韧带(ACL)重建技术对合并ACL缺损的膝内侧间室骨关节炎(OA)的中期疗效。方法回顾性队列研究。回顾性分析2012年1月至2020年1月因合并ACL缺损的膝内侧间室OA在中国中医科学院望京医院行一期UKA联合ACL重建的13例(14膝)患者的临床资料。选择同期ACL完整的膝内侧间室OA患者13例(14膝),为单纯UKA手术,进行1∶1配对研究,配对条件为性别、年龄、术侧、影像学病变程度和麻醉方式相同,伴随疾病相似。两组共计26例(28膝)患者,其中男6例(6膝),女20例(22膝),年龄(58.9±4.2)岁。依据两组患者治疗后末次随访时关节活动度(ROM)、牛津膝关节评分(OKS)评价膝关节功能;随访时拍摄膝关节正侧轴位X线片及负重位下肢全长正位X线片,测量并比较下肢髋膝踝(HKA)角、胫骨假体后倾角(PSA)、胫骨前移(ATT)距离;评估外侧间室OA进展、假体松动、脱位等情况,从而比较两种术式的中期随访临床疗效,并进行患者病因分析。结果两组患者随访时间为(7.14±2.45)年。末次随访时,联合组关节ROM与单纯UKA组差异无统计学意义(120.90°±2.95°比122.29°±3.22°,P=0.260);两组OKS评分差异无统计学意义[(42.50±1.99)分比(43.21±2.26)分,P=0.380]。术前两组下肢HKA角、ATT距离差异均无统计学意义(均P>0.05),末次随访时均较术前改善,差异均有统计学意义(均P<0.05)。末次随访时,联合组与单纯组HKA角差异无统计学意义(177.79°±1.25°比177.86°±1.29°,P=0.880),胫骨假体PSA、ATT距离差异亦均无统计学意义[4.57°±0.94°比4.50°±1.34°和(0.21±0.89)mm比(0.14±1.35)mm,均P>0.05]。两组末次随访均未出现假体松动及明显外侧间室OA进展。结论继发于ACL缺损的膝内侧间室OA的年轻患者,推荐UKA联合ACL重建手术治疗,可获得良好的中期疗效。

Objective To evaluate the mid-term efficacy of one-stage unicompartmental knee arthroplasty(UKA)combined with anterior cruciate ligament(ACL)reconstruction in the treatment of medial compartment osteoarthritis(OA)with ACL deficiency.Methods Retrospective cohort study.The clinical data of 13 patients(14 knees)who underwent UKA with ACL reconstruction for knee medial compartment OA combined with ACL deficiency in Wangjing Hospital of China Academy of Chinese Medical Sciences from January 2012 to January 2020 were retrospective analyzed.A 1∶1 proportioning study was conducted with 13 patients(14 knees)who underwent UKA due to medial compartment OA with intact ACL during the same period.The matching conditions were the same gender,age,surgical side,anesthesia method,comorbidities,and imaging lesions.There were 26 patients(28 knees)in the two groups,including 6 males(6 knees)and 20 females(22 knees),aged(58.9±4.2)years.The range of motion(ROM)and Oxford Knee Score(OKS)were used to evaluate the knee joint function at the last follow-up.The anteroposterior,lateral and axial X-ray films of the knee joint and the weight-bearing full-length X-ray films of the lower limbs were taken during follow-up.The hip knee ankle(HKA)angle,the posterior slope angle(PSA)of tibial prosthesis,and the anterior tibial translation(ATT)were recorded and compared between the two groups.The progression of lateral compartment OA,prosthesis loosening,and dislocation were evaluated.The mid-term follow-up clinical efficacy of the two surgical methods was compared,and the etiology of the patients was analyzed to verify the clinical efficacy and patient selection of one-stage UKA combined with ACL reconstruction.Results The follow-up time of the two groups was(7.14±2.45)years.At the last follow-up,there was no significant difference in joint ROM between the combined group and the UKA group(120.90°±2.95°vs 122.29°±3.22°,P=0.260).There was no significant difference in OKS score between the two groups[(42.50±1.99)vs(43.21±2.26),P=0.380].There was no significant difference in HKA angle and ATT distance between the two groups before operation(both P>0.05).At the last follow-up,the results were better than those before operation,and the differences were statistically significant(both P<0.05).At the last follow-up,there was no significant difference in HKA Angle between the combined group and the simple group(177.79°±1.25°vs 177.86°±1.29°,P=0.880).Tibial prosthesis PSA and ATT distance were not significantly different between the two groups[(4.57°±0.94°vs 4.50°±1.34°and(0.21±0.89)mm vs(0.14±1.35)mm,both P>0.05)].There was no prosthesis loosening and obvious progression of lateral compartment OA in both groups at the last follow-up.Conclusion For young patients with medial compartment OA secondary to ACL deficiency,UKA combined with ACL reconstruction is recommended,it can obtain good mid-term results.